Consensus on Items and Quantities of Clinical Equipment Required to Deal With a Mass Casualties Big Bang Incident

A National Delphi Study

Edward A S Duncan; Keith Colver; Nadine Dougall; Kevin Swingler; John Stephenson; Purva Abhyankar

BMC Emerg Med. 2014;14(5)

Conclusion

An expert panel of individuals with either clinical experience of providing a professional pre-hospital emergency medical response to a mass casualties incident or responsibility and authority in health emergency planning for mass casualties incidents reached a consensus that 134 items of emergency clinical equipment were either important or very important when responding to a big bang mass casualties event. A further 30 items neared the agreed 80% consensus level. Indicative quantities for each item were provided. The study findings provide an important resource for the UK, and other countries with similar response mechanisms and planning assumptions, to inform the development of evidence-based policies and the planning of future emergency responses to big bang mass casualties events.

1 2 3 4 5 6

Next Section

Competing interests
The authors declare that they do not have any financial or non-financial competing interests in relation to this paper.

Authors' contributions
EASD led the study design, managed the overall study, chaired the study advisory committee, and drafted and revised the manuscript; KC was the study research fellow, he conceived the study idea, undertook day-to-day study management, participated in the study advisory committee and contributed to revisions of the final paper; ND provided statistical advice and expertise, and commented on revisions to the final paper; KS designed and managed the study website and background database, and commented on revisions to the final paper provided read and approved of the final manuscript; JS provided expert policy awareness, convened the study advisory committee, and commented on revisions to the final paper; PA advised on study design and statistical analysis, participated in the study advisory committee and contributed to revisions of the final paper. All authors read and approved the final manuscript.

Acknowledgements
A study advisory committee was set up to guide the researchers with expert subject area advice. Grateful thanks are given to the following individuals who participated in at least one meeting: Prof. Kevin Mackway-Jones (University of Manchester); Mr Mike Herriot (Scottish Ambulance Service); Dr Darren Walter (University of Manchester); and Mr David Whitmore (London Ambulance Service NHS Trust).

Table 1. Planning assumptions for the potential percentages of casualties in each category [1,4]
Category	Patient condition	% of total
P1	Casualties needing immediate life-saving resuscitation and/or surgery	25% (25 casualties)
P2	Stabilized casualties needing early surgery but delay is acceptable	25% (25 casualties)
P3	Casualties requiring treatment but a longer delay is acceptable	50% (50 casualties)

Table 2. Consensus levels of items' importance
Group	Number of items in group	Agreement of number of items at end of round 3 (%)
Group	Number of items in group	≥ 80%	≥ 70%	≤ 69%
Airway 1	17	10 (59)	12 (71)	5 (29)
Airway 2	31	11 (35)	15 (48)	16 (52)
Breathing	16	10 (62)	10 (62)	6 (38)
Circulation	48	35 (73)	44 (92)	4 (8)
Examination	18	9 (50)	9 (50)	9 (50)
Medicine 1	50	21 (42)	31 (62)	19 (38)
Medicine 2	16	5 (31)	7 (44)	9 (56)
Splintage	11	8 (73)	10 (91)	1 (9)
Comfort	6	3 (50)	3 (50)	3 (50)
COI	10	10 (100)	10 (100)	0 (0)
Other	14	6 (43)	6 (43)	8 (57)
Transport	11	6 (43)	7 (64)	4 (36)
Totals	248	134 (54)	164 (66)	84 (34)

Table 3. Items that gained consensus as 'Important' and 'Very Important' and their recommended quantities
Subset & item (shaded items neared consensus)	Quantity Median (IQR)
Airway 1
OPA size 3	25 (20–25)
OPA size 4	25 (20–25)
Suction catheter - hard	30 (25–35)
Nasopharyngeal airway 7	22 (2–25)
Suction - handheld manual	23 (20–25)
Non-inflatable SG Airway device	21 (20–25)
Nasopharyngeal airway 6	22 (20–25)
OPA size 2	15 (10–15)
Particulate respirators [dust mask]	75 (50–100)
Suction - battery powered	10 (8–10)
Airway2
ET Securing device	25 (20–25)
Catheter mount	25 (25–25)
Laryngeal mask size 2	10 (5–10)
Laryngeal mask size 4	16 (15–20)
Laryngoscope & Blade(s) - adult	20 (15–20)
Magill forceps - adult	20 (15–20)
ET Tube size 8	15 (10–15)
Surgical airway set	8 (5–10)
ET Tube size 7	15 (10–15)
Laryngeal mask size 5	15 (10–15)
Laryngoscope & Blade(s) - child	10 (6–10)
Breathing
Bag Valve mask - adult	25 (20–25)
Bag Valve mask - child	10 (10–13)
Chest seal	25 (25–30)
Reservoir mask and tubing - adult	50 (40–50)
Reservoir mask and tubing - child	25 (25–30)
Nebuliser mask and tubing - adult	25 (24–30)
Nebuliser mask and tubing - child	20 (15–20)
Portable ventilator	10 (10–15)
Chest/thoracic drainage kits and sets	15 (10–15)
Bag valve mask - infant	10 (5–10)
Circulation
3 way tap & extension tube (IO/IV)	35 (30–40)
Blast bandage	80 (75–100)
Disposable latex free tourniquet IV access	50 (50–50)
EZ IO	10 (10–10)
Haemostatic dressings	80 (70–100)
Administration set blood and blood derivatives	55 (50–60)
Combat application tourniquet	60 (50–70)
Syringe 2 ml	50 (46–50)
Transpore/micropore tape	55 (50–60)
Cannula 16 g	50 (50–50)
Cannula 18 g	50 (50–51)
IO Catheter	30 (25–36)
IO needle blue	15 (14–20)
IO needle red	15 (10–20)
IO needle yellow	15 (12–20)
Cannula 20 g	50 (40–50)
Dressing - extra large	90 (75–100)
Dressing - large	100 (100–100)
Dressing - medium	100 (100–110)
Dressing wound with conforming stretch bandage	85 (80–100)
IV Dressing - Transparent	100 (100–125)
Oales modular bandage	60 (50–95)
Swabs packet	95 (76–100)
Cling film - one roll	29 (20–30)
Hypodermic needles 19 g	50 (50–50)
Syringe 5 ml	50 (50–60)
Dressing burn gel-soaked sterile	62.5 (50–75)
AED	6 (5–10)
Safety/Drawing up needle	100 (93–100)
Cannula 22 g	30 (25–40)
Hypodermic needles 25 g	50 (50–50)
Syringe 1 ml	20 (15–25)
Syringe caps male/female red	100 (80–100)
AED Pads - adult	12 (10–15)
AED Pads - child	7 (5–10)
Examination
Stethoscope - adult	20 (15–20)
Monitor SPO2	25 (22–30)
Glucose test strips (for use with glucose meter)	60 (50–75)
Triage tape - child	10 (10–14)
Glucose meter	10 (10–10)
Rectal thermometer	5 (0–5)
Monitor CO2	15 (10–20)
Torch - examination pen disposable	25 (25–25)
Manual sphygmomanometer	15 (10–15)
Medicines1
Morphine sulphate	100 (84–100)
Oxygen mass delivery [1 unit]	3 (2–4)
Saline .9% 500 mls bag	90 (75–100)
Naloxone hydrochloride (Min-I-jet, 2 mg/5 mls)	35 (25–50)
Salbutamol - Nebuliser liquid 2 mg/ml 2.5 ml UDV	45 (40–50)
Clopidogrel 75 mg	2.5 (0–5)
Oxygen D size	28 (25–30)
Entonox [with mouthpiece]	25 (20–25)
Adrenaline (1 mg/1 ml, 1:1000)	20 (20–25)
Adrenaline (Min-I-Jet, 1 mg in 10 ml, 1:10,000)	40 (30–50)
Lidocaine -100 mg/10 ml (1%) solution for injection pfs	20 (15–25)
Saline ampoule 10 mls	100 (82–100)
Clopidogrel 300 mg	5 (0–5)
Ipratopium bromide (6 × 250 mcg/1 ml)	20 (15–20)
Clindamycin	5 (0–5)
Atropine sulphate (Min-I-Jet, 3 mg in 10 ml)	28 (25–31)
Diazepam emulsion 10 mg in 2 mls	22(20–25)
Eyewash 500 mls	30 (25–40)
Saline 10 mls pre-filled syringe	50 (50–52)
Saline ampule 5 mls	15 (0–20)
Oxygen F size	10 (10–12)
Medicines2
Tranexamic acid	50 (40–50)
Ketamine	47.5 (40–50)
Midazolam	45 (35–50)
Suxamethonium chloride -Injection PFS 100 MG/2 ML	21 (20–25)
Ondansetron 4 mg	20 (19–25)
Splintage
Pelvic sling	25 (25–30)
Cervical collars (set)	25 (20–30)
Head hugger with straps	25 (20–25)
Frac straps/packs	20 (16–25)
Traction splint	20 (16–20)
Triangular bandage	50 (50–50)
Box splint	25 (20–25)
Tape 100% cotton for medical or general use	25 (20–30)
Comfort
Emergency blanket	120 (100–127)
Re-robe/modesty suits	65 (50–75)
De-robe suits	65 (50–75)
Control of infection
Clinical waste bag	100 (100–120)
Latex free gloves extra large	102 (100–147)
Latex free gloves large	150 (107–195)
Latex free gloves medium	150 (139–195)
Latex free gloves small	115 (100–145)
Alcohol hand gel	50 (40–60)
Sharps box .2 lt	20 (14–20)
Sharps box 10 lt	10 (5–12)
Skin wipes (Tub)	30 (16–34)
Pre injection swabs	150 (112–200)
Other
Entonox mouthpiece	50 (40–50)
Tuffcut scissors	30 (25–30)
Self help packs	75 (64–94)
Medication/drug syringe stickers	120 (100–150)
Shears - hardened stainless steel, circa 25 cm	20 (20–25)
Scalpel	25 (20–25)
Transport
Carry sheet	30 (25–39)
Rescue board and straps	15 (10–20)
Stretcher - drag	15 (10–15)
Stretcher - orthopaedic	11 (10–15)
Stretcher - large wheeled	10 (4–10)
Stretcher - basket	10 (5–10)