Mass Casualty Response - Adults and Children Emergency Department (ED) and Critical Care Consumables List Purpose 1. Reserves of many consumable items on hospital sites are now lower than in the past given the sophisticated just in time stock ordering systems in place in NHS organisations. 2. In order to improve response resilience to a mass casualty incident the stock levels of some consumables may need increasing locally. This is likely to be most pertinent in the event that lockdown is in place and resupply/additional stock may not be available for 24 hours. 3. This list provides a clinically reviewed summary of consumables that may need augmenting above normal stock levels held locally by an ED or within Critical Care. In order to improve resilience to a mass casualty situation. It considers disposables not capital equipment. 4. The list indicates the essential and the essential AND high volume usage items for adults and children as shown.: = Essential for maintaining response HV = Essential for response AND high usage 5. The overlap of and variance between items for critical care and for ED is also illustrated to help avoid any potential double counting and to help with discussion and agreement at trust /site level on locally preferred stockpile items. 6. Some items have not been prioritised even though they may be used normally, in order to promote delivery of a more generic/ flexible mass casualty response. Assumptions made in drawing up this list 7. In a mass casualty response, staffing skills and ratios may not be optimal particularly so in relation to children. 8. Where novel areas are used for management of emergency department patients, these areas may have piped oxygen and suction. However there will be portable oxygen and suction in every area. 9. Where novel areas are used for management of critical care patients, these areas will have piped oxygen and suction. 10. Cylinders will be available for the transportation of patients from A to B to C within Trust (or may need to add air/oxygen cylinders to list). 11. Emphasis for the Emergency Department and Critical Care is on ensuring and maintaining as appropriate a) Haemorrhage control saving life and limb b) Respiratory stability c) Fluid resuscitation d) Analgesia, sedation, paralysis, antibiotic therapies and fluids e) Wound management 12. Wound management is likely to be arising from a) Gunshot injuries North West London Critical Care Network March 2011 Page 1 of 12
b) Burns c) Blast d) Eyes e) Traumatic limb injuries f) Fractures Children 13. There may be management of ++children in facilities not designated as Paediatric ICU or HDU centres. 14. Consumables shortage may arise most acutely for children in some Trusts as low volumes of airways/tubes etc held. 15. Some Trusts may also wish to consider augmenting response for children with Broselow grab bags for children given potential skill mix issues for some sites. Other 16. The overall response model should facilitate expert advice being made available (from non receiving organisations with high level expertise) to receiving organisations without those specialists. 17. The overall response model should give strong consideration to moving expert staff (i.e. surgeon/additional intensivists/additional ED staff ) from non receiving sites to receiving sites when possible. March 2011 Mass Casualty Stockpiling Task & Finish Group Clinical Membership NHS London LAS clinician Major Trauma Centre clinician Trauma Unit clinicians (Nursing and Medical) Critical Care Network NWL clinical team (Nursing and Medical) North West London Critical Care Network March 2011 Page 2 of 12
Essential for maintaining response HV Essential for maintaining response AND high usage Consumables - Drugs Description Unit Emergency Dept Critical care Actrapid 1000u amp HV Adrenaline 1:10,000 1mg amp Adrenaline 1:1000 Atropine 3mg Bupivicaine Eye Ceftazidime or tazocin 1-2 g Cefuroxime 750mg Chloramphenicol eye ointment Co-amoxiclav 1.2g amp HV Diazepam Etomidate Enoxaparin 40mg dose Erythromycin 500mg amp Fentanyl Flucloxacillin Frusemide 20mg amp Gentamicin 80mg amp Hydrocortisone 100mg amp Immunoglobulin Ipratropium Nebulisers Ketamine HV Lignocaine 5-10ml amp HV Magnesium sulfate 10ml HV Meropenem Metronidazole IV Midazolam 50mg vial Morphine 60mg amp HV HV Naloxone Noradrenaline 4mg amp Normal saline 0.9% 10ml amp Nutrison 1000ml feed Potassium 13 mmol amp Praladoxime Prednisolone Propofol 200mg amp HV HV Ranitidine 50mg amp Salbutamol IV Salbutamol Nebulisers 5mg Tet-Tox Tranexamic acid HV Vecuronium 10 mg amp HV Water For Injection 10ml HV North West London Critical Care Network March 2011 Page 3 of 12
Essential for maintaining response HV Essential for maintaining response AND high usage Consumables - Fluids Description Units Emergency Dept Critical care 5% dextrose 1000ml Normal Saline 0.9% 500ml HV Normal Saline 0.9% 1000ml Normal Saline / 20mmol 1000ml HV KCL Dextrose Saline 1000ml Dextrose Saline/20mmols 1000ml KCL Hartmann s 1000ml HV Haemaccel 500mls HV Consumables Airway & Respiratory Bag Valve Masks Adult Bougie Catheter mounts Closed suction 12g CPAP Valve 7.5cmH20 CPAP Valves 5cmH20 Cricothyroidotomy set Adult Endotracheal tube Size 8.0 Endotracheal tube Size 9.0 ET Tape Roll HME filters Hudson masks high flow Adult reservoir Humidifier circuits Insertion set percutaneous Laryngoscope (adult) Disposable Magills forceps Nasal Cannulae Nasopharyngeal airway Size 8.0 Nebuliser acorns Non invasive circuits (NIV) Oropharyngeal airway Size 3 Oropharyngeal airway Size 4 Oxygen tubing Suction catheters 12 FG Suction catheters 8g Suction liners Suction tubing Tracheostomy masks Tracheostomy Tube Size 8.0 Ventilator circuits Yankauers with control North West London Critical Care Network March 2011 Page 4 of 12
Essential for maintaining response HV Essential for maintaining response AND high usage Consumables Monitoring and Investigation Arterial blood gas syringe Blood collection bottles Blood gas machine consumables ECG dots Sample bags Sputum traps Tympanic covers Urinary catheter bags Urinary catheters Size 10 Urinary catheters Size 12 Consumables - Cardiovascular 3 way taps Arterial line 16G Arterial line 20G Arterial line 22G Blood giving sets (gravity) HV HV Cannulae 16G Cannulae 20G CVP lines 5 lumen EZ IO Gun EZ IO needles 40kg and above Blue Infusion lines (50ml HV syringes) IV fluid giving sets (gravity) HV Needles Blue Needles Green Needles Orange Rapid infusion (level one) Red bungs Syringes 1ml HV Syringes 10ml HV Syringes 50ml HV Consumables Haemothorax / Pneumothorax 3 Bottle chest / thoracic drainage kit Chest drain insertion kits Chest seal Connector Y type Sterile water Trocars North West London Critical Care Network March 2011 Page 5 of 12
Essential for maintaining response HV Essential for maintaining response AND high usage Consumables - Wound Management - Gunshot Bandage HV HV Gamgee HV HV Gauze HV HV Pads HV HV Sterile dressing packs Small HV HV Sterile dressing packs Large HV HV Consumables - Wound Management - Burns Cling film Ointment (flamazine) Burns dressing (celox) Padding Absorbent dressing Consumables - Wound management Haemorrhage control Disposable mosquitoes Disposable Spencer wells Dressings 6 Elastoplast Combat application tourniquets Oleas emergency 6 bandage Oleas emergency 4 bandage Swabs Consumables Skin closure Steri-strips Staples? sizes Surgical knife assorted Suture pack Sutures 9.0 Nylon? Consumables - Eyes Eye pads Eye wash Bupivocaine eye gel/drops Also on drugs list North West London Critical Care Network March 2011 Page 6 of 12
Essential for maintaining response HV Essential for maintaining response AND high usage Consumables Wound management - Fractures Skin traction kits Splints Plaster of Paris Consumables - Miscellaneous Batteries for laryngoscopes Betadine skin clean HV HV Black Marker pens Clinical waste bags HV HV Defib pads Adult Drug additive labels Incontinence sheets HV HV NG tube Post-it notes Pt gowns Razors Scissors Sharps disposal large Sterile gloves Size 7 HV HV Sterile gloves Size 8 HV HV Thermal blankets Triage cards Theatre scrubs Consumables - PPE Alcohol gel HV Masks (FFP3) Gloves Medium HV HV Gloves Large HV HV Plastic aprons HV HV Sharps bins Surgical gowns HV Paper hats Body Bags Red Bags North West London Critical Care Network March 2011 Page 7 of 12
Essential for maintaining response HV Essential for maintaining response AND high usage Managing children initially in non paediatric centres (in extreme circumstances) Broselow type emergency system Includes twenty-eight size-specific procedural modules in seven pouches, flying carpet, Broselow Paediatric Emergency Tape. For children 3 to 34 kg on Critical Care list on Emergency dept list Consumables Children Airway and Respiratory Bag Valve Mask (BVM) child HV 10-22kg Bag Valve Mask (BVM) Infant HV Bougie child HV Closed Suction 6fr Closed Suction 8fr Closed Suction 10fr Closed Suction 12fr CPAP valve 5.0cm H20 CPAP valve 7.5cm H20 ET Tube uncuffed 2.0 ET Tube uncuffed 3.0 ET Tube uncuffed 4.0 ET Tube uncuffed 5.0 ET Tube uncuffed 6.0 ET Tube uncuffed 7.0 ET Tubes Cuffed 5 ET Tubes Cuffed 6 ET Tubes Cuffed 7 laryngoscopes (straight 0 blade) laryngoscopes (straight 1 HV blade) laryngoscopes (straight 2 blade) laryngoscopes (straight 3 HV blade) Nasal Cannulae child Nebuliser kit Non rebreathe facemask child Oropharyngeal 0 HV Oropharyngeal 000 HV Oropharyngeal 1 HV North West London Critical Care Network March 2011 Page 8 of 12
Oropharyngeal 3 HV Oxygen facemask child HV Oxygen facemask aerosol child HV Stylet for intubation 2mmID HV Stylet for intubation 4mmID HV Tracheostomy dressing Tracheostomy guide Tracheostomy inner cannula cuffed cuffed cuffed cuffed uncuffed uncuffed uncuffed uncuffed Tracheostomy tape Trocars 5ch 50cm child 2.0 3.0 4.0 5.0 3.0 4.0 5.0 6.0 100% cotton 8FG Ventilator circuits child HV Yankauers child HV Dry / wet ventilator circuits HV NIV tubing Suction liners Elephant tubing Cold water humidification system & adaptor Consumables Children Monitoring and Investigation ECG dots HV Pressure transducer sets child Urinary catheter bags Urinary catheters Child 6FG Urinary catheters Child 8FG Blood collection bottles HV Sputum traps Mucous traps Thermometer Arterial blood gas syringe HV North West London Critical Care Network March 2011 Page 9 of 12
Essential for maintaining response HV Essential for maintaining response AND high usage Consumables Children - Cardiovascular EZ IO Gun EZ IO Needle Pink 3 39 kg Syringes 1ml HV HV Syringes 10ml HV HV Syringes 20ml HV HV Needles 19G HV HV Needles 25G HV HV Cannulae 16G Cannulae 20G Cannulae 22G HV HV Cannulae 24G HV Short 3-way connector HV Blood giving set HV IV giving set (burette) HV Consumables Children Haemothorax / Pneumothorax Chest drain insertion kits child HV Trocar 8FG 3 Bottle chest / thoracic drainage kit Connector Y type Sterile water HV Chest seal Consumables Children Wound management - Gunshot Bandage HV HV Gamgee HV HV Gauze HV HV Pads HV HV Sterile dressing packs Small HV HV Sterile dressing packs Large HV HV Consumables Children Wound management - Burns Description Unit Emergency Dept Comment Cling film HV Ointment (flamazine) HV Burns dressing (celox) HV Padding HV Absorbent dressing HV This line is empty North West London Critical Care Network March 2011 Page 10 of 12
Consumables Children Wound Management Haemorrhage control Description Unit Emergency Dept Comment Disposable mosquitoes clips Disposable Spencer wells forceps Dressings HV 6 Elastoplast Combat application tourniquets Oleas emergency 6 bandage Oleas emergency 4 bandage Swabs Consumables Children Skin closure Steri-strips HV Skin glue HV Staples Surgical knife assorted Suture pack HV Sutures 9.0 Nylon? Consumables Children - Eyes Eye pads HV Eye wash HV Bupivocaine eye gel/drops Also on drugs list Consumables Children Wound Management - Fractures Skin traction kits Splints HV Plaster of Paris HV Essential for maintaining response HV Essential for maintaining response AND high usage North West London Critical Care Network March 2011 Page 11 of 12
Consumables Children - Miscellaneous Batteries Betadine skin clean HV Black Marker pens Clinical waste bags HV Defib pads Child Drug additive labels Incontinence sheets HV NG tube 6FG NG tube 8FG Post its Pt gowns Razors Scissors Sharps disposal large Sterile gloves Size 7 HV HV Sterile gloves Size 8 HV HV Thermal blankets Triage cards Theatre scrubs Ends North West London Critical Care Network March 2011 Page 12 of 12