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Weinstein ES, Cuthbertson JL, Herbert TL, Voicescu GT, Bortolin M, Magalini S, Gui D, Helou M, Lennquist Montan K, Montan C, Rafalowsky C, Ratto G, Damele S, Bazurro S, Laist I, Marzi F, Borrello A, Fransvea P, Fidanzio A, Benitez CY, Faccincani R, Ragazzoni L, Caviglia M. Advancing the scientific study of prehospital mass casualty response through a Translational Science process: the T1 scoping literature review stage. Eur J Trauma Emerg Surg 2023; 49:1647-1660. [PMID: 37060443 PMCID: PMC10449715 DOI: 10.1007/s00068-023-02266-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/26/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE The European Union Horizon 2020 research and innovation funding program awarded the NIGHTINGALE grant to develop a toolkit to support first responders engaged in prehospital (PH) mass casualty incident (MCI) response. To reach the projects' objectives, the NIGHTINGALE consortium used a Translational Science (TS) process. The present work is the first TS stage (T1) aimed to extract data relevant for the subsequent modified Delphi study (T2) statements. METHODS The authors were divided into three work groups (WGs) MCI Triage, PH Life Support and Damage Control (PHLSDC), and PH Processes (PHP). Each WG conducted simultaneous literature searches following the PRISMA extension for scoping reviews. Relevant data were extracted from the included articles and indexed using pre-identified PH MCI response themes and subthemes. RESULTS The initial search yielded 925 total references to be considered for title and abstract review (MCI Triage 311, PHLSDC 329, PHP 285), then 483 articles for full reference review (MCI Triage 111, PHLSDC 216, PHP 156), and finally 152 articles for the database extraction process (MCI Triage 27, PHLSDC 37, PHP 88). Most frequent subthemes and novel concepts have been identified as a basis for the elaboration of draft statements for the T2 modified Delphi study. CONCLUSION The three simultaneous scoping reviews allowed the extraction of relevant PH MCI subthemes and novel concepts that will enable the NIGHTINGALE consortium to create scientifically anchored statements in the T2 modified Delphi study.
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Affiliation(s)
- Eric S Weinstein
- CRIMEDIM-Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy.
| | - Joseph L Cuthbertson
- CRIMEDIM-Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
| | - Teri Lynn Herbert
- Research and Education Services, Medical University of South Carolina Library, Charleston, SC, USA
| | - George T Voicescu
- CRIMEDIM-Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
| | - Michelangelo Bortolin
- CRIMEDIM-Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
| | - Sabina Magalini
- Department of Surgery, Policlinico Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Daniele Gui
- Department of Surgery, Policlinico Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Mariana Helou
- School of Medicine, Department of Emergency Medicine, Lebanese American University, Beirut, Lebanon
| | - Kristina Lennquist Montan
- MRMID-International Association for Medical Response to Major Incidents and Disasters, and Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Carl Montan
- MRMID-International Association for Medical Response to Major Incidents and Disasters, and Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Chaim Rafalowsky
- Magen David Adom, National Emergency Medical, Disaster, Ambulance and Blood Bank Service, Ashkelon, Israel
| | - Giuseppe Ratto
- Emergency Department, Azienda Sociosanitaria Ligure 2, Liguria, Italy
| | - Stefano Damele
- Emergency Department, Azienda Sociosanitaria Ligure 2, Liguria, Italy
| | - Simone Bazurro
- Emergency Department, Azienda Sociosanitaria Ligure 2, Liguria, Italy
| | - Itamar Laist
- ESTES-European Society for Trauma and Emergency Surgery, Disaster and Military Surgery Section, Milan, Italy
| | - Federica Marzi
- Department of Surgery, Policlinico Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Alessandro Borrello
- Department of Surgery, Policlinico Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Pietro Fransvea
- Department of Surgery, Policlinico Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Andrea Fidanzio
- Department of Surgery, Policlinico Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Carlos Yanez Benitez
- ESTES-European Society for Trauma and Emergency Surgery, Disaster and Military Surgery Section, Milan, Italy
| | - Roberto Faccincani
- ESTES-European Society for Trauma and Emergency Surgery, Disaster and Military Surgery Section, Milan, Italy
| | - Luca Ragazzoni
- CRIMEDIM-Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department of Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
| | - Marta Caviglia
- CRIMEDIM-Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
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Sensitivity and Specificity of Spanish Prehospital Advanced Triage Method (META). Prehosp Disaster Med 2022; 37:321-326. [PMID: 35379369 DOI: 10.1017/s1049023x22000504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Mass-casualty incident (MCI) triage systems aim to provide the best possible health care to the greatest number of affected people with the available resources in the context of a mass-casualty event. The Spanish Prehospital Advanced Triage Method (Modelo Extrahospitalario de Triaje Avanzado; META) was designed to improved patient sorting in MCIs. OBJECTIVE The aim of this study was to estimate and compare sensitivity and specificity of META and the Manchester Triage System (MTS) in MCIs by retrospectively applying both triage algorithms to real MCI patients from the Emergency and Disaster Research Unit (Unidad de Investigación en Emergencia y Desastres; UIED) MCI database. METHOD This was a comparative study of two triage methods using sensitivity and specificity with the Revised Trauma Score (RTS) as the gold standard. A total of 134 MCI patients from the UIED database were included. An MCI in Asturias is defined as an incident that involves four or more victims that require ambulance mobilization. RESULTS Patients mean age was 39.85 years (95% CI, 35.9-43.8) with an age range from one to 88 years old. In total, 54.4% of the patients were female. The most common types of MCI involved were fires (51.0%), followed by road traffic accident (43.3%) and street fight (3.7%). For MTS, the overall sensitivity was 30.6% (95% CI, 22.9-39.1) and specificity was 66.0% (95% CI, 60.0-71.7). For META triage algorithm, the overall sensitivity was 79.9% (95% CI, 72.1-86.3) and specificity was 89.9% (95% CI, 85.7-93.3). CONCLUSION The META triage algorithm is a reliable triage system; thus, it can be recommended to be used in an MCI.
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Khorram-Manesh A, Nordling J, Carlström E, Goniewicz K, Faccincani R, Burkle FM. A translational triage research development tool: standardizing prehospital triage decision-making systems in mass casualty incidents. Scand J Trauma Resusc Emerg Med 2021; 29:119. [PMID: 34404443 PMCID: PMC8369703 DOI: 10.1186/s13049-021-00932-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background There is no global consensus on the use of prehospital triage system in mass casualty incidents. The purpose of this study was to evaluate the most commonly used pre-existing prehospital triage systems for the possibility of creating one universal translational triage tool. Methods The Rapid Evidence Review consisted of (1) a systematic literature review (2) merging and content analysis of the studies focusing on similarities and differences between systems and (3) development of a universal system. Results There were 17 triage systems described in 31 eligible articles out of 797 identified initially. Seven of the systems met the predesignated criteria and were selected for further analysis. The criteria from the final seven systems were compiled, translated and counted for in means of 1/7’s. As a product, a universal system was created of the majority criteria. Conclusions This study does not create a new triage system itself but rather identifies the possibility to convert various prehospital triage systems into one by using a triage translational tool. Future research should examine the tool and its different decision-making steps either by using simulations or by experts’ evaluation to ensure its feasibility in terms of speed, continuity, simplicity, sensitivity and specificity, before final evaluation at prehospital level. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00932-z.
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Affiliation(s)
- Amir Khorram-Manesh
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, Gothenburg University, 413 45, Gothenburg, Sweden. .,Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska Academy, 413 45, Gothenburg, Sweden. .,Department of Research and Development, Armed Forces Center for Defense Medicine, 426 76, Västra Frölunda, Gothenburg, Sweden.
| | - Johan Nordling
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, Gothenburg University, 413 45, Gothenburg, Sweden
| | - Eric Carlström
- Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska Academy, 413 45, Gothenburg, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden.,USN School of Business, University of South-Eastern Norway, 3616, Kongsberg, Norway
| | - Krzysztof Goniewicz
- Department of Aviation Security, Military University of Aviation, 08-521, Dęblin, Poland
| | - Roberto Faccincani
- Emergency Department, Humanitas Mater Domini, 210 53, Castellanza, Italy
| | - Frederick M Burkle
- T.H. Chan School of Public Health, Harvard Humanitarian Initiative, Harvard University, Boston, MA, 02115, USA
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Prehospital Triage by Lay Person First Responders: A Scoping Review and Proposal for a new Prehospital Triage Tool. Disaster Med Public Health Prep 2021; 16:1242-1252. [PMID: 33827731 DOI: 10.1017/dmp.2021.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The primary aim of this study is to review the available tools for prehospital triage in case of mass casualty incidents and secondly, to develop a tool which enables lay person first responders (LPFRs) to perform triage and start basic life support in mass casualty incidents. METHODS In July 2019, online databases were consulted. Studies addressing prehospital triage methods for lay people were analyzed. Secondly, a new prehospital triage tool for LPFRs was developed. Therefore, a search for prehospital triage models available in literature was conducted and triage actions were extracted. RESULTS The search resulted in 6188 articles, and after screening, a scoping review of 4 articles was conducted. All articles stated that there is great potential to provide accurate prehospital triage by people with no healthcare experience. Based on these findings, and combined with the pre-existing prehospital triage tools, we developed a, not-yet validated, prehospital triage tool for lay people, which may improve disaster awareness and preparedness and might positively contribute to community resilience. CONCLUSION The prehospital triage tool for lay person first responders may be useful and may help professional medical first responders to determine faster, which casualties most urgently need help in a mass casualty incident.
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Abstract
INTRODUCTION The use of triage systems is one of the most important measures in response to mass-casualty incidents (MCIs) caused by emergencies and disasters. In these systems, certain principles and criteria must be considered that can be achieved with a lack of resources. Accordingly, the present study was conducted as a systematic review to explore the principles of triage systems in emergencies and disasters world-wide. METHODS The present study was conducted as a systematic review of the principles of triage in emergencies and disasters. All papers published from 2000 through 2019 were extracted from the Web of Science, PubMed, Scopus, Cochrane Library, and Google Scholar databases. The search for the articles was conducted by two trained researchers independently. RESULTS The classification and prioritization of the injured people, the speed, and the accuracy of the performance were considered as the main principles of triage. In certain circumstances, including chemical, biological, radiation, and nuclear (CBRN) incidents, certain principles must be considered in addition to the principles of the triage based on traumatic events. Usually in triage systems, the classification of the injured people is done using color labeling. The short duration of the triage and its accuracy are important for the survival of the injured individuals. The optimal use of available resources to protect the lives of more casualties is one of the important principles of triage systems and does not conflict with equity in health. CONCLUSION The design of the principles of triage in triage systems is based on scientific studies and theories in which attempts have been made to correctly classify the injured people with the maximum correctness and in the least amount of time to maintain the survival of the injured people and to achieve the most desirable level of health. It is suggested that all countries adopt a suitable and context-bond model of triage in accordance with all these principles, or to propose a new model for the triage of injured patients, particularly for hospitals in emergencies and disasters.
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Accuracy of National Early Warning Score 2 (NEWS2) in Prehospital Triage on In-Hospital Early Mortality: A Multi-Center Observational Prospective Cohort Study. Prehosp Disaster Med 2019; 34:610-618. [PMID: 31648657 DOI: 10.1017/s1049023x19005041] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION In cases of mass-casualty incidents (MCIs), triage represents a fundamental tool for the management of and assistance to the wounded, which helps discriminate not only the priority of attention, but also the priority of referral to the most suitable center. HYPOTHESIS/PROBLEM The objective of this study was to evaluate the capacity of different prehospital triage systems based on physiological parameters (Shock Index [SI], Glasgow-Age-Pressure Score [GAP], Revised Trauma Score [RTS], and National Early Warning Score 2 [NEWS2]) to predict early mortality (within 48 hours) from the index event for use in MCIs. METHODS This was a longitudinal prospective observational multi-center study on patients who were attended by Advanced Life Support (ALS) units and transferred to the emergency department (ED) of their reference hospital. Collected were: demographic, physiological, and clinical variables; main diagnosis; and data on early mortality. The main outcome variable was mortality from any cause within 48 hours. RESULTS From April 1, 2018 through February 28, 2019, a total of 1,288 patients were included in this study. Of these, 262 (20.3%) participants required assistance for trauma and injuries by external agents. Early mortality within the first 48 hours due to any cause affected 69 patients (5.4%). The system with the best predictive capacity was the NEWS2 with an area under the curve (AUC) of 0.891 (95% CI, 0.84-0.94); a sensitivity of 79.7% (95% CI, 68.8-87.5); and a specificity of 84.5% (95% CI, 82.4-86.4) for a cut-off point of nine points, with a positive likelihood ratio of 5.14 (95% CI, 4.31-6.14) and a negative predictive value of 98.7% (95% CI, 97.8-99.2). CONCLUSION Prehospital scores of the NEWS2 are easy to obtain and represent a reliable test, which make it an ideal system to help in the initial assessment of high-risk patients, and to determine their level of triage effectively and efficiently. The Prehospital Emergency Medical System (PhEMS) should evaluate the inclusion of the NEWS2 as a triage system, which is especially useful for the second triage (evacuation priority).
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A Multicenter Observational Prospective Cohort Study of Association of the Prehospital National Early Warning Score 2 and Hospital Triage with Early Mortality. Emerg Med Int 2019; 2019:5147808. [PMID: 31355000 PMCID: PMC6633971 DOI: 10.1155/2019/5147808] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 06/09/2019] [Indexed: 11/18/2022] Open
Abstract
Aim of the Study To evaluate the ability of the prehospital National Early Warning Score 2 scale (NEWS2) to predict early mortality (within 48 hours) after the index event based on the triage priority assigned for any cause in the emergency department. Methods This is a multicenter longitudinal observational cohort study on patients attending Advanced Life Support units and transferred to the emergency department of their reference hospital. We collected demographic, physiological, and clinical variables, main diagnosis, and hospital triage level as well as mortality. The main outcome variable was mortality from any cause within two days of the index event. Results Between April 1 and November 30, 2018, a total of 1054 patients were included in our study. Early mortality within the first 48 hours after the index event affected 55 patients (5.2%), of which 23 cases (41.8%) had causes of cardiovascular origin. In the stratification by triage levels, the AUC of the NEWS2 obtained for short-term mortality varied between 0.77 (95% CI: 0.65-0.89) for level I and 0.94 (95% CI: 0.79-1) for level III. Conclusions The Prehospital Emergency Medical Services should evaluate the implementation of the NEWS2 as a routine evaluation, which, together with the structured hospital triage system, effectively serves to predict early mortality and detect high-risk patients.
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Bazyar J, Farrokhi M, Khankeh H. Triage Systems in Mass Casualty Incidents and Disasters: A Review Study with A Worldwide Approach. Open Access Maced J Med Sci 2019; 7:482-494. [PMID: 30834023 PMCID: PMC6390156 DOI: 10.3889/oamjms.2019.119] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND: Injuries caused by emergencies and accidents are increasing in the world. To prioritise patients to provide them with proper services and to optimally use the resources and facilities of the medical centres during accidents, the use of triage systems, which are one of the key principles of accident management, seems essential. AIM: This study is an attempt to identify available triage systems and compare the differences and similarities of the standards of these systems during emergencies and disasters through a review study. METHODS: This study was conducted through a review of the triage systems used in emergencies and disasters throughout the world. Accordingly, all articles published between 1990 and 2018 in both English and Persian journals were searched based on several keywords including Triage, Disaster, Mass Casualty Incidents, in the Medlib, Scopus, Web of Science, PubMed, Cochrane Library, Science Direct, Google scholar, Irandoc, Magiran, Iranmedex, and SID databases in isolation and in combination using both and/ or conjunctions. RESULTS: Based on the search done in these databases, twenty different systems were identified in the primary adult triage field including START, Homebush triage Standard, Sieve, CareFlight, STM, Military, CESIRA Protocol, MASS, Revers, CBRN Triage, Burn Triage, META Triage, Mass Gathering Triage, SwiFT Triage, MPTT, TEWS Triage, Medical Triage, SALT, mSTART and ASAV. There were two primary triage systems including Jump START and PTT for children, and also two secondary triage systems encompassing SAVE and Sort identified in this respect. ESI and CRAMS were two other cases distinguished for hospital triage systems. CONCLUSION: There are divergent triage systems in the world, but there is no general and universal agreement on how patients and injured people should be triaged. Accordingly, these systems may be designed based on such criteria as vital signs, patient’s major problems, or the resources and facilities needed to respond to patients’ needs. To date, no triage system has been known as superior, specifically about the patients’ clinical outcomes, improvement of the scene management or allocation of the resources compared to other systems. Thus, it is recommended that different countries such as Iran design their triage model for emergencies and disasters by their native conditions, resources and relief forces.
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Affiliation(s)
- Jafar Bazyar
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehrdad Farrokhi
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hamidreza Khankeh
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Going the Full Circle: Upgrading the Patient Field Chart and Tag for Electronic Mass Casualty Incidents Solutions in Romania. ACTA MEDICA MARISIENSIS 2018. [DOI: 10.2478/amma-2018-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Objective: Mass casualty incidents and disasters require functional and efficient patient data management systems, as well as smart interconnections with patient tracking applications. Various initiatives developed and tested patient field charts for large-scale events but there is no one definite general format accepted. The current research proposes an upgraded model of the official patient field chart issued by the Romanian Department for Emergency Situations in 2015 to be used for large-scale events.
Measures: An upgraded model is created after a thorough content analysis, physical analysis, design upgrade and optimization process. Differences between the official and the upgraded model are measured and compared, and statistical computations are carried out.
Results: The main distinctive features of the patient field chart are dynamic triage, unique code identification, QR visual codes, wireless tags and irreversible clear contamination status highlighting. The upgrade process results in almost doubling the available active area without the need to change the document size format of the product. Visual elements and features are included to optimize operation workflow.
Conclusions: The upgraded model offers a variety of improvements for both the overall rescue effort as well as the end user of the product. It allows for previously unavailable features like unlimited dynamic triage and enables the use of electronic management solutions.
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Romero Pareja R, Castro Delgado R, Turégano Fuentes F, Jhon Thissard-Vasallo I, Sanz Rosa D, Arcos González P. Prehospital triage for mass casualty incidents using the META method for early surgical assessment: retrospective validation of a hospital trauma registry. Eur J Trauma Emerg Surg 2018; 46:425-433. [PMID: 30406394 DOI: 10.1007/s00068-018-1040-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 10/28/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND In mass casualty incidents (MCI), death usually occurs within the first few hours and thus early transfer to a trauma centre can be crucial in selected cases. However, most triage systems designed to prioritize the transfer to hospital of these patients do not assess the need for surgery, in part due to inconclusive evidence regarding the value of such an assessment. Therefore, the aim of the present study was to evaluate the capacity of a new triage system-the Prehospital Advanced Triage Method (META)-to identify victims who could benefit from urgent surgical assessment in case of MCI. METHODS Retrospective, descriptive, observational study of a multipurpose cohort of patients included in the severe trauma registry of the Gregorio Marañón University General Hospital (Spain) between June 1993 and December 2011. All data were prospectively evaluated. All patients were evaluated with the META system to determine whether they met the criteria for urgent transfer. The META defines patients in need of urgent surgical assessment: (a) All penetrating injuries to head, neck, torso and extremities proximal to elbow or knee, (b) Open pelvic fracture, (c) Closed pelvic fracture with mechanical or haemodynamic instability and (d) Blunt torso trauma with haemodynamic instability. Patients who fulfilled these criteria were designated as "Urgent Evacuation for Surgical Assessment" (UESA) cases; all other cases were designated as non-UESA. The following variables were assessed: patient status at the scene; severity scales [RTS, Shock index, MGAP (Mechanism, Glasgow coma scale, Age, pressure), GCS]; need for surgery and/or interventional procedure to control bleeding (UESA); and mortality. The two groups (UESA vs. non-UESA) were then compared. RESULTS A total of 1882 cases from the database were included in the study. Mean age was 39.2 years and most (77%) patients were male. UESA patients presented significantly worse on-scene hemodynamic parameters (systolic blood pressure and heart rate) and greater injury severity (RTS, shock index, and MGAP scales). No differences were observed for respiratory rate, need for orotracheal intubation, or GCS scores. The anatomical injuries of patients in the UESA group were less severe but these patients had a greater need for urgent surgery and higher mortality rates. CONCLUSION These findings suggest that the META triage classification system could be beneficial to help identify patients with severe trauma and/or in need of urgent surgical assessment at the scene of injury in case of MCI. These findings demonstrate that, in this cohort, the META fulfils the purpose for which it was designed.
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Affiliation(s)
- Rodolfo Romero Pareja
- Servicio de urgencias, Hospital Universitario de Getafe, Universidad Europea de Madrid Medical School, Madrid, Spain
| | - Rafael Castro Delgado
- Unit for Research in Emergency and Disaster, Department of Medicine, Public Health Area, Faculty of Medicine, Universidad de Oviedo, C/ Julián Clavería, 6, 33006, Oviedo, Spain.
- SAMU-Asturias, Servicio de Salud del Principado de Asturias, Oviedo, Spain.
| | | | | | - David Sanz Rosa
- School of Doctoral Studies and Research, Universidad Europea, Madrid, Spain
| | - Pedro Arcos González
- Unit for Research in Emergency and Disaster, Department of Medicine, Public Health Area, Faculty of Medicine, Universidad de Oviedo, C/ Julián Clavería, 6, 33006, Oviedo, Spain
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Blancher M, Albasini F, Elsensohn F, Zafren K, Hölzl N, McLaughlin K, Wheeler AR, Roy S, Brugger H, Greene M, Paal P. Management of Multi-Casualty Incidents in Mountain Rescue: Evidence-Based Guidelines of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). High Alt Med Biol 2018; 19:131-140. [PMID: 29446647 PMCID: PMC6014052 DOI: 10.1089/ham.2017.0143] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Blancher, Marc, François Albasini, Fidel Elsensohn, Ken Zafren, Natalie Hölzl, Kyle McLaughlin, Albert R. Wheeler III, Steven Roy, Hermann Brugger, Mike Greene, and Peter Paal. Management of multi-casualty incidents in mountain rescue: Evidence-based guidelines of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). High Alt Med Biol. 19:131–140, 2018. Introduction: Multi-Casualty Incidents (MCI) occur in mountain areas. Little is known about the incidence and character of such events, and the kind of rescue response. Therefore, the International Commission for Mountain Emergency Medicine (ICAR MEDCOM) set out to provide recommendations for the management of MCI in mountain areas. Materials and Methods: Details of MCI occurring in mountain areas related to mountaineering activities and involving organized mountain rescue were collected. A literature search using (1) PubMed, (2) national mountain rescue registries, and (3) lay press articles on the internet was performed. The results were analyzed with respect to specific aspects of mountain rescue. Results: We identified 198 MCIs that have occurred in mountain areas since 1956: 137 avalanches, 38 ski lift accidents, and 23 other events, including lightning injuries, landslides, volcanic eruptions, lost groups of people, and water-related accidents. Discussion: General knowledge on MCI management is required. Due to specific aspects of triage and management, the approach to MCIs may differ between those in mountain areas and those in urban settings. Conclusions: Mountain rescue teams should be prepared to manage MCIs. Knowledge should be reviewed and training performed regularly. Cooperation between terrestrial rescue services, avalanche safety authorities, and helicopter crews is critical to successful management of MCIs in mountain areas.
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Affiliation(s)
- Marc Blancher
- 1 Department of Emergency Medicine, University Hospital of Grenoble-Alps , Grenoble, France .,2 The French Mountain Rescue Association (ANMSM) , Grenoble, France
| | - François Albasini
- 2 The French Mountain Rescue Association (ANMSM) , Grenoble, France .,3 Department of Emergency Medicine, St. Jean de Maurienne Hospital , St. Jean de Maurienne, France
| | | | - Ken Zafren
- 4 ICAR MedCom , Roethis, Austria .,5 Department of Emergency Medicine, Stanford University Medical Center , Stanford, California.,6 Alaska Mountain Rescue Group , Anchorage, Alaska
| | - Natalie Hölzl
- 7 Department of Anesthesiology and Intensive Care Medicine, Klinikum Kempten, Germany
| | - Kyle McLaughlin
- 8 Department of Emergency Medicine, Canmore, Canada .,9 Department of Emergency Medicine, University of Calgary , Calgary, Canada
| | - Albert R Wheeler
- 10 Department of Emergency Medicine, St John's Medical Center , Jackson, Wyoming.,11 Search and Rescue Medical Director, Grand Teton National Park , Jackson, Wyoming
| | - Steven Roy
- 12 Quebec Secours SAR, Resident Physician Elective in Wilderness Medicine, McGill University , Montreal, Canada
| | - Hermann Brugger
- 13 Institute of Mountain Emergency Medicine , EURAC Research, Bolzano, Italy
| | - Mike Greene
- 14 Emergency Medicine Physician, Medical Officer Mountain Rescue England and Wales , Whitehaven, England
| | - Peter Paal
- 15 Department of Anesthesiology and Intensive Care, Hospitallers Brothers Hospital, Paracelsus Medical University , Salzburg, Austria
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Yu W, Lv Y, Hu C, Liu X, Chen H, Xue C, Zhang L. Research of an emergency medical system for mass casualty incidents in Shanghai, China: a system dynamics model. Patient Prefer Adherence 2018; 12:207-222. [PMID: 29440876 PMCID: PMC5798575 DOI: 10.2147/ppa.s155603] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Emergency medical system for mass casualty incidents (EMS-MCIs) is a global issue. However, China lacks such studies extremely, which cannot meet the requirement of rapid decision-support system. This study aims to realize modeling EMS-MCIs in Shanghai, to improve mass casualty incident (MCI) rescue efficiency in China, and to provide a possible method of making rapid rescue decisions during MCIs. METHODS This study established a system dynamics (SD) model of EMS-MCIs using the Vensim DSS program. Intervention scenarios were designed as adjusting scales of MCIs, allocation of ambulances, allocation of emergency medical staff, and efficiency of organization and command. RESULTS Mortality increased with the increasing scale of MCIs, medical rescue capability of hospitals was relatively good, but the efficiency of organization and command was poor, and the prehospital time was too long. Mortality declined significantly when increasing ambulances and improving the efficiency of organization and command; triage and on-site first-aid time were shortened if increasing the availability of emergency medical staff. The effect was the most evident when 2,000 people were involved in MCIs; however, the influence was very small under the scale of 5,000 people. CONCLUSION The keys to decrease the mortality of MCIs were shortening the prehospital time and improving the efficiency of organization and command. For small-scale MCIs, improving the utilization rate of health resources was important in decreasing the mortality. For large-scale MCIs, increasing the number of ambulances and emergency medical professionals was the core to decrease prehospital time and mortality. For super-large-scale MCIs, increasing health resources was the premise.
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Affiliation(s)
- Wenya Yu
- Department of Military Health Service Management, College of Military Health Service Management, Second Military Medical University, Shanghai, People’s Republic of China
| | - Yipeng Lv
- Department of Military Health Service Management, College of Military Health Service Management, Second Military Medical University, Shanghai, People’s Republic of China
| | - Chaoqun Hu
- Department of Military Health Service Management, College of Military Health Service Management, Second Military Medical University, Shanghai, People’s Republic of China
| | - Xu Liu
- Department of Military Health Service Management, College of Military Health Service Management, Second Military Medical University, Shanghai, People’s Republic of China
| | - Haiping Chen
- Department of Military Health Service Management, College of Military Health Service Management, Second Military Medical University, Shanghai, People’s Republic of China
| | - Chen Xue
- Department of Military Health Service Management, College of Military Health Service Management, Second Military Medical University, Shanghai, People’s Republic of China
| | - Lulu Zhang
- Department of Military Health Service Management, College of Military Health Service Management, Second Military Medical University, Shanghai, People’s Republic of China
- Correspondence: Lulu Zhang, Department of Military Health Service Management, College of Military Health Service Management, Second Military Medical University, Shanghai 200433, People’s Republic of China, Tel +86 21 8187 1421, Email
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