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Leclerc T, Sjöberg F, Jennes S, Martinez-Mendez JR, van der Vlies CH, Battistutta A, Lozano-Basanta JA, Moiemen N, Almeland SK. European Burns Association guidelines for the management of burn mass casualty incidents within a European response plan. Burns 2023; 49:275-303. [PMID: 36702682 DOI: 10.1016/j.burns.2022.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 12/19/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND A European response plan to burn mass casualty incidents has been jointly developed by the European Commission and the European Burn Association. Upon request for assistance by an affected country, the plan outlines a mechanism for coordinated international assistance, aiming to alleviate the burden of care in the affected country and to offer adequate specialized care to all patients who can benefit from it. To that aim, Burn Assessment Teams are deployed to assess and triage patients. Their transportation priority recommendations are used to distribute outnumbering burn casualties to foreign burn centers. Following an appropriate medical evacuation, these casualties receive specialized care in those facilities. METHODS The European Burns Association's disaster committee developed medical-organizational guidelines to support this European plan. The experts identified fields of interest, defined questions to be addressed, performed relevant literature searches, and added their expertise in burn disaster preparedness and response. Due to the lack of high-level evidence in the available literature, recommendations and specially designed implementation tools were provided from expert opinion. The European Burns Association officially endorsed the draft recommendations in 2019, and the final full text was approved by the EBA executive committee in 2022. RECOMMENDATIONS The resulting 46 recommendations address four fields. Field 1 underlines the need for national preparedness plans and the necessary core items within such plans, including coordination and integration with an international response. Field 2 describes Burn Assessment Teams' roles, composition, training requirements, and reporting goals. Field 3 addresses the goals of specialized in-hospital triage, appropriate severity criteria, and their effects on priorities and triage. Finally, field 4 covers medical evacuations, including their timing and organization, the composition of evacuation teams and their assets, preparation, and the principles of en route care.
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Affiliation(s)
- Thomas Leclerc
- Percy Military Teaching Hospital, Clamart, France; Val-de-Grâce Military Medical Academy, Paris, France
| | | | - Serge Jennes
- Charleroi Burn Wound Center, Skin-burn-reconstruction Pole, Grand Hôpital de Charleroi, Charleroi, Belgium
| | | | - Cornelis H van der Vlies
- Department of Trauma and Burn Surgery, Maasstad Hospital, Rotterdam, the Netherlands; Trauma Research Unit Department of Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - Anna Battistutta
- Directorate-General for European Civil Protection and Humanitarian Aid Operations (DG-ECHO), European Commission, Brussels, Belgium
| | - J Alfonso Lozano-Basanta
- Emergency Response Coordination Center, Directorate-General for European Civil Protection and Humanitarian Aid Operations (DG-ECHO), European Commission, Brussels, Belgium
| | - Naiem Moiemen
- University Hospitals Birmingham Foundation Trust, Birmingham, UK; University of Birmingham, College of Medical and Dental Sciences, Birmingham, UK
| | - Stian Kreken Almeland
- Norwegian National Burn Center, Department of Plastic, Hand, and Reconstructive Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway; Norwegian Directorate of Health, Department of Preparedness and Emergency Medical Services, Oslo, Norway.
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Aguirrezabala JA, Aguilera-Sáez J, Illa-Boixaderas M, Serracanta J, Monte-Soldado A, Rivas-Nicolls D, Barret JP. Response of a single European burn center to Centelles mass casualty burn disaster: enzymatic debridement utility. INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2022; 12:224-231. [PMID: 36660262 PMCID: PMC9845805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 11/11/2022] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Mass burn casualty disasters present with a big challenge due to the complex multidisciplinary management of severely burned patients and the limited capacity of the specialized centers. Literature is scarce, and so is the management of these disasters with enzymatic debridement (ED). METHODS Retrospective observational analysis of nine patients admitted to the Vall d'Hebron University Hospital Burn Center (Barcelona, Spain), as a consequence of a bell tower explosion on December 30, 2019. The patients with intermediate-deep second-degree burns, either in circumferential or affecting highly functional areas as hands, feet or face, were included in the ED group. Continuous variables are expressed as mode and standard deviation and quantitative ones as percentages. RESULTS Fourteen people were injured after the explosion of gunpowder-containing bags in a bell tower during a cultural celebration. Nine casualties (6 men and 3 women) suffered burn injuries that required assessment and admission in our Burn Center. The mean age was 44.33 years (range 19-61 years), with burns covering a mean total body surface area (TBSA) of 15% (range 5-48% TBSA). One patient required invasive mechanical ventilation and intensive care management. Seven patients required ED, with an average debrided TBSA of 6.1% (range 3-10% TBSA). Seven out of 9 patients required at least one surgery. The average hospital stay was 23.33 days (range 2-53 days). No escharotomy was required and no patient died. CONCLUSIONS This experience brought out the weak and strong features of our center when facing a situation that implies an important care stress. It can be useful for other Burn Centers in similar situations in the future. We found that new tools, such as ED, can be advantageous in such situations.
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Affiliation(s)
- Jon Ander Aguirrezabala
- Department of Plastic Surgery and Burn Center, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital CampusPasseig Vall d’Hebron 119-129, Barcelona 08035, Spain
| | - Jorge Aguilera-Sáez
- Department of Plastic Surgery and Burn Center, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital CampusPasseig Vall d’Hebron 119-129, Barcelona 08035, Spain
| | - Marc Illa-Boixaderas
- Department of Plastic Surgery and Burn Center, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital CampusPasseig Vall d’Hebron 119-129, Barcelona 08035, Spain
| | - Jordi Serracanta
- Department of Plastic Surgery and Burn Center, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital CampusPasseig Vall d’Hebron 119-129, Barcelona 08035, Spain
| | - Alejandra Monte-Soldado
- Department of Plastic Surgery and Burn Center, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital CampusPasseig Vall d’Hebron 119-129, Barcelona 08035, Spain
| | - Danilo Rivas-Nicolls
- Department of Plastic Surgery and Burn Center, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital CampusPasseig Vall d’Hebron 119-129, Barcelona 08035, Spain
| | - Juan P Barret
- Department of Plastic Surgery and Burn Center, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital CampusPasseig Vall d’Hebron 119-129, Barcelona 08035, Spain,Department of Surgery, Universitat Autònoma de BarcelonaBellaterra 08193, Spain
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Zhu Z, Xu B, Shao J, Wang S, Jin R, Weng T, Xia S, Zhang W, Yang M, Han C, Wang X. Use of the Braden Scale to Predict Injury Severity in Mass Burn Casualties. MEDICAL SCIENCE MONITOR : INTERNATIONAL MEDICAL JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022; 28:e934039. [PMID: 35105848 PMCID: PMC8820233 DOI: 10.12659/msm.934039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Mass burn casualties impose an enormous burden on triage systems. The triage capacity of the Braden Scale for detecting injury severity has not been evaluated in mass burn casualties. Material/Methods The New Injury Severity Score (NISS) was used to dichotomize the injury severity of patients. The Braden Scale and other potentially indicative measurement tools were evaluated using univariate analysis and multivariate logistic regression. The relationships between the Braden Scale and other continuous variables with injury severity were further explored by correlation analysis and fitted with regression models. Receiver operating characteristic (ROC) curve analysis was used to validate triage capacity and compare prognostic accuracy. Results A total of 160 hospitalized patients were included in our study; 37 were severely injured, and 123 were not. Injury severity was independently associated with the Numerical Rating Scale (adjusted OR, 1.816; 95% CI, 1.035–3.187) and Braden Scale (adjusted OR, 0.693; 95% CI, 0.564–0.851). The ROC curve of the fitted quadratic model of the Braden Scale was 0.896 (0.840–0.953), and the cut-off value was 17. The sensitivity was 81.08% (64.29–91.44%) and the specificity was 82.93% (74.85–88.89%). Comparison of ROC curves demonstrated an infinitesimal difference between the Braden Scale and NISS for predicting 30-day hospital discharge (Z=0.291, P=0.771) and Intensive Care Unit admission (Z=2.016, P=0.044). Conclusions The Braden Scale is a suitable triage tool for predicting injury severity and forecasting disability-related outcomes in patients affected by mass burn casualty incidents.
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Affiliation(s)
- Zhikang Zhu
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Bin Xu
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Jiaming Shao
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Shuangshuang Wang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland).,Wenling First People's Hospital, Taizhou, Zhejiang, China (mainland)
| | - Ronghua Jin
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Tingting Weng
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Sizhan Xia
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Wei Zhang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Min Yang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Chunmao Han
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Xingang Wang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
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Simple triage and rapid treatment protocol for emergency department mass casualty incident victim triage. Am J Emerg Med 2021; 53:99-103. [PMID: 35007873 DOI: 10.1016/j.ajem.2021.12.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Triage plays an essential role in emergency medical care. It is crucial to adopt appropriate triage in a mass casualty incident (MCI) when resources are limited. The simple triage and rapid treatment (START) protocol is commonly used worldwide; however, the effectiveness of the START protocol for emergency department (ED) triage is unclear. This study aimed to examine the accuracy of START for the ED triage of victims following a MCI. METHODS We retrospectively reviewed the records of victims who presented to our ED during a MCI response after a train crash. The ED nurses applied the START protocol upon patient arrival, and we used a consensus-based standard to determine the outcome-based categories of these same patients. We compared the START protocol and outcome-based categories. In addition, the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of START in terms of predicting surgery and ED disposition were determined. RESULTS This study enrolled 47 patients (predominantly women, 68.1%; median age: 39.0years). Most victims were triaged into the START minor category (61.7%) and discharged from the ED (68.1%). Twenty-nine patients had matched START and outcome-based categories, whereas 2 patients were over-triaged and 16 patients were under-triaged. Additionally, the START system had acceptable AUC and sensitivities for predicting surgery and ED disposition (AUC/sensitivity/specificity for surgery: 0.850/100%/69.1%; AUC/sensitivity/specificity for admission: 0.917/93.3%/87.5%; AUC/sensitivity/specificity for intensive care unit (ICU)/ED death: 0.994/100%/97.8%). CONCLUSIONS This study demonstrated poor agreement between START categories, as determined in the ED, and the consensus-based standard categories. However, the START protocol was acceptable in terms of identifying emergent patients (100% sensitivity for the immediate and deceased categories) and predicting ED disposition (surgery, admission, and ICU/ED mortality). Although START is not perfect, our findings suggest that it could be used for the ED triage of trauma-related MCI victims.
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Kiely J, Natalwala I, Stallard J, Austin O, Anwar U, Muthayya P. The potential benefits of enzymatic debridement in multi-casualty burns incidents. TRAUMA-ENGLAND 2021. [DOI: 10.1177/14604086211002583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Bromelain-based enzymatic debridement (ED) is a topical treatment that is growing in popularity for the non-surgical management of burn wounds. Although initially used for small injuries, experience has grown in using it for burns >15% Total Burns Surface Area (TBSA). A household explosion resulted in burns to multiple patients, with four requiring burn wound debridement. This case report demonstrates their management using ED. Four adult male patients were treated with ED, mean age 38.4 years. Their injuries ranged from 5–24% TBSA (mean 14.9%), with a high proportion of intermediate-deep dermal injury to their faces and limbs. Our centre has performed enzymatic debridement since 2016 and all senior burns surgeons and burns intensive care specialists in the team are experienced in its use. We perform enzymatic debridement using Nexobrid™ (Mediwound Ltd., Israel). Three patients were managed on a single theatre list, using ED for their burns at 19, 16 and 23 hours post-injury. One patient had ED of his injuries on intensive care at 18 hours. Patients with >15% TBSA were treated in a critical care setting with goal directed fluid therapy. Through the use of enzymatic debridement we were able to achieve burn debridement for four patients in under 24 hours. While not a true mass casualty incident, our experience suggests that for an appropriately resourced service it is likely to have advantages in this scenario. We suggest that burns services regularly using this technique consider inclusion into mass casualty protocols, with training to staff to enable provision in such an incident.
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Affiliation(s)
- John Kiely
- Department of Burns and Plastic Surgery, Mid Yorkshire NHS Foundation Trust, Wakefield, UK
| | - Ibrahim Natalwala
- Department of Burns and Plastic Surgery, Mid Yorkshire NHS Foundation Trust, Wakefield, UK
| | - Joseph Stallard
- Department of Burns and Plastic Surgery, Mid Yorkshire NHS Foundation Trust, Wakefield, UK
| | - Orla Austin
- Department of Burns and Plastic Surgery, Mid Yorkshire NHS Foundation Trust, Wakefield, UK
| | - Umair Anwar
- Department of Burns and Plastic Surgery, Mid Yorkshire NHS Foundation Trust, Wakefield, UK
| | - Preetha Muthayya
- Department of Burns and Plastic Surgery, Mid Yorkshire NHS Foundation Trust, Wakefield, UK
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Lin YK, Niu KY, Seak CJ, Weng YM, Wang JH, Lai PF. Comparison between simple triage and rapid treatment and Taiwan Triage and Acuity Scale for the emergency department triage of victims following an earthquake-related mass casualty incident: a retrospective cohort study. World J Emerg Surg 2020; 15:20. [PMID: 32156308 PMCID: PMC7065314 DOI: 10.1186/s13017-020-00296-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Triage plays a crucial role in the emergency department (ED) management of mass casualty incidents (MCIs) when resources are limited. This study aimed to compare the performance of simple triage and rapid treatment (START) with that of the Taiwan Triage and Acuity Scale (TTAS) for the ED triage of victims following an earthquake-related MCI. METHODS We retrospectively reviewed the records of victims presenting at our ED with earthquake-related injuries within 24 h of a large-scale earthquake. TTAS was initially used at our ED for this event, and START was performed by retrospectively reviewing the patient records in a blinded manner. Area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of START and TTAS were determined for predicting ED discharge. RESULTS We enrolled 105 patients (predominantly women, 60.0%; median age, 45.0 years) in this study; most of them presented with traumatic injuries and were initially triaged as TTAS level III (78.1%), followed by TTAS level II (11.4%). Although the majority of the victims (81.0%) were discharged, four deaths occurred. A moderate agreement in differentiating emergency from nonemergency patients was observed between START and TTAS. Furthermore, both the triage systems showed similar predictions for ED disposition (START AUC/sensitivity/specificity: 0.709/82.35%/55.00%; TTAS AUC/sensitivity/specificity: 0.709/90.59%/45.00%). CONCLUSIONS The present study demonstrated that START and TTAS have similar triage accuracy and ability to predict ED disposition. Our findings demonstrate that START may be used as an alternative to TTAS for the ED triage of victims following earthquake-related MCIs.
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Affiliation(s)
- Yun-Kuan Lin
- Department of Emergency Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Kuang-Yu Niu
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chen-June Seak
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Ming Weng
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Emergency Medicine, Prehospital Care Division, Taoyuan General Hospital, Taoyuan, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Pei-Fang Lai
- Department of Emergency Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan. .,Department of Medicine, Tzu Chi University, Hualien, Taiwan.
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Ryan CM, Schneider JC, Jeng JC. Beyond lessons learned: Establishing longitudinal data collection to improve burn disaster response. Burns 2019; 46:17-18. [PMID: 31732219 DOI: 10.1016/j.burns.2019.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/26/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Shriners' Hospitals for Children-Boston, Boston, MA, USA; American Burn Association Organization and Delivery of Burn Care Committee, USA.
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA; Harvard Medical School, USA; American Burn Association Rehabilitation Committee, USA
| | - James C Jeng
- Nathan Speare Regional Burn Treatment Center, Crozer-Chester Medical Center, Upland, PA, USA; Clinical Professor of Surgery, Icahn School of Medicine, Mount Sinai Healthcare System, New York, NY, USA; American Burn Association Organization and Delivery of Burn Care Disaster Subcommittee, USA
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Lin CH. Disaster Medicine in Taiwan. J Acute Med 2019; 9:83-109. [PMID: 32995238 PMCID: PMC7440387 DOI: 10.6705/j.jacme.201909_9(3).0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study aimed to examine scientific publications that were related to disaster medicine and were authored by emergency medicine physicians in Taiwan. This descriptive study utilized the electronic databases of PubMed, Scopus, and Web of Science. Academic works that were published between January 1, 1999, and December 31, 2018, were collected for review and analysis. Of the 53 articles included in the final analysis,40 (75.5%) were original research, 3 (5.7%) were reviews, 1 (1.9%) was a brief report, and 9 (17.0%) were perspectives. The top 5 themes were disaster response systems (17, 32.1%), endemic diseases (11, 20.8%), emergency department (ED) overcrowding (10, 18.9%), earthquakes (10, 18.9%), and ED administration (9, 17.0%). Sixteen (30.2%) articles involved international collaborations. The median, interquartile range and range of the numbers of citations of the articles were 3, 1-11, and 0-65, respectively. Twenty-four (45.3%) articles were related to specific incidents: the Chi-Chi earthquake in 1999 (n = 5), the Singapore airline crash in 2000 (n = 1), Typhoon Nari in 2001 (n = 1), the outbreak of severe acute respiratory syndrome in 2003 (n = 7), Typhoon Morakot in 2009 (n = 1), the color party explosion in Formosa Fun Coast Park in 2015 (n = 4), and the Tainan earthquake in 2016 (n = 5). Regarding the study methods, 19 (35.8%) articles were quantitative studies; 10 (18.9%) were qualitative or semiqualitative studies; 8 (15.1%) used questionnaire surveys; 3 (5.7%) were literature reviews; 3 (5.7%) used computer simulations; and 10 (18.9%) were descriptive/narrative or other types of studies. Though the number of academic publications related to disaster medicine from the EDs in Taiwan is relatively limited, the quality and diversity of research seem promising. The research environment and education programs on disaster medicine in Taiwan deserve thoughtful consideration.
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Affiliation(s)
- Chih-Hao Lin
- National Cheng Kung University Department of Emergency Medicine National Cheng Kung University Hospital College of Medicine Tainan Taiwan
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