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Schleedoorn MJ, Mulder BH, Braat DDM, Beerendonk CCM, Peek R, Nelen WLDM, Van Leeuwen E, Van der Velden AAEM, Fleischer K, Turner Fertility Expert Panel OBOT. International consensus: ovarian tissue cryopreservation in young Turner syndrome patients: outcomes of an ethical Delphi study including 55 experts from 16 different countries. Hum Reprod 2021; 35:1061-1072. [PMID: 32348471 PMCID: PMC7493129 DOI: 10.1093/humrep/deaa007] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/09/2020] [Indexed: 12/29/2022] Open
Abstract
STUDY QUESTION What is the standpoint of an international expert panel on ovarian tissue cryopreservation (OTC) in young females with Turner syndrome (TS)? SUMMARY ANSWER The expert panel states that OTC should be offered to young females with TS, but under strict conditions only. WHAT IS KNOWN ALREADY OTC is already an option for preserving the fertility of young females at risk of iatrogenic primary ovarian insufficiency (POI). Offering OTC to females with a genetic cause of POI could be the next step. One of the most common genetic disorders related to POI is TS. Due to an early depletion of the ovarian reserve, most females with TS are confronted with infertility before reaching adulthood. However, before offering OTC as an experimental fertility preservation option to young females with TS, medical and ethical concerns need to be addressed. STUDY DESIGN, SIZE, DURATION A three-round ethical Delphi study was conducted to systematically discuss whether the expected benefits exceed the expected negative consequences of OTC in young females with TS. The aim was to reach group consensus and form an international standpoint based on selected key statements. The study took place between February and December 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS Anonymous panel selection was based on expertise in TS, fertility preservation or medical ethics. A mixed panel of 12 gynaecologists, 13 (paediatric) endocrinologists, 10 medical ethicists and 20 patient representatives from 16 different countries gave consent to participate in this international Delphi study. In the first two rounds, experts were asked to rate and rank 38 statements regarding OTC in females with TS. Participants were offered the possibility to adjust their opinions after repetitive feedback. The selection of key statements was based on strict inclusion criteria. MAIN RESULTS AND THE ROLE OF CHANCE A total of 46 participants completed the first Delphi round (response rate 84%). Based on strict selection criteria, six key statements were selected, and 13 statements were discarded. The remaining 19 statements and two additional statements submitted by the expert panel were re-evaluated in the second round by 41 participants (response rate 75%). The analysis of the second survey resulted in the inclusion of two additional key statements. After the approval of these eight key statements, the majority of the expert panel (96%) believed that OTC should be offered to young females with TS, but in a safe and controlled research setting first, with proper counselling and informed consent procedures, before offering this procedure in routine care. The remaining participants (4%) did not object but did not respond despite several reminders. LIMITATIONS, REASONS FOR CAUTION The anonymous nature of this study may have led to lack of accountability. The selection of experts was based on their willingness to participate. The fact that not all panellists took part in all rounds may have resulted in selection bias. WIDER IMPLICATIONS OF THE FINDINGS This international standpoint is the first step in the global acceptance of OTC in females with TS. Future collaborative research with a focus on efficacy and safety and long-term follow-up is urgently needed. Furthermore, we recommend an international register for fertility preservation procedures in females with TS. STUDY FUNDING/COMPETING INTEREST(S) Unconditional funding (A16-1395) was received from Merck B.V., The Netherlands. The authors declare that they have no conflict of interest.
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Affiliation(s)
- M J Schleedoorn
- Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - B H Mulder
- Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - D D M Braat
- Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - C C M Beerendonk
- Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - R Peek
- Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - W L D M Nelen
- Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - E Van Leeuwen
- Medical Ethics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - A A E M Van der Velden
- Paediatric Endocrinology, Radboud University Medical Centre Amalia Children's Hospital, Nijmegen, The Netherlands
| | - K Fleischer
- Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Bird R, Braunold D, Dryburgh-Jones J, Davis J, Rogers S, Sohrabi C, Ismail E, Mclean N, O'neill B, Edmonds N, Tallach R. Paediatric major incident simulation and the number of discharges achieved using a major incident rapid discharge protocol in a major trauma centre: a retrospective study. BMJ Open 2020; 10:e034861. [PMID: 33303429 PMCID: PMC7733198 DOI: 10.1136/bmjopen-2019-034861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 07/29/2020] [Accepted: 09/21/2020] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES Hospitals have the responsibility of creating, testing and maintaining major incident (MI) plans. Plans emphasise readiness for acceptance of casualties, though often they neglect discharge planning and care for existing inpatients to make room for the sudden influx.After collaboration and design of a discharge policy for a paediatric MI, we aimed to establish the number of beds made available (primary outcome) to assess potential surge and patient flow. We hypothesised that prompt patient discharge would improve overall departmental flow. Flow is vital for sick patients awaiting admission, for those requiring theatre and also to keep the emergency department clear for ongoing admissions. METHOD AND SETTING A simulated MI was declared at a London major trauma centre. Five paediatric priority 1 and 15 priority 2 and priority 3 patients were admitted. Using live bed boards, staff initiated discharge plans, and audits were conducted based on hospital bed occupancy and discharge capacity. The patients identified as dischargable were identified and folllowed up for 7 days. RESULTS Twenty-nine ward beds were created (42% of the total capacity). Handwritten summaries just took 13.3% of the time that electronic summaries took for the same patients by the same doctor. In-hospital transfers allowed five critically injured children into paediatric intensive care unit (PICU), and creation of a satellite PICU allowed for an additional six more if needed. CONCLUSION We increased level 3 capacity threefold and created 40% extra capacity for ward patients. A formalised plan helped with speed and efficiency of safe discharge during an MI. Carbon copy handwritten discharge letters allowed tracking and saved time. Robust follow-up procedures must be in place for any patients discharged.
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Affiliation(s)
- Ruth Bird
- Anaesthetics, Royal London Hospital, London, UK
| | | | - Jack Dryburgh-Jones
- Barts and The London School of Medicine and Dentistry Postgraduate Studies, London, UK
| | - Jordan Davis
- Barts and The London School of Medicine and Dentistry Postgraduate Studies, London, UK
| | - Sam Rogers
- Barts and The London School of Medicine and Dentistry Postgraduate Studies, London, UK
| | - Catrin Sohrabi
- Barts and The London School of Medicine and Dentistry Postgraduate Studies, London, UK
| | - Elliot Ismail
- Barts and The London School of Medicine and Dentistry Postgraduate Studies, London, UK
| | - Nina Mclean
- Major Incident Planning, Barts Health NHS Trust, London, UK
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Al-Shamsi M, Moitinho de Almeida M, Nyanchoka L, Guha-Sapir D, Jennes S. Assessment of the Capacity and Capability of Burn Centers to Respond to Burn Disasters in Belgium: A Mixed-Method Study. J Burn Care Res 2020; 40:869-877. [PMID: 31211825 PMCID: PMC6797226 DOI: 10.1093/jbcr/irz105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Burn disaster is defined as a massive influx of patients that exceeds a burn center's capacity and capability. This study investigates the capacity and capability of burn centers to respond to burn disasters in the Belgian ground. Quantitative survey and qualitative semistructured interview questionnaires were administered directly to key informants of burn centers. The data collected from both methods were compared to get a more in-depth overview of the issue. Quantitative data were converted into a narrative to enrich the qualitative data and included in the thematic analysis. Finally, data from both methods were analyzed and organized into five themes. The Belgian Association of Burn Injury (BABI) has a specific prehospital plan for burn disaster management. Once the BABI Plan is activated, all burn centers respond as one entity. Burn Team (B-Team) is a professional team that is formed in case of urgent need and it is deployed to a scene or to nonburn specialized hospitals to help in disaster relief. The challenges for burn disasters response occur particularly in the area of triage, transfer, communication, funding, and training. We conclude that there is a variation in the capacity and capability of burn centers. Overall, the system of burn disaster management is advanced and it is comparable to other high-income countries. Nevertheless, further improvement in the areas of preparation, triage, communication, and finally training would make disaster response more resilient in the future. Therefore, there is still space for further improvement of the management of burn disasters in Belgium.
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Affiliation(s)
- Mustafa Al-Shamsi
- Centre for Research on the Epidemiology of Disasters (CRED), Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium.,Unit for Research in Emergency and Disaster, University of Oviedo, Oviedo, Spain
| | - Maria Moitinho de Almeida
- Centre for Research on the Epidemiology of Disasters (CRED), Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Linda Nyanchoka
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.,INSERM, UMR1153, Epidemiology and Statistics Sorbonne Paris Cité Research Center (CRESS), Team METHODS, Paris, France.,University of Liverpool, Institute of Translational Medicine, Liverpool, UK
| | - Debarati Guha-Sapir
- Centre for Research on the Epidemiology of Disasters (CRED), Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Serge Jennes
- Burn Wound Centers of Loverval and Brussels (IMTR Loverval, Centre des brûlés) Charleroi, Belgium
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How to Choose? Using the Delphi Method to Develop Consensus Triggers and Indicators for Disaster Response. Disaster Med Public Health Prep 2017; 11:467-472. [PMID: 28153060 DOI: 10.1017/dmp.2016.174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To identify key decisions along the continuum of care (conventional, contingency, and crisis) and the critical triggers and data elements used to inform those decisions concerning public health and health care response during an emergency. METHODS A classic Delphi method, a consensus-building survey technique, was used with clinicians around Washington State to identify regional triggers and indicators. Additionally, using a modified Delphi method, we combined a workshop and single-round survey with panelists from public health (state and local) and health care coalitions to identify consensus state-level triggers and indicators. RESULTS In the clinical survey, 122 of 223 proposed triggers or indicators (43.7%) reached consensus and were deemed important in regional decision-making during a disaster. In the state-level survey, 110 of 140 proposed triggers or indicators (78.6%) reached consensus and were deemed important in state-level decision-making during a disaster. CONCLUSIONS The identification of consensus triggers and indicators for health care emergency response is crucial in supporting a comprehensive health care situational awareness process. This can inform the creation of standardized questions to ask health care, public health, and other partners to support decision-making during a response. (Disaster Med Public Health Preparedness. 2017;11:467-472).
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Vassallo J, Smith JE, Bruijns SR, Wallis LA. Major incident triage: A consensus based definition of the essential life-saving interventions during the definitive care phase of a major incident. Injury 2016; 47:1898-902. [PMID: 27375012 DOI: 10.1016/j.injury.2016.06.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 05/16/2016] [Accepted: 06/17/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Triage is a key principle in the effective management of major incidents. The process currently relies on algorithms assigning patients to specific triage categories; there is, however, little guidance as to what these categories represent. Previously, these algorithms were validated against injury severity scores, but it is accepted now that the need for life-saving intervention is a more important outcome. However, the definition of a life-saving intervention is unclear. The aim of this study was to define what constitutes a life-saving intervention, in order to facilitate the definition of an adult priority one patient during the definitive care phase of a major incident. METHODS We conducted a modified Delphi study, using a panel of subject matter experts drawn from the United Kingdom and Republic of South Africa with a background in Emergency Care or Major Incident Management. The study was conducted using an online survey tool, over three rounds between July and December 2013. A four point Likert scale was used to seek consensus for 50 possible interventions, with a consensus level set at 70%. RESULTS 24 participants completed all three rounds of the Delphi, with 32 life-saving interventions reaching consensus. CONCLUSIONS This study provides a consensus definition of what constitutes a life-saving intervention in the context of an adult, priority one patient during the definitive care phase of a major incident. The definition will contribute to further research into major incident triage, specifically in terms of validation of an adult major incident triage tool.
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Affiliation(s)
- James Vassallo
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa; Institute of Naval Medicine, Alverstoke, Gosport, UK.
| | - Jason E Smith
- Emergency Department, Derriford Hospital, Plymouth, UK; Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Medical Directorate, Joint Medical Command, Birmingham, UK
| | - Stevan R Bruijns
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Lee A Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
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Duncan EAS, Colver K, Dougall N, Swingler K, Stephenson J, Abhyankar P. Consensus on items and quantities of clinical equipment required to deal with a mass casualties big bang incident: a national Delphi study. BMC Emerg Med 2014; 14:5. [PMID: 24559111 PMCID: PMC3936839 DOI: 10.1186/1471-227x-14-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 02/18/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Major short-notice or sudden impact incidents, which result in a large number of casualties, are rare events. However health services must be prepared to respond to such events appropriately. In the United Kingdom (UK), a mass casualties incident is when the normal response of several National Health Service organizations to a major incident, has to be supported with extraordinary measures. Having the right type and quantity of clinical equipment is essential, but planning for such emergencies is challenging. To date, the equipment stored for such events has been selected on the basis of local clinical judgment and has evolved without an explicit evidence-base. This has resulted in considerable variations in the types and quantities of clinical equipment being stored in different locations. This study aimed to develop an expert consensus opinion of the essential items and minimum quantities of clinical equipment that is required to treat 100 people at the scene of a big bang mass casualties event. METHODS A three round modified Delphi study was conducted with 32 experts using a specifically developed web-based platform. Individuals were invited to participate if they had personal clinical experience of providing a pre-hospital emergency medical response to a mass casualties incident, or had responsibility in health emergency planning for mass casualties incidents and were in a position of authority within the sphere of emergency health planning. Each item's importance was measured on a 5-point Likert scale. The quantity of items required was measured numerically. Data were analyzed using nonparametric statistics. RESULTS Experts achieved consensus on a total of 134 items (54%) on completion of the study. Experts did not reach consensus on 114 (46%) items. Median quantities and interquartile ranges of the items, and their recommended quantities were identified and are presented. CONCLUSIONS This study is the first to produce an expert consensus on the items and quantities of clinical equipment that are required to treat 100 people at the scene of a big bang mass casualties event. The findings can be used, both in the UK and internationally, to support decision makers in the planning of equipment for such incidents.
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Affiliation(s)
- Edward A S Duncan
- NMAHP Research Unit, Scion House, University of Stirling, Stirling, FK9 4LA, Scotland, UK
| | - Keith Colver
- Scottish Ambulance Service, Edinburgh, Scotland, UK
| | - Nadine Dougall
- School of Nursing Midwifery and Health, The University of Stirling, Stirling, Scotland, UK
| | - Kevin Swingler
- Department of Maths and Computing Science, University of Stirling, Stirling FK9 4LA, Scotland, UK
| | - John Stephenson
- National Ambulance Resilience Unit, Unit 9 Granada Trading Estate, Demuth Way, Oldbury B69 4LH, UK
| | - Purva Abhyankar
- NMAHP Research Unit, Scion House, University of Stirling, Stirling, FK9 4LA, Scotland, UK
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An International Expert Delphi Study to Determine Research Needs in Major Incident Management. Prehosp Disaster Med 2012; 27:351-8. [DOI: 10.1017/s1049023x12000982] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo collate the opinions of experts and to reach consensus about the research priorities in the management of major incidents.DesignA three-round e-Delphi study was conducted using an international panel of experts drawn from active researchers and active educators in major incident management. General areas for consideration were derived from the literature analysis undertaken as part of the overall project.ResultsExperts generated 221 statements in 11 topic areas in the first round. Fifty-one of these statements reached consensus in Round 2. A further 23 statements reached consensus in Round 3, leaving 147 statements that did not reach consensus.ConclusionsAn international expert panel reached consensus on 74 topics of research priority in major incidents management. The strongest themes within these topics were education and training, planning, and communication.Mackway-Jones K, Carley S. An international expert Delphi study to determine research needs in major incident management. Prehosp Disaster Med. 2012;27(4):1-8.
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Abstract
AbstractIntroduction: The aim of this study was to describe the current state of disaster preparedness in hospitals in the public sector in the Western Cape, South Africa with the advent of the FIFA 2010 Soccer World Cup. The objectives included the completion of a self-reported assessment of readiness at all Western Cape public sector hospitals, to identify best practice and shortfalls in these facilities, as well as putting forward recommendations for improving disaster preparedness at these hospitals.Methods: The National Department of Health, as part of the planning for the FIFA 2010 World Cup, appointed an expert committee to coordinate improvements in disaster medicine throughout the country. This workgroup developed a Self Reported Hospital Assessment Questionnaire, which was sent to all hospitals across the country. Data only were collected from public hospitals in the Western Cape and entered onto a purpose-built database. Basic descriptive statistics were calculated. Ethical approval was obtained from the Health Sciences Faculty Research Committee of the University of Cape Town.Results: Twenty-seven of the 41 (68%) public hospitals provided completed data on disaster planning. The study was able to ascertain what infrastructure is available and what planning already has been implemented at these institutions.Recommendations: Most hospitals in the Western Cape have a disaster plan for their facility. Certain areas need more focus and attention; these include: (1) increasing collaborative partnerships; (2) improving HAZMAT response resources; (3) specific plans for vulnerable populations; (4) contingency plans for communication failure; (5) visitor, media and VIP dedicated areas and personnel; (6) evacuation and surge capacity plans; and (7) increased attention to training and disaster plan exercises.
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Lyle K, Thompson T, Graham J. Pediatric Mass Casualty: Triage and Planning for the Prehospital Provider. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2009. [DOI: 10.1016/j.cpem.2009.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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The Needs of Children in Natural or Manmade Disasters. INTENSIVE AND CRITICAL CARE MEDICINE 2009. [PMCID: PMC7120869 DOI: 10.1007/978-88-470-1436-7_32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Disasters have been described as “events of sufficient scale, asset depletion, or numbers of victims to overwhelm medical resources” [1] or as “a serious disruption of the functioning of a community or a society causing widespread human, material, economic or environmental losses that exceed the ability of the affected community or society to cope using its own resources” [2]. Importantly, that definition goes on to state: “A disaster is a function of the risk process. It results from the combination of hazards, conditions of vulnerability and insufficient capacity or measures to reduce the potential negative consequences of risk.”
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Mace SE, Bern AI. Needs assessment: are Disaster Medical Assistance Teams up for the challenge of a pediatric disaster? Am J Emerg Med 2007; 25:762-9. [PMID: 17870478 DOI: 10.1016/j.ajem.2006.12.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Revised: 12/11/2006] [Accepted: 12/13/2006] [Indexed: 10/22/2022] Open
Abstract
Pediatric patients are likely victims in a disaster and are more vulnerable in a disaster than adults, yet they have been essentially overlooked in disaster management according to the Pediatric Institute of Medicine Report. We did a needs assessment of Disaster Medical Assistance Teams regarding pediatric issues. Results were as follows: pediatric patients comprise a significant percentage of disaster victims (up to 85% in one disaster), and deficiencies were noted in the curriculum/training/resources. The percentage of time pediatric topics were missing from the curriculum was as follows: airway, 16%; trauma, 33%; disaster triage, 36%; burns, 42%; pain management, 42%; mental health, 45%; patient scenarios, 45%. The percentage of time pediatric equipment was missing was as follows: airway, 16%; intravenous lines, 37%; cervical collars, 38%; medicines, 38%; Broselow tape, 46%; backboards, 62%. Pediatric patients were included in disaster drills 63% of the time. Only 33% had pediatric protocols other than JumpSTART. A need to improve the pediatric components of Disaster Medical Assistance Teams was identified.
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Affiliation(s)
- Sharon E Mace
- Department of Emergency Medicine, Cleveland Clinic, Cleveland, OH 44195, USA.
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Abstract
Recommended steps for improved medical services to children and those needing urgent medical attention
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Brown N, Crawford I, Carley S, Mackway-Jones K. A Delphi-based consensus study into planning for biological incidents. J Public Health (Oxf) 2006; 28:238-41. [PMID: 16809791 DOI: 10.1093/pubmed/fdl015] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Biological incidents present a significant threat to health services in the UK. The objective of this study was to achieve consensus in all phases of biological incident planning and response. METHODS A three-round Delphi study was conducted using a panel of 23 experts from specialities involved in the management of biological incidents. The consensus and non-consensus outcomes from the Delphi study were subsequently presented for discussion in four syndicate groups at a one-day consensus conference funded by the Health Protection Agency. RESULTS The results of each syndicate group discussion were presented at a subsequent plenary session at the end of the conference. Further iteration of both the consensus and the non-consensus outcomes of the Delphi study resulted in the endorsement, modification, integration or rejection of individual statements. 125 consensus statements were produced. CONCLUSIONS The 125 synopsis consensus statements that all phases of biological incident planning and response. These can be used to inform policy decisions and translated into practical guidance for emergency planners and first responders at local, regional and national levels.
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Affiliation(s)
- Nina Brown
- Emergency Medicine Research Group, Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
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Welling L, Boers M, Mackie DP, Patka P, Bierens JJLM, Luitse JSK, Kreis RW. A consensus process on management of major burns accidents. J Health Organ Manag 2006; 20:243-52. [PMID: 16869357 DOI: 10.1108/14777260610662762] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The optimum response to the different stages of a major burns incident is still not established. The fire in a café in Volendam on New Year's Eve 2000 was the worst incident in recent Dutch history and resulted in mass burn casualties. The fire has been the subject of several investigations concerned with organisational and medical aspects. Based on the findings in these investigations, a multidisciplinary research group started a consensus study. The aim of this study was to further identify areas of improvement in the care after mass burns incidents. DESIGN/METHODOLOGY/APPROACH The consensus process comprised three postal rounds (Delphi Method) and a consensus conference (modified nominal group technique). The multidisciplinary panel consisted of 26 Dutch-speaking experts, working in influential positions within the sphere of disaster management and healthcare. FINDINGS In response to the postal questionnaires, consensus was reached for 66 per cent of the statements. Six topics were subsequently discussed during the consensus conference; three topics were discussed within the plenary session and three during subgroup meetings. During the conference, consensus was reached for seven statements (one subject generated two statements). In total, the panel agreed on 21 statements. These covered the following topics: registration and evaluation of disaster care, capacity planning for disasters, pre hospital care of victims of burns disasters, treatment and transportation priorities, distribution of casualties (including interhospital transports), diagnosis and treatment and education and training. ORIGINALITY/VALUE In disaster medicine, the paper shows how a consensus process is a suitable tool to identify areas of improvement of care after mass burns incidents.
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Affiliation(s)
- L Welling
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
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Dolan MA, Krug SE. Pediatric Disaster Preparedness in the Wake of Katrina: Lessons to be Learned. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2006. [DOI: 10.1016/j.cpem.2006.01.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Graham J, Shirm S, Liggin R, Aitken ME, Dick R. Mass-casualty events at schools: a national preparedness survey. Pediatrics 2006; 117:e8-15. [PMID: 16396851 DOI: 10.1542/peds.2005-0927] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Recent school shootings and terrorist events have demonstrated the need for well-coordinated planning for school-based mass-casualty events. The objective of this study was to document the preparedness of public schools in the United States for the prevention of and the response to a mass-casualty event. METHODS A survey was mailed to 3670 school superintendents of public school districts that were chosen at random from a list of school districts from the National Center for Education Statistics of the US Department of Education in January 2004. A second mailing was sent to nonresponders in May 2004. Descriptive statistics were used for survey variables, and the chi2 test was used to compare urban versus rural preparedness. RESULTS The response rate was 58.2% (2137 usable surveys returned). Most (86.3%) school superintendents reported having a response plan, but fewer (57.2%) have a plan for prevention. Most (95.6%) have an evacuation plan, but almost one third (30%) had never conducted a drill. Almost one quarter (22.1%) have no disaster plan provisions for children with special health care needs, and one quarter reported having no plans for postdisaster counseling. Almost half (42.8%) had never met with local ambulance officials to discuss emergency planning. Urban school districts were better prepared than rural districts on almost all measures in the survey. CONCLUSIONS There are important deficiencies in school emergency/disaster planning. Rural districts are less well prepared than urban districts. Disaster/mass-casualty preparedness of schools should be improved through coordination of school officials and local medical and emergency officials.
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Affiliation(s)
- James Graham
- Department of Pediatrics, University of Arkansas for Medical Sciences College of Medicine, Arkansas Children's Hospital, Little Rock, Arkansas, USA.
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Beattie E, Mackway-Jones K. A Delphi study to identify performance indicators for emergency medicine. Emerg Med J 2005; 21:47-50. [PMID: 14734375 PMCID: PMC1756339 DOI: 10.1136/emj.2003.001123] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The aim of this study was to identify performance indicators thought to reflect the quality of patient care in the emergency department. METHODS A three round accelerated Expert Delphi study was conducted by email or fax. A panel of 33 experts drawn from the fields of emergency medicine, emergency nursing, professional service users, and patients were consulted. Participants were initially asked to propose performance indicators that reflected the quality of care given in the emergency department setting in the United Kingdom. In the second round these proposals were collated and scored using a 9 point Likert scale; those that had not reached consensus were returned for reconsideration in the light of group opinion. Those statements reaching a pre-defined consensus were identified. RESULTS 224 performance indicators were proposed. Altogether 36 indicators reached consensus reflecting good departmental performance after round three; 24 of these were process measures. CONCLUSIONS 36 potential indicators of good quality of care in the emergency department in the UK have been identified.
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Affiliation(s)
- E Beattie
- Accident and Emergency Department, St Mary's Hospital, London, UK.
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18
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Crawford IWF, Mackway-Jones K, Russell DR, Carley SD. Planning for chemical incidents by implementing a Delphi based consensus study. Emerg Med J 2005; 21:20-3. [PMID: 14734368 PMCID: PMC1756355 DOI: 10.1136/emj.2003.003095] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This paper provides a practical approach to the difficulties surrounding planning for chemical incidents, based upon the results of a Delphi based consensus study. It is intended to offer advice, which can be implemented at regional and local prehospital and hospital level. The phases of the response that are covered include preparation, management of the incident, delivery of medical support during the incident, and recovery and support after the incident.
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Affiliation(s)
- I W F Crawford
- Department of Emergency Medicine, Manchester Royal Infirmary, Manchester, UK.
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Crawford IWF, Mackway-Jones K, Russell DR, Carley SD. Delphi based consensus study into planning for chemical incidents. Emerg Med J 2005; 21:24-8. [PMID: 14734369 PMCID: PMC1756368 DOI: 10.1136/emj.2003.003087] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To achieve consensus in all phases of chemical incident planning and response. DESIGN A three round Delphi study was conducted using a panel of 39 experts from specialties involved in the management of chemical incidents. Areas that did not reach consensus in the Delphi study were presented as synopsis statements for discussion in four syndicate groups at a conference hosted by the Department of Health Emergency Planning Co-ordination Unit. RESULTS A total of 183 of 322 statements had reached consensus upon completion of the Delphi study. This represented 56.8% of the total number of statements. Of these, 148 reached consensus at >94% and 35 reached consensus at >89%. The results of the process are presented as a series of synopsis consensus statements that cover all phases of chemical incident planning and response. CONCLUSIONS The use of a Delphi study and subsequent syndicate group discussions achieved consensus in aspects of all phases of chemical incident planning and response that can be translated into practical guidance for use at regional prehospital and hospital level. Additionally, areas of non-consensus have been identified where further work is required.
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Affiliation(s)
- I W F Crawford
- Department of Emergency Medicine, Manchester Royal Infirmary, Manchester, UK.
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20
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Markenson D, Redlener I. Pediatric Terrorism Preparedness National Guidelines and Recommendations: Findings of an Evidenced-based Consensus Process. Biosecur Bioterror 2004; 2:301-19. [PMID: 15650440 DOI: 10.1089/bsp.2004.2.301] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A cadre of experts and stakeholders from government agencies, professional organizations, emergency medicine and response, pediatrics, mental health, and disaster preparedness were gathered to review and summarize the existing data on the needs of children in the planning, preparation, and response to disasters or terrorism. This review was followed by development of evidence-based consensus guidelines and recommendations on the needs of children in disasters, including chemical, biological, and radiological terrorism. An evidence-based consensus process was used in conjunction with a modified Delphi approach for selection of topic areas and discussion points. These recommendations and guidelines represent the first national evidence-based standards for pediatric disaster and terrorism preparedness.
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Affiliation(s)
- David Markenson
- National Center for Disaster Preparedness, Columbia University College of Physicians and Surgeons, New York City, NY, USA
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21
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Abstract
This last article in the series focuses on the impact of a major incident in the emergency department, leadership qualities, and summarises the topics discussed in the previous papers.
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Affiliation(s)
- S McCormick
- Department of Accident and Emergency Medicine, Northern General Hospital, Sheffield, UK
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22
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Woollard M. Miracles take a little longer: the challenges of the uncompensated major incident. TRAUMA-ENGLAND 2003. [DOI: 10.1191/1460408603ta273oa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The challenges of managing uncompensated major incidents (UMI) are many and complex. A concomitant loss of infrastructure is common in large-scale disasters. Significant planning, including liaison with relevant agencies on an international basis is necessary to facilitate a rapid and co-ordinated response to such events. UMIs must be managed in a structured manner in common with that utilized for smaller-scale major incidents, although some modification may be appropriate. Use of the ‘expectant’ triage category should be implemented at an early stage to prevent scarce health service resources being monopolized by patients with no possibility of survival. Many patients will be suitable for treatment at the scene without subsequent urgent referral to hospital facilities. The early involvement of military forces is vital to provide manpower, tents (for casualty clearing stations and temporary shelter), high volume transportation and forward dressing stations at the scene and at receiving hospitals. The military can also facilitate the restoration of infrastructure, including access and egress routes. The risk of uncompensated major incidents occurring is real and is not limited to natural catastrophes occurring in developing countries.
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Affiliation(s)
- Malcolm Woollard
- Executive Officer, Prehospital Emergency Research Unit, Welsh Ambulance Services NHS Trust/University of Wales College of Medicine, Cardiff, UK,
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McKenna H, Hasson F, Smith M. A delphi survey of midwives and midwifery students to identify non-midwifery duties. Midwifery 2002; 18:314-22. [PMID: 12473446 DOI: 10.1054/midw.2002.0327] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM OF THE STUDY to explore the skill mix requirements for the potential role of an unqualified midwifery assistant in the clinical setting. Using results from the study we report the difference between student midwives' and qualified midwives' perceptions of what constitute non-midwifery duties. DESIGN a two-round Delphi survey. SETTING large maternity hospital in Ireland. PARTICIPANTS population of midwives (n=194) and midwifery students (n=79). FINDINGS the non-midwifery duties identified were wide ranging and could be categorised under the headings of clerical, stock, porter, domestic and other basic-care-related duties. CONCLUSION although no agreed definition of non-midwifery duty exists it can be seen that, through the process undertaken in this study, a definition is created. This suggests that the values and beliefs that qualified midwives and students hold regarding their role shapes the role of the care assistant. IMPLICATIONS FOR PRACTICE the inclusion of perceptions from student and staff midwives enabled the researchers to compare and contrast similarities and differences regarding how these different parties constitute a non-midwifery duty. The process also gave respondents a sense of ownership and involvement in the development of the midwifery assistant role. In addition, this study has demonstrated the need for further clarification of how midwives perceive and understand their role.
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Affiliation(s)
- Hugh McKenna
- School of Health Sciences, University of Ulster, Jordanstown Co Antrim, Northern Ireland BT37 0QB
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24
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Carley S, Mackway-Jones K, Randic L, Dunn K. Planning for major burns incidents by implementing an accelerated Delphi technique. Burns 2002; 28:413-8. [PMID: 12163278 DOI: 10.1016/s0305-4179(02)00107-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This paper presents a series of practical guides for use in planning and responding to a major incident involving large numbers of burns casualties. METHOD The guidance is based on the findings of an expert Delphi study published as an accompanying paper. RESULTS The guidance covers preparation and all aspects of the response from prehospital care and hospital care to resolution recovery. Emphasis is placed on the management of the secondary/tertiary care interface as this is the point at which significant difficulties may arise. The importance of local interpretation of guidelines is emphasised. CONCLUSION This practical guide for emergency planners will improve the preparation and response to a major incident involving burns.
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Affiliation(s)
- Simon Carley
- Department of Emergency Medicine, Manchester Royal Infirmary, Manchester, UK.
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Randic L, Carley S, Mackway-Jones K, Dunn K. Planning for major burns incidents in the UK using an accelerated Delphi technique. Burns 2002; 28:405-12. [PMID: 12163277 DOI: 10.1016/s0305-4179(02)00108-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Major incidents require careful planning if they are to be managed well. Although a generic plan to deal with all major incidents is essential, a number of "special incidents" deserve special consideration because of their potential to impact on specialist services. This paper examines the problems of managing a major incident involving large numbers of burns casualties. METHOD A three-round Delphi study was conducted using a multidisciplinary panel of experts from prehospital care, emergency medicine, burns surgery, intensive care and emergency planning. RESULTS A series of consensus statements on the management of burns incidents are presented. An accompanying paper describes the practical implementation of this guidance. CONCLUSION Specific consideration should be given to the problems of managing a major incident involving burns casualties.
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Affiliation(s)
- Luka Randic
- Department of Emergency Medicine, Royal Preston Hospital, Manchester, UK
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26
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Iskit SH, Alpay H, Tuğtepe H, Ozdemir C, Ayyildiz SH, Ozel K, Bayramiçli M, Tetik C, Dağli TE. Analysis of 33 pediatric trauma victims in the 1999 Marmara, Turkey earthquake. J Pediatr Surg 2001; 36:368-72. [PMID: 11172437 DOI: 10.1053/jpsu.2001.20719] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND/PURPOSE The Marmara earthquake, which destroyed more than 150,000 buildings and caused 15,000 deaths and 40,000 casualties, resembled the Hanshin-Awaji earthquake in many respects. Previous reports from similar disasters from several centres have not addressed trauma in the pediatric age group. The aim of this study was to analyze the clinical and laboratory data of pediatric trauma patients referred to a tertiary center after the 1999 Marmara earthquake. METHODS The medical records of 33 injured children, aged from 14 days to 16 years, were reviewed retrospectively. The time spent buried under rubble, type of injury, treatment given, complications, laboratory data, and development of acute renal failure (ARF) were noted. Patients in whom ARF developed were treated with a standard regimen of fluid replacement, alkalinization, and diuretics. Limbs with crush injuries were managed as conservatively as possible. RESULTS All except 3 cases were evacuated from under the debris of collapsed buildings after 1 to 110 (mean, 30.04 +/- 6.48) hours. Seventy-eight percent were transported to our center within the first 3 days. Crush injury (CI) was present in 15 cases, and in 10 of them ARF had already developed by admission. Although serum levels of creatinine were elevated (1.2 to 5 mg/dL) in all cases with ARF, hyperkalemia was observed in only 4. The mean serum creatinine kinase (CK) level of cases with crush syndrome (CS) was 6,040 +/- 4,158 U/L. No significant correlations were detected between the development of CS, age, the time spent under the rubble, the time before admission, or the number of crushed extremities. CONCLUSIONS CI and CS were the most common entities encountered among our pediatric patients after the 1999 Marmara earthquake. The high incidence of ARF indicates the importance of medical management of this age group during rescue. Because neither laboratory data nor clinical findings predicted CS in our patients, we recommend close observation and monitoring of children with CI for the development of ARF.
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Affiliation(s)
- S H Iskit
- Department of Pediatric Surgery, Marmara University School of Medicine, Istanbul, Turkey
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Mackway-Jones K, Carley SD, Robson J. Planning for major incidents involving children by implementing a Delphi study. Arch Dis Child 1999; 80:410-3. [PMID: 10208943 PMCID: PMC1717916 DOI: 10.1136/adc.80.5.410] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This paper provides a practical approach to the difficult problem of planning for a major incident involving children. It offers guidance on how general principles resulting from an expert Delphi study can be implemented regionally and locally. All phases of the response are covered including preparation, management of the incident, delivery of medical support during the incident, and recovery and support. A check list for regional planners is provided. Supplementary equipment is discussed and action cards for key roles in the paediatric hospital response are shown. Particular emphasis is placed on management of the secondary-tertiary interface including the special roles of paediatric assessment teams and paediatric transfer teams. A paediatric primary triage algorithm is provided. The important role of local interpretation of guidance is emphasised.
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Affiliation(s)
- K Mackway-Jones
- Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK.
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