A-E-M-S Medical Mass Casualty Algorithm for Ghana
The “AEMS Collaborative” is a unique multinational, multidisciplinary team of emergency physicians, emergency nurses, disaster experts, global health scholars, and emergency medicine fellows dedicated to researching, identifying, and implementing timely Ghana-specific solutions to mass casualty disaster emergencies in low-resource settings. Therefore, it is with great anticipation and optimism that the AEMS Medical Mass Casualty Collaborative present our initiative to allocate Ghana’s existing Emergency Medical Services (EMS) resources more effectively—ultimately saving more lives and reducing the acuity, suffering (disabilities, etc.) and long-term healthcare costs of trauma patients throughout Ghana.
Through the support of Dr. Roxane Richter’s 2016-2017 United States’ Fulbright-Fogarty (U.S. Dept. of State and the National Institutes of Health, Washington, D.C.) Postdoctoral Global Health Fellowship, Richter studied and researched EMS trauma response in Mass Casualty Incidents in Kumasi, Ghana. Through this fellowship, she developed a unique four-stage “AEMS” algorithm—Analysis, Emergency Operations Planning, Mapping, and Simulation—which she made public at the U.S. Embassy in Accra on May 18, 2017. This algorithm, designed exclusively for low-resource environments, is not only an “evidence-based” EMS response model, but ultimately a far less costly alternative, as no additional infrastructure requisites or costly resources, other than limited training and research support, will be deemed necessary. Richter’s “AEMS” algorithm includes 3 “AEM” Geographic Information System (GIS)-mapped layers (Analysis, Emergency operations planning, drones, and mapping), followed by the final stage of hands-on Simulation training sessions for EMS/healthcare providers.
1. On-scene transmission of photographs/videos of high-acuity patient injuries to skilled EM physician, thereby "virtually augmenting" the on-scene trauma triage skill-level of the EMTs at the RTA scene. We simply cannot underestimate the grave importance of assessing exact mechanisms of injury (compression, shearing, penetrating, blunt trauma) and the kinetic forces that patients may have been subjected to during traumatic incidents or accidents. Improper on-scene triage can have serious life-and-death consequences for MCI victims.
2. On-scene photo and video transmission of entire physical RTA/MCI accident scene to MD for skilled mechanism of injury (MOI) assessment. MOI = The manner in which a physical injury occurred—used to estimate the mechanism(s) involved in trauma and, thus, the potential severity for wounding, fractures, and internal organ damage that a patient may suffer as a result of the injury. As examples, injury patterns are different for a.) lateral (side) motor vehicle collisions and/or b.) rollovers vs. c.) frontal impact collisions.
3. On-scene photo and video transmission of kinetic energy forces assessment by skilled MDs. Understanding kinetics allows responders to ascertain the RTA’s MOI and trauma associated with it. By understanding the Kinetics of Trauma, we can make a reasonable prediction of the kind and extent of injuries based on the MOI. EMTs usually ask the same type of questions when they arrive at an RTA/MCI, but they have the advantage of being able to see the setting(s) where injuries occurred. They, therefore, have a better appreciation of the MOI and the kinetic forces that patients have been subjected to before initiating treatment. The amount and direction of the force to which an individual has been subjected can be evident from the scene of the impact (amount of damage done to a vehicle following a crash - or distance and type of surface onto which the individual has been ejected from the vehicle). Failure to appreciate the type and amount of force to which patients have been subjected can lead to subtle signs and symptoms being overlooked, and potential life-or limb-threatening injuries going undetected at the earliest opportunity (at EMT scene arrival). The energy of movement is “kinetic energy (KE)” = 1/2 MV2, where M is mass and V is velocity. The velocity of an object has a much greater effect on its kinetic energy than its mass; therefore, the velocity at which an object strikes a person, rather than the object’s mass, determines the severity of that person’s injuries.
4. Real-time road access and traffic recognition patterns for EMS/fire/police rescue/response vehicles. The drones could search for available routes in a variety of locations, especially in 1.) inaccessible or rural areas, and 2.) finding low(er)-traffic option routes for response vehicles in high-traffic centers, and also 3.) gridlocked areas block an entire network of intersecting streets, bringing traffic flow in all directions to a complete standstill, and 4.) in post-disaster scenarios, such as flooding or mass riots or stampedes, where previous routes have collapsed or been destroyed.
