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Mass casualty incidents are characterised by an immediate, unforeseen and unquantifiable surge in demand for ambulance services which soon becomes apparent and will exceed any “local” resources available. Casualties require the correct treatment, promptly, at an appropriate resource without incurring any further harm. In the absence of firm operational guidelines, this paper provides templates for ambulance commanders both at call centre and on-site to approach the management of mass casualty incidents.

Desk research indicated that there were both guidelines on how various elements of the emergency services should work together plus academic papers on techniques to adopt in mass casualty situations. Standing orders or written protocols for ambulance commanders, however, provide little or no specific guidance or an outline plan upon how they should command in a mass casualty situation. Following analysis of relevant public enquiry reports and discussions with ambulance commanders and using the materials from desk research, a four-stage approach was devised for testing using retrospective analysis from field and desktop exercises.

To have confidence, each commander needs simple digital real-time templates from which they understand their role and how the overall plan defines priorities with the greatest need. A plan should cover call-centre and on-site operations including a basic operational checklist from start to finish; resource structure and inter-relationships; sources and availability of resources plus information and control procedures to impose limited quality control procedures.

The design and implementation of digital templates to provide minute-by-minute visibility to all commanders which have not been recorded before. Such templates give commanders confidence to determine, locate and call forward relevant resources to attend casualties in order of priority of need. Time-lapsed records are useful not just in the minute-by-minute decision processes but also for critical organisational learning and in any post-event review by either a coroner or lawyers at a public enquiry.

Decontamination following chemical, biological, radiological and nuclear (CBRN)/Hazmat incidents is a critical activity carried out in order to mitigate and contain the risk posed by any hazardous materials involved. Human behaviour plays a crucial role in such incidents, as casualties will have little understanding of the situation they find themselves in, leading to uncertainty in what actions to take. This will result in very difficult circumstances within which first responders must operate. However, the importance of human behaviour appears to be a fundamental element being missed in the preparation, training and planning assumptions being made by emergency services and planners in preparation for these events.

This paper looks to understand the scope of this omission by reviewing relevant literature on the subject and engaging with Fire and Rescue Service personnel and managers in the UK. This study utilised semi-structured interviews with 10 Fire and Rescue Service Mass Decontamination Operatives, four Fire and Rescue Service Hazardous Material Advisers and three Fire and Rescue Service Strategic Officers participating. These interviews were then analysed using a thematic framework to identified key themes from the research which were then validated using two independent researchers to provide an inter-rater reliability measure. Finally, a follow-up validation questionnaire was also developed to test the validity of the themes identified and this was completed by another with 36 Fire and Rescue Service Mass Decontamination Operatives.

Both the literature review and interviews undertaken with emergency responders and mangers demonstrated the crucial importance of accounting for behavioural aspects in these situations especially in regards to the likely levels of compliance to be expected by responders and the potential problem of casualties not remaining at the scene of an incident to undergo decontamination.

This research identifies a number of key themes so far not recognized through any other research and in doing so offers insights into potential flaws in the UK Fire and Rescue Service response planning for CBRN/Hazmat incidents requiring mass decontamination. It is intended that this research will inform further study into the areas identified in order to ensure gaps in planning, training and strategies for mass decontamination operations can be more fully informed and if required allow for a more effective response.

When modeling environmental jolts from terrorist attacks, various aspects should be analyzed in order to properly present an accurate configuration. The following article discusses how asymmetrical warfare has an impact on the outcomes of a terrorist attack. The several dimensions of terrorist attacks can be extracted to deduce the ways that asymmetrical warfare can damage the health care system. The article will relate real life terrorist attacks and hypothetical scenarios to better inform the reader about the weak attacking the strong, and then explain how this relates to health care providers.

When designing an optimization model for use in a mass casualty event response, it is common to encounter the heavy and considerable demand of injured patients and inadequate resources and personnel to provide patients with care. The purpose of this study is to create a model that is more practical in the real world. So the concept of “predicting the resource and personnel shortages” has been used in this research. Their model helps to predict the resource and personnel shortages during a mass casualty event. In this paper, to deal with the shortages, some temporary emergency operation centers near the hospitals have been created, and extra patients have been allocated to the operation center nearest to the hospitals with the purpose of improving the performance of the hospitals, reducing congestion in the hospitals and considering the welfare of the applicants.

The authors research will focus on where to locate health-care facilities and how to allocate the patients to multiple hospitals to take into view that in some cases of emergency situations, the patients may exceed the resource and personnel capacity of hospitals to provide conventional standards of care.

In view of the fact that the problem is high degree of complexity, two multi-objective meta-heuristic algorithms, including non-dominated sorting genetic algorithm (NSGA-II) and non-dominated ranking genetic algorithm (NRGA), were proposed to solve the model where their performances were compared in terms of four multi-objective metrics including maximum spread index (MSI), spacing (S), number of Pareto solution (NPS) and CPU run-time values. For comparison purpose, paired t-test was used. The results of 15 numerical examples showed that there is no significant difference based on MSI, S and NPS metrics, and NRGA significantly works better than NSGA-II in terms of CPU time, and the technique for the order of preference by similarity to ideal solution results showed that NRGA is a better procedure than NSGA-II.

The planning horizon and time variable have not been considered in the model, for example, the length of patients’ hospitalization at hospitals.

Presenting an effective strategy to respond to a mass casualty event (natural and man-made) is the main goal of the authors’ research.

This paper strategy is used in all of the health-care centers, such as hospitals, clinics and emergency centers when dealing with disasters and encountering with the heavy and considerable demands of injured patients and inadequate resources and personnel to provide patients with care.

This paper attempts to shed light onto the formulation and the solution of a three-objective optimization model. The first part of the objective function attempts to maximize the covered population of injured patients, the second objective minimizes the distance between hospitals and temporary emergency operation centers and the third objective minimizes the distance between the warehouses and temporary centers.

Terrorists’ threats pose a grave danger to the health care environment in which we live. In the following paper, we look at how bioterrorist plots can effect a given population and show ways to dissect terrorist actions. We look at variables that use various cause and effect relationships, and lead the reader down a path of being able to use information presented in a real life or fictitious bioterrorist attacks. We seek to inform the reader reasons why preparedness is essential in dealing with the likelihood of the following scenarios.

Disaster management and humanitarian logistics (HT) play crucial roles in large-scale events such as earthquakes, floods, hurricanes and tsunamis. Well-organized disaster response is crucial for effectively managing medical centres, staff allocation and casualty distribution during emergencies. To address this issue, this study aims to introduce a multi-objective stochastic programming model to enhance disaster preparedness and response, focusing on the critical first 72 h after earthquakes. The purpose is to optimize the allocation of resources, temporary medical centres and medical staff to save lives effectively.

This study uses stochastic programming-based dynamic modelling and a discrete-time Markov Chain to address uncertainty. The model considers potential road and hospital damage and distance limits and introduces an a-reliability level for untreated casualties. It divides the initial 72 h into four periods to capture earthquake dynamics.

Using a real case study in Istanbul’s Kartal district, the model’s effectiveness is demonstrated for earthquake scenarios. Key insights include optimal medical centre locations, required capacities, necessary medical staff and casualty allocation strategies, all vital for efficient disaster response within the critical first 72 h.

This study innovates by integrating stochastic programming and dynamic modelling to tackle post-disaster medical response. The use of a Markov Chain for uncertain health conditions and focus on the immediate aftermath of earthquakes offer practical value. By optimizing resource allocation amid uncertainties, the study contributes significantly to disaster management and HT research.

The purpose of this paper is to systematically review published literature for the research question “what issues are considered (and changes made) for vulnerable groups as part of the chemical, biological, radiological, nuclear or explosive (CBRNe) response for casualty collection, decontamination, triage and casualty clearing processes?”.

Seven-stage framework from the PRISMA statement for research question, eligibility (definition), search, identification of relevant papers from title and abstract, selection and retrieval of papers, appraisal and synthesis. Data sources: Medline, Embase, Cochrane Library, Web of Science, Scopus (Elsevier), Chemical Abstracts, Assia (Proquest), Sociological abstracts (Proquest), Cinahl, HMIC, Health business elite, PsycInfo (ebsco), PILOTS (Proquest) and supplemented by other search strategies (e.g. exploding reference lists). The included references were critically appraised using the mixed methods appraisal tool (MMAT).

Results: 1,855 papers were returned from the literature search, of which 221 were screened by abstract and 48 by full paper. In total, 11 papers were included for appraisal, of which three achieved a quality score of 50 per cent or over. The papers were categorised into three phases on CBRNe response; evacuation, triage and decontamination.

The limitations of the search process included the use of emerging exclusion criteria. This may have excluded research that would provide more information in some topic areas but it was felt necessary to set a high publication standard for inclusion to generate trustworthy results and recommendations. The MMAT appraisal tool has been validated for different study types and provided a useful categorisation approach for critical appraisal, albeit resulting in only three included studies. Future reviews could include papers published in a wider range of languages to include research from non-English sources.

These evidence-based results should be used by practitioners to review current operational policies for vulnerable people and plan future improvements. Evacuation accessibility can be described as characteristics for exit, route and obstacles. This takes a systems approach to consider how building planning and layout can have implications for safety critical but low frequency events. Decontamination recommendations include: at least one additional re-robe section per mass decontamination unit and adaptations to the decontamination plan including accessible equipment for non-ambulatory individuals; and additional (specialist) staff in the decontamination team (sign language, interpreters and physical therapists).

Although very little new medium/high quality research is available, the findings are summarised as considerations for building design (route choice and information), communication (including vision, hearing and language differences) and the composition of the response team. It is suggested that evidence-based practice from other care domains could be considered (patient movement and handling) for fire service and ambulance guidelines.

Effective communication has been recognised as an important issue for the management of incidents involving decontamination; evidence shows that failure to communicate effectively may result in increased public anxiety and non‐compliance. This paper aims to examine current provision for communicating with members of the public during decontamination, to facilitate the development of improved responder communication strategies.

To examine the current provision for communicating with members of the public, the authors reviewed open source decontamination guidance documents for responders, as well as published reports of emergency preparedness exercises involving decontamination.

The review of decontamination guidance documents showed that specific guidance for professional responders on how to communicate with the public during incidents that involve decontamination could be improved. Similarly, the review of published decontamination exercises shows that a stronger emphasis on communication with members of the public is needed, in addition to the use of exercises to evaluate the effectiveness of communication strategies.

The present research summarises existing evidence relating to how communication strategies employed by responders can shape public responses to decontamination. Analysed alongside current decontamination guidance for emergency responders, this evidence highlights potential gaps in planning for communicating with members of the public during decontamination. It is hoped that this will promote an increased understanding of the importance of communication during these types of incidents, which will in turn facilitate the development of more comprehensive responder communication strategies.

The threat of future biological attacks within the United States forces the additional responsibility of preparedness and response onto health care managers. An endless amount of information on this topic can be readily obtained from a variety of sources. The purpose of this resource guide is to provide health care managers with a well-organized, up-to-date listing of credible sources that can be accessed electronically. This resource guide is designed to facilitate the retrieval of relevant information that is crucial in the process of health care managers designing a bioterrorism preparedness and response plan.

The implications of a bioterrorist attack within the United States were well observed in the 2001 anthrax attacks. The effects of these attacks were not only felt by the primary victims but also reached into communities and health care organizations that treated patients. The concerns for future attacks have spurred an enormous amount of interest and forced health care administrators to implement safety measures and develop plans encompassing preparedness and response. With respect to this topic, a major problem facing health care managers is the ability to obtain relevant, up-to-date, reliable information.

Many health care managers are aware of the endless amount of resources that are available pertaining to preparedness and response planning. It should also be noted that the information concerning bioterrorism rapidly changes and the available information can be overwhelming. To that end, the authors have compiled an array of selected websites that provide excellent, up-to-date, and unique resources in attempts to facilitate the gathering of knowledge and make that experience more efficient.

The objective of the following resource guide is to provide a comprehensive list of topics in a “user-friendly” format that can be obtained electronically. To facilitate information retrieval, electronic resources have been categorized according to topic. For example, up-to-date information concerning the multitude of biological agents can be obtained by using the links contained within the biological agents category. Under this topic heading you will find a listing of important resources. Each listing contains a heading that identifies the sponsoring organization, a short explanation of information and materials that can be expected, and a web address identifying its location.

The authors’ compilation was not intended to be exhaustive nor do the authors necessarily endorse or warrant the reliability of the information/products. Websites may change regularly; please visit www.bioterrorism@ba.ttu.edu to obtain an electronic version of this resource guide and for updates to web addresses.

This paper presents an overview of the articles used in this edition of Advances in Health Care Management. The beginning of the article gives the reader a history of bioterrorist activity within the United States, and how these events have led to current situations. It also provides a model for health care leaders to follow when looking at a bioterrorist attack. The model includes descriptions of how the articles within this book relate to an overall bioterrorist formula. Through this, the reader shall be able to deduce which individual article fits into the vastness of healthcare research pertaining to bioterrorism.