Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Radiology
Published in: European Radiology 3/2014

01-03-2014 | Emergency Radiology

Radiological work-up after mass casualty incidents: are ATLS guidelines applicable?

Authors: Ingri L. E. Postma, L. F. M. Beenen, T. S. Bijlsma, F. H. Berger, M. J. Heetveld, F. W. Bloemers, J. C. Goslings

Published in: European Radiology | Issue 3/2014

Login to get access

Abstract

Objectives

In mass casualty incidents (MCI) a large number of patients need to be evaluated and treated fast. Well-designed radiological guidelines can save lives. The purpose of this study was to evaluate the Advanced Trauma Life Support (ATLS) radiological guidelines in the MCI of an aeroplane crash.

Methods

Medical data of all 126 survivors of an aeroplane crash were analysed. Data included type and body region of the radiological studies performed on the survivors, Abbreviated Injury Score (AIS) and Injury Severity Score (ISS) codes and trauma care level of the hospitals.

Results

Ninety patients (72 %) underwent one or more imaging studies: in total 297 radiographs, 148 CTs and 18 ultrasounds were performed. Only 18 % received diagnostic imaging of all four body regions as recommended by ATLS. Compliance with ATLS was highest (73.3 %) in severely injured victims (ISS ≥16); this group underwent two thirds of the (near) total body CTs, all performed in level I trauma centres.

Conclusion

Overall compliance with ATLS radiological guidelines was low, although high in severely injured patients. Level I trauma centres frequently used (near) total body CT. Deviation from ATLS guidelines in radiological work-up in less severely injured patients can be safe and did not result in delayed diagnosis of serious injury.

Key Points

• Radiological imaging protocols can assist the management of mass casualty incidents needs.
• Advanced Trauma Life Support (ATLS) radiological guidelines have been developed.
• But radiological guidelines have not frequently been applied in aeroplane crashes.
• Aircraft accidents are of high energy so ATLS guidelines should be applied.
• Following mass casualty incidents total body CT seems appropriate within ATLS protocols.
Literature
1.
American College of Surgeons Committee on Trauma (2008) Advanced Trauma Life Support for docters: student course manual, 8th edn. American College of Surgeons, Chicago
2.
Engel A, Soudack M, Ofer A et al (2009) Coping with war mass casualties in a hospital under fire: the radiology experience. AJR 193:1212–1221PubMedCrossRef
3.
McConachie NS, Wilson F, Preston BJ et al (1990) The impact of the M1 air crash on the radiological services at the Queen's Medical Centre, Nottingham. Clin Radiol 42:317–320PubMedCrossRef
4.
Körner M, Geyer LL, Wirth S, Reiser MF, Linsenmaier U (2011) 64-MDCT in mass casualty incidents: volume image reading boosts radiological workflow. AJR 197:W399–W404PubMedCrossRef
5.
Hodgetts TJ, Porter C (2002) Major incident medical management and support. BMJ, London
6.
7.
Fung Kon Jin PH, Goslings JC, Ponsen KJ, Kuijk C, Hoogerwerf N, Luitse JS (2008) Assessment of a new trauma workflow concept implementing a sliding CT scanner in the trauma room: the effect on workup times. J Trauma 64:1320–1326PubMedCrossRef
8.
Saltzherr TP, Fung Kon Jin PH, Bakker FC et al (2008) An evaluation of a shockroom located CT scanner: a randomized study of early assessment by CT scanning in trauma patients in the bi-located trauma center North-West Netherlands (REACT trial). BMC Emerg Med 8:1–5CrossRef
9.
Sierink JC, Saltzherr TP, Beenen LF et al (2012) A multicenter, randomized controlled trial of immediate total-body CT scanning in trauma patients (REACT-2). BMC Emerg Med 12:1–9CrossRef
10.
Huber-Wagner S, Lefering R, Qvick LM et al (2009) Effect of whole-body CT during trauma resuscitation on survival: aretrospective, multicentre study. Lancet 373:1455–1461PubMedCrossRef
11.
12.
Postma IL, Winkelhagen J, Bloemers FW, Heetveld MJ, Bijlsma TS, Goslings JC (2011) February 2009 airplane crash at Amsterdam Schiphol Airport: an overview of injuries and patient distribution. Prehospital Disaster Med 26:299–304PubMedCrossRef
13.
14.
Stiell IG, Wells GA, Vandemheen KL et al (2001) The canadian c-spine rule for radiography in alert and stable trauma patients. JAMA 285:1841–1848CrossRef
15.
Baker SP, O'Neill B, Haddon W, Long WB (1974) The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196PubMedCrossRef
16.
17.
Postma IL, Winkelhagen J, Bijlsma TS, Bloemers FW, Heetveld MJ, Goslings JC (2012) Delayed diagnosis of injury in survivors of the February 2009 crash of flight TK1951. Injury 43:2012–2017PubMedCrossRef
18.
Postma IL, Weel H, Heetveld MJ et al (2013) Patient distribution in a mass casualty event of an airplane crash. Injury 44:1574–1578PubMedCrossRef
19.
Postma IL, Weel H, Heetveld MJ et al (2013) Mass casualty triage after an airplane crash near Amsterdam. Injury 44:1061–1067PubMedCrossRef
20.
Sharma OP, Oswanski MF, Sidhu R et al (2011) Analysis of radiadtion exposure in trauma patients at a level I trauma center. J Emerg Med 41:640–648PubMedCrossRef
21.
Winslow JE, Hinshaw JW, Hughes MJ, Williams RC, Bozeman WP (2008) Quantitative assessment of diagnostic radiation doses in adult blunt trauma patients. Ann Emerg Med 52:93–97PubMedCrossRef
22.
Brismar B, Bergenwald L (1982) The terrorist bomb explosion in Bologna, Italy, 1980; an analysis of the effects of injuries sustained. J Trauma 22:216–220PubMedCrossRef
23.
Carley SD, Mackway-Jones K (1997) The casualty profile from the Manchester bombing 1996: a proposal for the construction and diddemination of casualty profiles from major incidents. J Accid Emerg Med 14:76–80PubMedCentralPubMedCrossRef
24.
Aylwin CJ, König TC, Brennan NW, Davies G, Walsh MS, Brohi K (2006) Reduction in critical mortality in urban mass casualty incidents: analysis of triage, surge, and resource use after the London bombings on July 7, 2005. Lancet 368:2219–2225PubMedCrossRef
25.
Raja AS, Propper BW, VandenBerg SL et al (2010) Imaging utilization during explosive multiple casualty incidents. J Trauma 68:1421–1424PubMedCrossRef
26.
Rowles JM, Learmonth DJ, Tait GR, Macey AC (1992) Survivors of the M1 aircrash. Outcomes after 1 year. Injury 22:362–364CrossRef
27.
Korner M, Krotz MM, Wirth S et al (2009) Evaluation of a CT triage protocol for mass casualty incidents: results from two large-scale exercises. Eur Radiol 19:1867–1874PubMedCrossRef
28.
Sierink JC, Saltzherr TP, Reitsma JB, van Delden OM, Luitse JS, Goslings JC (2012) Systematic review and meta-analysis of immediate total-body computed tomography compared with selective radiological imaging of injured patients. Br J Surg 99:52–58PubMedCrossRef
Metadata
Title
Radiological work-up after mass casualty incidents: are ATLS guidelines applicable?
Authors
Ingri L. E. Postma
L. F. M. Beenen
T. S. Bijlsma
F. H. Berger
M. J. Heetveld
F. W. Bloemers
J. C. Goslings
Publication date
01-03-2014
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 3/2014
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-013-3072-y

Other articles of this Issue 3/2014

European Radiology 3/2014 Go to the issue

Cardiac

320-row CT coronary angiography predicts freedom from revascularisation and acts as a gatekeeper to defer invasive angiography in stable coronary artery disease: a fractional flow reserve-correlated study

Urogenital

Diffusion-weighted MRI, 11C-choline PET and 18F-fluorodeoxyglucose PET for predicting the Gleason score in prostate carcinoma

Computed Tomography

Current knowledge on tumour induction by computed tomography should be carefully used

Head and Neck

Diffusivity of intraorbital lymphoma vs. IgG4-related DISEASE: 3D turbo field echo with diffusion-sensitised driven-equilibrium preparation technique

Musculoskeletal

High-resolution MRI predicts steroid injection response in carpal tunnel syndrome patients

Computed Tomography

Non-invasive determination of pulmonary hypertension with dynamic contrast-enhanced computed tomography: a pilot study