Development of a Trauma Surge Protocol Following Viaduct Collapse

Summary: In the early hours of July 14, 2017, a structural collapse of a viaduct under construction in the east of Singapore resulted in 1 fatality and 10 casualties with serious injuries. All casualties were conveyed to the nearest hospital, Changi General Hospital (CGH). The unexpected wave of patients exposed critical inefficiencies in interdepartmental coordination and resource management, highlighting the need for a protocolled response to a casualty surge. Singapore has a tiered civil emergency response plan to cater to mass casualty incidents with more than 20 casualties at a single institution. CGH’s experience identified a gap in the management of moderate patient surges, defined as an influx of 5-20 critically injured individuals. Based on findings from internal audits and post-event analysis, a trauma surge protocol was developed, addressing coordination, resource allocation, and team communication. Key protocol recommendations: 1. Protocol Activation: The trauma surge protocol is activated when patient influx exceeds normal capacity with regard to casualty numbers and acuity level, triggering call tree activation with information cascade. This allows for rapid diversion and redeployment of resources and personnel. 2. Role Clarity: Interdepartmental role clarification enables the distribution of responsibilities among medical, nursing, and operational personnel from Emergency Medicine, General Surgery, Orthopedic Surgery, Anesthesiology, Radiology, and Laboratory Services. 3. Resource Management: Streamlined triage guidance optimizes the allocation of resources such as blood products, advanced imaging, and operating theatre space. This accelerates patient throughput and minimises disruption to in-flight patients. 4. Communication: Protocolization establishes communication channels and clear workflows, facilitating interprofessional collaboration among responders working in a high-pressure environment. Most recently, in July 2023, the trauma surge protocol enabled CGH to manage five critically injured casualties from a heavy vehicle road traffic accident more efficiently. Further protocol refinements will be supported with post-event evaluation and regular interprofessional simulation training.