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Khorram-Manesh A, Carlström E, Burkle FM, Goniewicz K, Gray L, Ratnayake A, Faccincani R, Bagaria D, Phattharapornjaroen P, Sultan MAS, Montán C, Nordling J, Gupta S, Magnusson C. The implication of a translational triage tool in mass casualty incidents: part three: a multinational study, using validated patient cards. Scand J Trauma Resusc Emerg Med 2023; 31:88. [PMID: 38017553 PMCID: PMC10683288 DOI: 10.1186/s13049-023-01128-3] [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: 05/10/2023] [Accepted: 10/09/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Mass casualty incidents (MCI) pose significant challenges to existing resources, entailing multiagency collaboration. Triage is a critical component in the management of MCIs, but the lack of a universally accepted triage system can hinder collaboration and lead to preventable loss of life. This multinational study uses validated patient cards (cases) based on real MCIs to evaluate the feasibility and effectiveness of a novel Translational Triage Tool (TTT) in primary triage assessment of mass casualty victims. METHODS Using established triage systems versus TTT, 163 participants (1575 times) triaged five patient cases. The outcomes were statistically compared. RESULTS TTT demonstrated similar sensitivity to the Sieve primary triage method and higher sensitivity than the START primary triage system. However, the TTT algorithm had a lower specificity compared to Sieve and higher over-triage rates. Nevertheless, the TTT algorithm demonstrated several advantages due to its straightforward design, such as rapid assessment, without the need for additional instrumental interventions, enabling the engagement of non-medical personnel. CONCLUSIONS The TTT algorithm is a promising and feasible primary triage tool for MCIs. The high number of over-triages potentially impacts resource allocation, but the absence of under-triages eliminates preventable deaths and enables the use of other personal resources. Further research involving larger participant samples, time efficiency assessments, and real-world scenarios is needed to fully assess the TTT algorithm's practicality and effectiveness in diverse multiagency and multinational contexts.
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Affiliation(s)
- Amir Khorram-Manesh
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, 405 30, Gothenburg, Sweden.
- Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska Academy, 413 45, Gothenburg, Sweden.
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, 405 30, Gothenburg, Sweden.
- Center for Disaster Medicine, Gothenburg University, 405 30, Gothenburg, Sweden.
| | - Eric Carlström
- Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska Academy, 413 45, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, 405 30, Gothenburg, Sweden
- USN School of Business, University of South-Eastern Norway, 3199, Borre, Norway
| | | | | | - Lesley Gray
- Department of Primary Health Care & General Practice, University of Otago, Wellington, New Zealand
- Joint Centre for Disaster Research, Massey University, Wellington, New Zealand
| | - Amila Ratnayake
- Sri Lanka Army Hospital, Narahenpita, Colombo, 08, Sri Lanka
| | - Roberto Faccincani
- Emergency Department, Humanitas Mater Domini, 210 53, Castellanza, Italy
| | - Dinesh Bagaria
- Division of Trauma Surgery & Critical Care, J.P.N. Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Carl Montán
- Karolinska MRMID-International Association for Medical Response to Major Incidents, Stockholm, Sweden
- Disasters, and Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Johan Nordling
- Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska Academy, 413 45, Gothenburg, Sweden
| | - Shailly Gupta
- Division of Trauma Surgery & Critical Care, J.P.N. Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Carl Magnusson
- Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska Academy, 413 45, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, 405 30, Gothenburg, Sweden
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López Bernal S, Quiles Pérez M, Martínez Beltrán ET, Martín Curto MDC, Yanakiev Y, Gil Pérez M, Martínez Pérez G. Opportunities for standardization in emergency scenarios in the European Union. Int J Med Inform 2023; 179:105232. [PMID: 37797352 DOI: 10.1016/j.ijmedinf.2023.105232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/31/2023] [Accepted: 09/21/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE Despite current standardization actions towards the unification between European Union (EU) countries, there is still much work to do. In this context, this paper aims to offer a comprehensive analysis of the limitations of the EU concerning emergency situations, specifically in cross-border, cross-hierarchical, and cross-sectorial emergencies, as well as the analysis of emergent opportunities for improvement. The final goal of this analysis is to serve as an initial step for pre-standardizing these opportunities. MATERIALS AND METHODS This work, performed in the context of the EU H2020 VALKYRIES project, first analyzed existing gaps from three dimensions: technological, procedural, collaboration, and training. Each gap was obtained from the literature, professional experience within VALKYRIES, or a consultation process on EU emergency agencies. This research subsequently obtained a list of opportunities from these limitations, aggregating those opportunities with similarities to ease their study. Then, this work prioritized the opportunities based on their feasibility and positive impact, performing an additional consultation process to EU emergencies for validation. Finally, this investigation provided a roadmap for pre-standardization for the five top-ranked opportunities per dimension. RESULTS This paper presents a set of 303 gaps and 255 opportunities across technological, procedural, collaboration, and training dimensions. After clustering the opportunities, this work provides a final set of 82 meta opportunities for improving emergency actions in the EU, prioritized based on their feasibility for adoption and positive impact. Finally, this work documents the roadmaps for three top-ranked opportunities for conciseness. CONCLUSION This publication highlights the limitations and opportunities in the EU concerning emergency agencies and, more specifically, those existing in cross-border and multi-casualty incidents. This work concludes that there is still room for improvement despite the current measures toward harmonization and standardization.
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Affiliation(s)
- Sergio López Bernal
- Department of Information and Communications Engineering, University of Murcia, Murcia, 30100, Spain.
| | - Mario Quiles Pérez
- Department of Information and Communications Engineering, University of Murcia, Murcia, 30100, Spain.
| | | | | | - Yantsislav Yanakiev
- Bulgarian Defence Institute "Prof. Tsvetan Lazarov", 2 Prof. Tsvetan Lazarov Blvd., Sofia, 1592, Bulgaria.
| | - Manuel Gil Pérez
- Department of Information and Communications Engineering, University of Murcia, Murcia, 30100, Spain.
| | - Gregorio Martínez Pérez
- Department of Information and Communications Engineering, University of Murcia, Murcia, 30100, Spain.
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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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Sigle M, Berliner L, Richter E, van Iersel M, Gorgati E, Hubloue I, Bamberg M, Grasshoff C, Rosenberger P, Wunderlich R. Development of an Anticipatory Triage-Ranking Algorithm Using Dynamic Simulation of the Expected Time Course of Patients With Trauma: Modeling and Simulation Study. J Med Internet Res 2023; 25:e44042. [PMID: 37318826 PMCID: PMC10337428 DOI: 10.2196/44042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/14/2023] [Accepted: 05/03/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND In cases of terrorism, disasters, or mass casualty incidents, far-reaching life-and-death decisions about prioritizing patients are currently made using triage algorithms that focus solely on the patient's current health status rather than their prognosis, thus leaving a fatal gap of patients who are under- or overtriaged. OBJECTIVE The aim of this proof-of-concept study is to demonstrate a novel approach for triage that no longer classifies patients into triage categories but ranks their urgency according to the anticipated survival time without intervention. Using this approach, we aim to improve the prioritization of casualties by respecting individual injury patterns and vital signs, survival likelihoods, and the availability of rescue resources. METHODS We designed a mathematical model that allows dynamic simulation of the time course of a patient's vital parameters, depending on individual baseline vital signs and injury severity. The 2 variables were integrated using the well-established Revised Trauma Score (RTS) and the New Injury Severity Score (NISS). An artificial patient database of unique patients with trauma (N=82,277) was then generated and used for analysis of the time course modeling and triage classification. Comparative performance analysis of different triage algorithms was performed. In addition, we applied a sophisticated, state-of-the-art clustering method using the Gower distance to visualize patient cohorts at risk for mistriage. RESULTS The proposed triage algorithm realistically modeled the time course of a patient's life, depending on injury severity and current vital parameters. Different casualties were ranked by their anticipated time course, reflecting their priority for treatment. Regarding the identification of patients at risk for mistriage, the model outperformed the Simple Triage And Rapid Treatment's triage algorithm but also exclusive stratification by the RTS or the NISS. Multidimensional analysis separated patients with similar patterns of injuries and vital parameters into clusters with different triage classifications. In this large-scale analysis, our algorithm confirmed the previously mentioned conclusions during simulation and descriptive analysis and underlined the significance of this novel approach to triage. CONCLUSIONS The findings of this study suggest the feasibility and relevance of our model, which is unique in terms of its ranking system, prognosis outline, and time course anticipation. The proposed triage-ranking algorithm could offer an innovative triage method with a wide range of applications in prehospital, disaster, and emergency medicine, as well as simulation and research.
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Affiliation(s)
- Manuel Sigle
- University Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
- University Department of Cardiology and Angiology, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Leon Berliner
- University Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Erich Richter
- University Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm, Germany
| | - Mart van Iersel
- Interactive Simulation Emergency Exercise support limited company, Wemmel, Belgium
| | - Eleonora Gorgati
- University Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Ives Hubloue
- Emergency Department, Universitair Ziekenhuis Brussel, Brussel, Belgium
- Research Group on Emergency and Disaster Medicine, Vrije Universiteit Brussel, Brussel, Belgium
| | - Maximilian Bamberg
- University Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Christian Grasshoff
- University Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Peter Rosenberger
- University Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Robert Wunderlich
- University Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
- German Society for Disaster Medicine (Deutsche Gesellschaft für Katastrophenmedizin), Kirchseeon, Germany
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Developing a translational triage research tool: part two-evaluating the tool through a Delphi study among experts. Scand J Trauma Resusc Emerg Med 2022; 30:48. [PMID: 35907858 PMCID: PMC9338674 DOI: 10.1186/s13049-022-01035-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background There are different prehospital triage systems, but no consensus on what constitutes the optimal choice. This heterogeneity constitutes a threat in a mass casualty incident in which triage is used during multiagency collaboration to prioritize casualties according to the injuries’ severity. A previous study has confirmed the feasibility of using a Translational Triage Tool consisting of several steps which translate primary prehospital triage systems into one. This study aims to evaluate and verify the proposed algorithm using a panel of experts who in their careers have demonstrated proficiency in triage management through research, experience, education, and practice. Method Several statements were obtained from earlier reports and were presented to the expert panel in two rounds of a Delphi study. Results There was a consensus in all provided statements, and for the first time, the panel of experts also proposed the manageable number of critical victims per healthcare provider appropriate for proper triage management. Conclusion The feasibility of the proposed algorithm was confirmed by experts with some minor modifications. The utility of the translational triage tool needs to be evaluated using authentic patient cards used in simulation exercises before being used in actual triage scenarios.
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Reliability and Validity of a New Computer-Based Triage Decision Support Tool: ANKUTRIAGE. Disaster Med Public Health Prep 2022; 17:e162. [PMID: 35765149 DOI: 10.1017/dmp.2022.101] [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: 02/07/2023]
Abstract
OBJECTIVE Triage is a tool used to determine patients' severity of illness or injury within minutes of arrival. This study aims to assess the reliability and validity of a new computer-based triage decision support tool, ANKUTRIAGE, prospectively. METHODS ANKUTRIAGE, a 5-level triage tool was established considering 2 major factors, patient's vital signs and characteristics of the admission complaint. Adult patients admitted to the ED between July and October, 2019 were consecutively and independently double triaged by 2 assessors using ANKUTRIAGE system. To measure inter-rater reliability, quadratic-weighted kappa coefficients (Kw) were calculated. For the validity, associations among urgency levels, resource use, and clinical outcomes were evaluated. RESULTS The inter-rater reliability between users of ANKUTRIAGE was excellent with an agreement coefficient (Kw) greater than 0.8 in all compared groups. In the validity phase, hospitalization rate, intensive care unit admission and mortality rate decreased from level 1 to 5. Likewise, according to the urgency levels, resource use decreased significantly as the triage level decreased (P < 0.05). CONCLUSIONS ANKUTRIAGE proved to be a valid and reliable tool in the emergency department. The results showed that displaying the key discriminator for each complaint to assist decision leads to a high inter-rater agreement with good correlation between urgency levels and clinical outcomes, as well as between urgency levels and resource consumptions.
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Civilian-Military Collaboration before and during COVID-19 Pandemic—A Systematic Review and a Pilot Survey among Practitioners. SUSTAINABILITY 2022. [DOI: 10.3390/su14020624] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Due to the similarity in skills and assets, Civilian-Military collaboration has emerged as one of the most reliable partnerships during the disaster and public health emergency management to address all necessary elements of surge capacity, i.e., staff, stuff, structure (space), and systems. This study aimed to evaluate this collaboration before and during the coronavirus 2019 pandemic. The outcomes of the systematic review revealed several published reports on successful civilian-military collaboration and proposed a need for further improvement. One hundred sixty-six individuals from 19 countries responded to nine questions, included in an online survey with the possibility to leave comments if necessary. The questionnaire referred to elements such as command and control, safety, communication, assessment, triage, treatment, and transport, as the crucial components of emergency management. The comprehensive examination of the survey results together with registered comments revealed a possible improvement in collaboration particularly on the strategic levels, i.e., meetings at the command-and-control level, safety, communication, and networking issues. While logistic collaboration seemed to be unchanged, the practical parts of the collaboration, i.e., clinical and non-clinical operational partnership (Triage and Treatment), mutual education, training, and operational understanding of each organization remained unchanged. In conclusion, although the current pandemic may have facilitated a more intense collaboration between civilian and military healthcare organizations, it lacks practical partnership and operative engagement, representing two crucial elements necessary for harmony and compatibility of both systems. Such collaboration may require a political will and perhaps a mutual civilian-military authority.
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The Influence of War and Conflict on Infectious Disease: A Rapid Review of Historical Lessons We Have Yet to Learn. SUSTAINABILITY 2021. [DOI: 10.3390/su131910783] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Armed conflicts degrade established healthcare systems, which typically manifests as a resurgence of preventable infectious diseases. While 70% of deaths globally are now from non-communicable disease; in low-income countries, respiratory infections, diarrheal illness, malaria, tuberculosis, and HIV/AIDs are all in the top 10 causes of death. The burden of these infectious diseases is exacerbated by armed conflict, translating into even more dramatic long-term consequences. This rapid evidence review searched electronic databases in PubMed, Scopus, and Web of Science. Of 381 identified publications, 73 were included in this review. Several authors indicate that the impact of infectious diseases increases in wars and armed conflicts due to disruption to surveillance and response systems that were often poorly developed to begin with. Although the true impact of conflict on infectious disease spread is not known and requires further research, the link between them is indisputable. Current decision-making management systems are insufficient and only pass the baton to the next unwary generation.
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