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1

Level I center triage and mass casualties.  

PubMed

The world has been marked by a recent series of high-profile terrorist attacks, including the attack of September 11, 2001, in New York City. Similar to natural disasters, these attacks often result in a large number of casualties necessitating triage strategies. The end of the twentieth century was marked by the development of trauma systems in the United States and abroad. By their very nature, trauma centers are best equipped to handle mass casualties resulting from natural and manmade disasters. Triage assessment tools and scoring systems have evolved to facilitate this triage process and to potentially reduce the morbidity and mortality associated with these events. PMID:15187829

Hoey, Brian A; Schwab, C William

2004-05-01

2

Model uniform core criteria for mass casualty triage.  

PubMed

There is a need for model uniform core criteria for mass casualty triage because disasters frequently cross jurisdictional lines and involve responders from multiple agencies who may be using different triage tools. These criteria (Tables 1-4) reflect the available science, but it is acknowledged that there are significant research gaps. When no science was available, decisions were formed by expert consensus derived from the available triage systems. The intent is to ensure that providers at a mass-casualty incident use triage methodologies that incorporate these core principles in an effort to promote interoperability and standardization. At a minimum, each triage system must incorporate the criteria that are listed below. Mass casualty triage systems in use can be modified using these criteria to ensure interoperability. The criteria include general considerations, global sorting, lifesaving interventions, and assignment of triage categories. The criteria apply only to providers who are organizing multiple victims in a discrete geographic location or locations, regardless of the size of the incident. They are classified by whether they were derived through available direct scientific evidence, indirect scientific evidence, expert consensus, and/or are used in multiple existing triage systems. These criteria address only primary triage and do not consider secondary triage. For the purposes of this document the term triage refers to mass-casualty triage and provider refers to any person who assigns primary triage categories to victims of a mass-casualty incident. PMID:21685308

2011-06-01

3

Mass-casualty triage: time for an evidence-based approach.  

PubMed

Mass-casualty triage has developed from a wartime necessity to a civilian tool to ensure that constrained medical resources are directed at achieving the greatest good for the most number of people. Several primary and secondary triage tools have been developed, including Simple Treatment and Rapid Transport (START), JumpSTART, Care Flight Triage, Triage Sieve, Sacco Triage Method, Secondary Assessment of Victim Endpoint (SAVE), and Pediatric Triage Tape. Evidence to support the use of one triage algorithm over another is limited, and the development of effective triage protocols is an important research priority. The most widely recognized mass-casualty triage algorithms in use today are not evidence-based, and no studies directly address these issues in the mass-casualty setting. Furthermore, no studies have evaluated existing mass-casualty triage algorithms regarding ease of use, reliability, and validity when biological, chemical, or radiological agents are introduced. Currently, the lack of a standardized mass-casualty triage system that is well validated, reliable, and uniformly accepted, remains an important gap. Future research directed at triage is recognized as a necessity, and the development of a practical, universal, triage algorithm that incorporates requirements for decontamination or special precautions for infectious agents would facilitate a more organized mass-casualty medical response. PMID:18491654

Jenkins, Jennifer Lee; McCarthy, Melissa L; Sauer, Lauren M; Green, Gary B; Stuart, Stephanie; Thomas, Tamara L; Hsu, Edbert B

4

Triage, monitoring, and treatment of mass casualty events involving chemical, biological, radiological, or nuclear agents  

PubMed Central

In a mass casualty situation due to chemical, biological, radiological, or nuclear (CBRN) event, triage is absolutely required for categorizing the casualties in accordance with medical care priorities. Dealing with a CBRN event always starts at the local level. Even before the detection and analysis of agents can be undertaken, zoning, triage, decontamination, and treatment should be initiated promptly. While applying the triage system, the available medical resources and maximal utilization of medical assets should be taken into consideration by experienced triage officers who are most familiar with the natural course of the injury presented and have detailed information on medical assets. There are several triage systems that can be applied to CBRN casualties. With no one standardized system globally or nationally available, it is important for deploying a triage and decontamination system which is easy to follow and flexible to the available medical resources, casualty number, and severity of injury.

Ramesh, Aruna C.; Kumar, S.

2010-01-01

5

Mass casualty triage: an evaluation of the science and refinement of a national guideline.  

PubMed

Mass casualty triage is the process of prioritizing multiple victims when resources are not sufficient to treat everyone immediately. No national guideline for mass casualty triage exists in the United States. The lack of a national guideline has resulted in variability in triage processes, tags, and nomenclature. This variability has the potential to inject confusion and miscommunication into the disaster incident, particularly when multiple jurisdictions are involved. The Model Uniform Core Criteria for Mass Casualty Triage were developed to be a national guideline for mass casualty triage to ensure interoperability and standardization when responding to a mass casualty incident. The Core Criteria consist of 4 categories: general considerations, global sorting, lifesaving interventions, and individual assessment of triage category. The criteria within each of these categories were developed by a workgroup of experts representing national stakeholder organizations who used the best available science and, when necessary, consensus opinion. This article describes how the Model Uniform Core Criteria for Mass Casualty Triage were developed. PMID:21685309

Lerner, E Brooke; Cone, David C; Weinstein, Eric S; Schwartz, Richard B; Coule, Phillip L; Cronin, Michael; Wedmore, Ian S; Bulger, Eileen M; Mulligan, Deborah Ann; Swienton, Raymond E; Sasser, Scott M; Shah, Umair A; Weireter, Leonard J; Sanddal, Teri L; Lairet, Julio; Markenson, David; Romig, Lou; Lord, Gregg; Salomone, Jeffrey; O'Connor, Robert; Hunt, Richard C

2011-06-01

6

Organization of Urgent Medical Aid, Including Mass Casualty and Triage  

Microsoft Academic Search

\\u000a Modern armed conflict is notable in that the violence of today’s weaponry and the profound severity of wounds create frequent\\u000a situations in which trauma care providers are faced with situations that severely strain available resources. When those resources\\u000a are strained beyond existing capacity to treat the sheer volume of wounded, the event becomes a mass casualty incident.

James R. Ficke; Anthony E. Johnson; Joseph R. Hsu

7

Clinical review: Mass casualty triage - pandemic influenza and critical care  

PubMed Central

Worst case scenarios for pandemic influenza planning in the US involve over 700,000 patients requiring mechanical ventilation. UK planning predicts a 231% occupancy of current level 3 (intensive care unit) bed capacity. Critical care planners need to recognise that mortality is likely to be high and the risk to healthcare workers significant. Contingency planning should, therefore, be multi-faceted, involving a robust health command structure, the facility to expand critical care provision in terms of space, equipment and staff and cohorting of affected patients in the early stages. It should also be recognised that despite this expansion of critical care, demand will exceed supply and a process for triage needs to be developed that is valid, reproducible, transparent and consistent with distributive justice. We advocate the development and validation of physiological scores for use as a triage tool, coupled with candid public discussion of the process.

Challen, Kirsty; Bentley, Andrew; Bright, John; Walter, Darren

2007-01-01

8

Orthopaedic triage during natural disasters and mass casualties: do scoring systems matter?  

PubMed

Mass casualty events, either natural disasters or man-made, are associated with extremities injuries. The treating surgeon often faces a challenging decision: can the affected extremity be saved or amputated? The following article will present the author's view on the subject of triage and the use of scoring systems in the decision-making process whether to salvage or amputate an affected extremity. The author will analyse the existing scoring systems and emphasise significance of the regional factors: geographical, cultural and level of health care, as factors playing roles in this process. PMID:23827955

Wolfson, Nikolaj

2013-07-05

9

Primary triage of mass burn casualties with associated severe traumatic injuries  

PubMed Central

Summary A key aim in any mass disaster event is to avoid diverting resources by overwhelming specialized tertiary centers with minor casualties. The most crucial aspect of an effective disaster response is pre-hospital triage at the scene. Unfortunately, many triage systems have serious shortcomings in their methodologies and no existing triage system has enough scientific evidence to justify its universal adoption. Moreover, it is observed that the optimal approach to planning is by no means clear-cut and that each new incident involving burns appears to produce its own unique problems not all of which were predictable. In most major burns disasters, victims mostly have combined trauma burn injuries and form a heterogeneous group with a broad range of devastating injuries. Are these victims primarily burn patients or trauma patients? Should they be taken care of in a burn center or in a trauma center or only in a combined burns-trauma center? Who makes the decision? The present review is aimed at answering some of these questions.

Atiyeh, B.; Gunn, S. William A.; Dibo, S.

2013-01-01

10

Using a joint triage model for multi-hospital response to a mass casualty incident in New York city  

PubMed Central

This paper defines a specific plan which allows two separate institutions, with different capabilities, to function as a single receiving entity in the event of a mass casualty incident. The street between the two institutions will be closed to traffic and a two-phase process initiated. Arriving ambulances will first be quickly screened to expedite the most critical patients followed by formal triage and directing patients to one of the two facilities. Preparation for this plan requires prior coordination between local authorities and the administrations of both institutions. This plan can serve as a general model for disaster preparedness when two or more institutions with different capabilities are located in close proximity.

Arquilla, Bonnie; Paladino, Lorenzo; Reich, Charlotte; Brandler, Ethan; Lucchesi, Michael; Shetty, Sanjay

2009-01-01

11

Mass casualty management of a large-scale bioterrorist event: an epidemiological approach that shapes triage decisions.  

PubMed

The threat of a BT event has catalyzed serious reflection on the troublesome issues that come with event management and triage. Such reflection has had the effect of multiplying the efforts to find solutions to what could become a catastrophic public health disaster. Management options are becoming more robust, as are reliable detection devices and rapid access to stockpiled antibiotics and vaccines. There is much to be done, however, especially in the organizing, warehousing, and granting/exercising authority for resource allocations. The introduction of these new options should encourage one to believe that, in time, evolving standards of care will make it possible to rethink the currently unthinkable consequences. Unfortunately the cost of such preparedness is high and out of reach of most governments. Most of the developing world has neither the will nor the means to plan for BT events and remains overwhelmed with basic public health concerns (i.e., water, food, sanitation, shelter) that must take priority. Therefore, developed countries will be expected to respond using international exogenous resources to mitigate the effects of such a disaster. As a result, the state capacity of the effected government will be severely compromised. If triage and management of casualties is further compromised, terrorists will have met their goals. One could argue that health sciences will continue for decades to play catch up with the advanced technology driving potential bioagent weaponry. If one lesson was learned from the review of the former Soviet Union's biological weapons program, it is that the unthinkable remains an option to terrorists who have comparable expertise. It is crucial to develop realistic strategies for a BT event. Triage planning (the process of establishing criteria for health care prioritization) permits society to see cases in the context of diverse moral perspectives, limited resources, and compelling health care demands. This includes a competent and compassionate management and triage system and an in-depth and accurate health information system that appropriately addresses every level of threat or consequence. In a PICE stage I to III BT event resources will be compromised. Triage and management will be one process requiring multiple levels of cooperation, coordination, and decision-making. An immediate challenge to existing emergency medical services systems (EMSS) is the recognition that locally there will be a shift of emphasis and decision-making from prehospital first responders to community public health authorities. The author suggests that a working relationship, in most areas, between EMSS and the public health system is lacking. As priorities shift in a BT event to hospitals and public health care systems, they need to: 1. Improve their capabilities and capacities in surveillance, discovery, and in the consequences of different triage and management decisions and interventions in a BT environment, starting at the local level. 2. Develop triage and management systems (with clear lines of authority) based on public health and epidemiologic requirements, capability, and capacity (triage teams, categories, tags, rapid response, established operational priorities, resource-driven responsible management process), and link local level surveillance systems with those at the national or regional level. 3. Use a triage and management system that reflects the population (cohort) at risk, such as the epidemiologic based SEIRV triage framework. 4. Develop an organizational capacity that uses lateral decision-making skills, pre-hospital outpatient centers for triage-specific treatments, health information systems, and resource-driven hospital level pre-designated protocols appropriate for a surge of unprecedented proportions. Such standards of care, it is recommended, should be set at the local to federal levels and spelled out in existing incident-management system protocols. PMID:12132490

Burkle, Frederick M

2002-05-01

12

Creating order from chaos: part I: triage, initial care, and tactical considerations in mass casualty and disaster response.  

PubMed

How do we train for the entire spectrum of potential emergency and crisis scenarios? Will we suddenly face large numbers of combat casualties, an earthquake, a plane crash, an industrial explosion, or a terrorist bombing? The daily routine can suddenly be complicated by large numbers of patients, exceeding the ability to treat in a routine fashion. Disaster events can result in patients with penetrating wounds, burns, blast injuries, chemical contamination, or all of these at once. Some events may disrupt infrastructure or result in loss of essential equipment or key personnel. The chaos of a catastrophic event impedes decision-making and effective treatment of patients. Disasters require a paradigm shift from the application of unlimited resources for the greatest good of each individual patient to the allocation of care, with limited resources, for the greatest good for the greatest number of patients. Training and preparation are essential to remain effective during crises and major catastrophic events. Disaster triage and crisis management represent a tactical art that incorporates clinical skills, didactic information, communication ability, leadership, and decision-making. Planning, rehearsing, and exercising various scenarios encourage the flexibility, adaptability, and innovation required in disaster settings. These skills can bring order to the chaos of overwhelming disaster events. PMID:17436764

Baker, Michael S

2007-03-01

13

Simple triage and rapid decontamination of mass casualties with colored clothes pegs (STARDOM-CCP) system against chemical releases.  

PubMed

The efficiency and speed with which first responders, paramedics, and emergency physicians respond to an event caused by the release of a chemical is an important concern in all modern cities worldwide. A system for the initial triage and decontamination of victims of a chemical release was developed using colored clothes pegs of the following seven colors: red, yellow, green, black, white, and blue. Red indicates the need for emergency care, yellow for semi-emergency care, green for non-emergency care, black for expectant, white for dry decontamination, and blue for wet decontamination. The system can be employed as one of the techniques directed at improving the efficiency of decontamination in countries where there is a risk of chemical releases. It is recommended that this system should be adopted internationally and used for both drills and actual events. PMID:17894219

Okumura, Tetsu; Kondo, Hisayoshi; Nagayama, Hitomi; Makino, Toshiro; Yoshioka, Toshiharu; Yamamoto, Yasuhiro

14

The "RTR" medical response system for nuclear and radiological mass-casualty incidents: a functional TRiage-TReatment-TRansport medical response model.  

PubMed

Developing a mass-casualty medical response to the detonation of an improvised nuclear device (IND) or large radiological dispersal device (RDD) requires unique advanced planning due to the potential magnitude of the event, lack of warning, and radiation hazards. In order for medical care and resources to be collocated and matched to the requirements, a [US] Federal interagency medical response-planning group has developed a conceptual approach for responding to such nuclear and radiological incidents. The "RTR" system (comprising Radiation-specific TRiage, TReatment, TRansport sites) is designed to support medical care following a nuclear incident. Its purpose is to characterize, organize, and efficiently deploy appropriate materiel and personnel assets as close as physically possible to various categories of victims while preserving the safety of responders. The RTR system is not a medical triage system for individual patients. After an incident is characterized and safe perimeters are established, RTR sites should be determined in real-time that are based on the extent of destruction, environmental factors, residual radiation, available infrastructure, and transportation routes. Such RTR sites are divided into three types depending on their physical/situational relationship to the incident. The RTR1 sites are near the epicenter with residual radiation and include victims with blast injuries and other major traumatic injuries including radiation exposure; RTR2 sites are situated in relationship to the plume with varying amounts of residual radiation present, with most victims being ambulatory; and RTR3 sites are collection and transport sites with minimal or no radiation present or exposure risk and a victim population with a potential variety of injuries or radiation exposures. Medical Care sites are predetermined sites at which definitive medical care is given to those in immediate need of care. They include local/regional hospitals, medical centers, other sites such as nursing homes and outpatient clinics, nationwide expert medical centers (such as cancer or burn centers), and possible alternate care facilities such as Federal Medical Stations. Assembly Centers for displaced or evacuating persons are predetermined and spontaneous sites safely outside of the perimeter of the incident, for use by those who need no immediate medical attention or only minor assistance. Decontamination requirements are important considerations for all RTR, Medical Care, and Assembly Center sites and transport vehicles. The US Department of Health and Human Services is working on a long-term project to generate a database for potential medical care sites and assembly centers so that information is immediately available should an incident occur. PMID:19618351

Hrdina, Chad M; Coleman, C Norman; Bogucki, Sandy; Bader, Judith L; Hayhurst, Robert E; Forsha, Joseph D; Marcozzi, David; Yeskey, Kevin; Knebel, Ann R

15

Mass casualty terrorist bombings  

Microsoft Academic Search

Study objectiveWe compared the epidemiologic outcomes of terrorist bombings that produced 30 or more casualties and resulted in immediate structural collapse, occurred within a confined space, or occurred in open air.

Jeffrey L Arnold; Pinchas Halpern; Ming-Che Tsai; Howard Smithline

2004-01-01

16

Biological dosimetry for triage of casualties in a large-scale radiological emergency:capacity of the EU member states.  

PubMed

In recent years, a number of events have occurred that highlight the necessity of being prepared for a possible large-scale radiological event. An important question is how well are European Union (EU) Member States prepared to cope with mass radiological casualties. A survey to establish the current status of biological dosimetry across the EU was carried out with the aim of assessing capacity to perform biodosimetric triage of accident victims. Information was sought from the radiation protection authorities of the 27 Member States plus Switzerland and Norway. Biology dosimetry is established in 15 EU countries. Their total capacity for dosimetric triage is about 1500 cases per week analysed with a dicentric assay or about 800 cases analysed with a micronucleus assay. Although these numbers appear encouraging, there is not much collaboration between the laboratories and what is required is a network at the EU level. PMID:19951985

Wojcik, Andrzej; Lloyd, David; Romm, Horst; Roy, Laurence

2009-12-01

17

Palliative care considerations in mass casualty events with scarce resources.  

PubMed

Catastrophic mass casualty events, such as pandemic flu outbreaks or large-scale terrorism-related events, could yield thousands of victims whose needs would overwhelm local and regional healthcare systems, personnel, and resources. Such conditions will require deploying scarce resources in a manner that is different from the more common single-event disaster. This article introduces the topic of palliative care during a mass casualty event and reviews the major findings for a federally funded planning guide that examined palliative care issues associated with providing medical care under circumstances where resources are scarce. We focus on the role of palliative care in the support of individuals not expected to survive and offer recommendations of specific actions for a coordinated disaster response plan. Semistructured telephone discussions with disaster management experts and a group meeting of experts identified issues, roles, responsibilities, procedures, and resources that offer the benefits of integrating palliative care into disaster planning and response. The investigations identified 5 domains of concern, along with guidance: (1) the role of palliative care in a mass casualty event with resulting scarce resources; (2) the triage and ensuing treatment decisions for those "likely to die"; (3) the critical palliative care services to provide, along with the personnel and settings; (4) the pragmatic plans needed for ensuring training, supplies, and organizational or jurisdictional arrangements; and (5) unusual issues affecting palliative care under mass casualty event scenarios. Palliative care minimizes the suffering of those who die, ensures comfort, addresses their needs, and may also free up resources to optimize survival of others. Planning to provide palliative care during mass casualty events should be part of the current state and local disaster planning/training guidelines, protocols, and activities. PMID:19635004

Matzo, Marianne; Wilkinson, Anne; Lynn, Joanne; Gatto, Maria; Phillips, Sally

2009-06-01

18

Prehospital Preparedness for Pediatric Mass Casualty Events  

Microsoft Academic Search

OBJECTIVES. Recent events have reiterated the need for well-coordinated planning for mass-casualty events, including those that involve children. The objective of this study was to document the preparedness of prehospital emergency medical ser- vices agencies in the United States for the care of children who are involved in mass-casualty events. METHODS. A national list of all licensed prehospital emergency medical

Steve Shirm; Rebecca Liggin; Rhonda Dick; James Graham

2008-01-01

19

Telemedical support of prehospital emergency care in mass casualty incidents.  

PubMed

In the German emergency medical service system (EMSS) medical treatment can be improved in most of mass casualty incidents (MCI). Currently, the incident commander who is responsible for classification of the victims (depending on their urgency and condition, the so called triage) and ordered transportation uses paper-based documentation. Triage tags are used to identify and classify patients and gather treatment information. This can cause problems in medical treatment and in transportation of injured victims. Object-oriented modelling, simulation, and visualisation of processes can show deficits in treatment and data processing and thereby help to optimise medical workflow and logistics. If documentation by paramedics and emergency physicians is done electronically, all patient records could be send to a telemedical centre for central data administration. A telemedical supported triage tag helps identifying victims and managing detailed identification protocols. The paper-based documentation in emergency would become obsolete, if hospitals can query all protocols, diagnoses, and findings from the telemedical centre. Safety and security aspects can be guaranteed. The complete medical treatment workflow can be supported by telemedicine. Therefore, in case of MCI, telemedicine can optimise medical treatment and exonerate the paramedics from unnecessary documentation. PMID:10477508

Plischke, M; Wolf, K H; Lison, T; Pretschner, D P

1999-09-01

20

Computer-assisted training program for simulation of triage, resuscitation, and evacuation of casualties.  

PubMed

The purpose of this paper is to introduce a multimedia computer software package that has been developed for the Federal Armed Forces of Germany to train military physicians in trauma management. The program presents different groups of casualties with characteristic wounds and multiple injuries on a CD-ROM and provides many clinical options at each decision point. Automatically evaluating the decisions for accuracy, the objective of the program is to train for triage, resuscitation, and evacuation of wounded in combat under pressure of time. The computer-assisted instruction program is inexpensive and allows easily accessible self-instruction as a supplement to formal classroom training. Using this teaching software, it may be possible to teach a standardized emergency case-management algorithm for battlefield trauma. There was a high level of acceptance for this type of instruction. This is encouraging for medical educators involved in producing multimedia packages for teaching emergency medicine. PMID:9575769

Willy, C; Sterk, J; Schwarz, W; Gerngross, H

1998-04-01

21

Adolescent epidemic hysteria presenting as a mass casualty, toxic exposure incident  

SciTech Connect

Discussed is a case of explosive epidemic hysteria presenting as a mass casualty, toxic inhalation incident. Fifteen adolescent female students were triaged from a school of 700 persons exposed to sewer gas and arrived simultaneously at the emergency department complaining of a variety of nonspecific symptoms without physical findings. These symptoms quickly remitted with reassurance and dispersion of the group. Factors important in the recognition and treatment of epidemic hysteria are presented.

Selden, B.S. (Humana Hospital-Alaska, Anchorage)

1989-08-01

22

Public experiences of mass casualty decontamination.  

PubMed

In this article, we analyze feedback from simulated casualties who took part in field exercises involving mass decontamination, to gain an understanding of how responder communication can affect people's experiences of and compliance with decontamination. We analyzed questionnaire data gathered from 402 volunteers using the framework approach, to provide an insight into the public's experiences of decontamination and how these experiences are shaped by the actions of emergency responders. Factors that affected casualties' experiences of the decontamination process included the need for greater practical information and better communication from responders, and the need for privacy. Results support previous findings from small-scale incidents that involved decontamination in showing that participants wanted better communication from responders during the process of decontamination, including more practical information, and that the failure of responders to communicate effectively with members of the public led to anxiety about the decontamination process. The similarity between the findings from the exercises described in this article and previous research into real incidents involving decontamination suggests that field exercises provide a useful way to examine the effect of responder communication strategies on the public's experiences of decontamination. Future exercises should examine in more detail the effect of various communication strategies on the public's experiences of decontamination. This will facilitate the development of evidence-based communication strategies intended to reduce anxiety about decontamination and increase compliance among members of the public during real-life incidents that involve mass decontamination. PMID:22823588

Carter, Holly; Drury, John; Rubin, G James; Williams, Richard; Amlôt, Richard

2012-07-23

23

Does START Triage Work? An Outcomes Assessment After a Disaster  

Microsoft Academic Search

Study objective: The mass casualty triage system known as simple triage and rapid treatment (START) has been widely used in the United States since the 1980s. However, no outcomes assessment has been conducted after a disaster to determine whether assigned triage levels match patients' actual clinical status. Researchers hypothesize that START achieves at least 90% sensitivity and specificity for each

Christopher A. Kahn; Carl H. Schultz; Ken T. Miller; Craig L. Anderson

2009-01-01

24

BIOLOGICAL DOSIMETRY OF IONIZING RADIATION AS APPLIED TO TRIAGE OF CASUALTIES FOLLOWING A THERMONUCLEAR DETONATION  

Microsoft Academic Search

The need for sorting of casualties following a nuclear disaster is ; discussed. The problem of radiation illness imposed upon conventional traumatic ; injuries and burns is emphasized. Arguments are presented for the need of a ; simple yet accurate biological dosimeter to aid medical officers responsible for ; casualty sorting. Criteria of and ideal biological dosimeter are proposed, and

Odland

1963-01-01

25

Mass casualties in the Oklahoma City bombing.  

PubMed

The Alfred P. Murrah Federal Building in Oklahoma City was partially destroyed by a terrorist bomb on April 19, 1995. Injuries were sustained by 759 people, 168 of whom died. Fatalities occurred primarily among victims in the collapse zone of the federal building. Only 83 survivors required hospitalization. Twenty-two surviving victims sustained multiple fractures. Most victims arrived at local emergency departments by private vehicle within 2 hours. More severely injured survivors were transported by ambulance. The closer receiving hospitals used emergency department facilities and minor treatment areas. Few survivors were extricated from the bombing site more than 3 hours after the detonation. Mass casualty plans must provide for improved communications, diversion and retriage from facilities nearest the disaster site, and effective coordination of community and hospital resources. PMID:15187837

Teague, David C

2004-05-01

26

Disasters and mass casualties: I. General principles of response and management.  

PubMed

Disaster planning and response to a mass casualty incident pose unique demands on the medical community. Because they would be required to confront many casualties with bodily injury and surgical problems, surgeons in particular must become better educated in disaster management. Compared with routine practice, triage principles in disasters require an entirely different approach to evaluation and care and often run counter to training and ethical values. An effective response to disaster and mass casualty events should focus on an "all hazards" approach, defined as the ability to adapt and apply fundamental disaster management principles universally to any mass casualty incident, whether caused by people or nature. Organizational tools such as the Incident Command System and the Hospital Incident Command System help to effect a rapid and coordinated response to specific situations. The United States federal government, through the National Response Plan, has the responsibility to respond quickly and efficiently to catastrophic incidents and to ensure critical life-saving assistance. International medical surgical response teams are capable of providing medical, surgical, and intensive care services in austere environments anywhere in the world. PMID:17602028

Born, Christopher T; Briggs, Susan M; Ciraulo, David L; Frykberg, Eric R; Hammond, Jeffrey S; Hirshberg, Asher; Lhowe, David W; O'Neill, Patricia A

2007-07-01

27

Mass Casualty Event During a Musical Parade: Lessons Learned  

Microsoft Academic Search

Objective: In the Netherlands, major incidents are sparse, and so there is a general feeling of a relatively low risk. Upon evaluating multiple casualty events (MCEs) in the Netherlands over the last 60 years, it is worth noting 39 major events. Our objective was to report the experiences from a mass casualty incident in an urban area, performing a critical

Michael Bemelman; Luke Leenen

2008-01-01

28

Mass casualty event during a musical parade: lessons learned  

Microsoft Academic Search

Objective: In the Netherlands, major incidents are sparse, and so there is a general feeling of a relatively low risk. Upon evaluating multiple casualty events (MCEs) in the Netherlands over the last 60 years, it is worth noting 39 major events. Our objective was to report the experiences from a mass casualty incident in an urban area, performing a critical

Michael Bemelman; Luke Leenen

2007-01-01

29

Assessment of biodosimetry methods for a mass-casualty radiological incident: medical response and management considerations.  

PubMed

Following a mass-casualty nuclear disaster, effective medical triage has the potential to save tens of thousands of lives. In order to best use the available scarce resources, there is an urgent need for biodosimetry tools to determine an individual's radiation dose. Initial triage for radiation exposure will include location during the incident, symptoms, and physical examination. Stepwise triage will include point of care assessment of less than or greater than 2 Gy, followed by secondary assessment, possibly with high throughput screening, to further define an individual's dose. Given the multisystem nature of radiation injury, it is unlikely that any single biodosimetry assay can be used as a standalone tool to meet the surge in capacity with the timeliness and accuracy needed. As part of the national preparedness and planning for a nuclear or radiological incident, the authors reviewed the primary literature to determine the capabilities and limitations of a number of biodosimetry assays currently available or under development for use in the initial and secondary triage of patients. Understanding the requirements from a response standpoint and the capability and logistics for the various assays will help inform future biodosimetry technology development and acquisition. Factors considered include: type of sample required, dose detection limit, time interval when the assay is feasible biologically, time for sample preparation and analysis, ease of use, logistical requirements, potential throughput, point-of-care capability, and the ability to support patient diagnosis and treatment within a therapeutically relevant time point. PMID:24162058

Sullivan, Julie M; Prasanna, Pataje G S; Grace, Marcy B; Wathen, Lynne K; Wallace, Rodney L; Koerner, John F; Coleman, C Norman

2013-12-01

30

Unstable Ethical Plateaus and Disaster Triage  

Microsoft Academic Search

Disasters are defined medically as mass casualty incidents in which the number of patients presenting during a given time period exceeds the capac- ity of the responders to render effective care in a timely manner. During such circumstances, triage is instituted to allocate scarce medical resources. Current disaster triage attempts to do the most for the most, with the least

Matthew D. Sztajnkrycer; Bo E. Madsen

2006-01-01

31

Integrated Civilian Medical Response to Mass Casualty Incidents.  

National Technical Information Service (NTIS)

U.S. military and civilian populations have much to accomplish in the effort to enhance preparedness for potential mass casualty incidents. In this effort, CIMERC has partnered with many regional, national, governmental, and nongovernmental organizations....

B. Onaral

2005-01-01

32

Medical management of toxicological mass casualty events.  

PubMed

The relative accessibility to various chemical agents, including chemical warfare agents and toxic industrial compounds, places a toxicological mass casualty event, including chemical terrorism, among the major threats to homeland security. TMCE represents a medical and logistic challenge with potential hazardous exposure of first-response teams. In addition, TMCE poses substantial psychological and economic impact. We have created a simple response algorithm that provides practical guidelines for participating forces in TMCE. Emphasis is placed on the role of first responders, highlighting the importance of early recognition of the event as a TMCE, informing the command and control centers, and application of appropriate self-protection. The medical identification of the toxidrome is of utmost importance as it may dictate radically different approaches and life-saving modalities. Our proposed emergency management of TMCE values the "Scoop & Run" approach orchestrated by an organized evacuation plan rather than on-site decontamination. Finally, continuous preparedness of health systems - exemplified by periodic CBRN (Chemical, Biological, Radio-Nuclear) medical training of both first responders and hospital staff, mandatory placement of antidotal auto-injectors in all ambulances and CBRN emergency kits in the emergency departments - would considerably improve the emergency medical response to TMCE. PMID:19070282

Markel, Gal; Krivoy, Amir; Rotman, Eran; Schein, Ophir; Shrot, Shai; Brosh-Nissimov, Tal; Dushnitsky, Tsvika; Eisenkraft, Arik

2008-11-01

33

Modelling Mass Casualty Decontamination Systems Informed by Field Exercise Data  

PubMed Central

In the event of a large-scale chemical release in the UK decontamination of ambulant casualties would be undertaken by the Fire and Rescue Service (FRS). The aim of this study was to track the movement of volunteer casualties at two mass decontamination field exercises using passive Radio Frequency Identification tags and detection mats that were placed at pre-defined locations. The exercise data were then used to inform a computer model of the FRS component of the mass decontamination process. Having removed all clothing and having showered, the re-dressing (termed re-robing) of casualties was found to be a bottleneck in the mass decontamination process during both exercises. Computer simulations showed that increasing the capacity of each lane of the re-robe section to accommodate 10 rather than five casualties would be optimal in general, but that a capacity of 15 might be required to accommodate vulnerable individuals. If the duration of the shower was decreased from three minutes to one minute then a per lane re-robe capacity of 20 might be necessary to maximise the throughput of casualties. In conclusion, one practical enhancement to the FRS response may be to provide at least one additional re-robe section per mass decontamination unit.

Egan, Joseph R.; Amlot, Richard

2012-01-01

34

Casualties.  

PubMed

Privation and disease have mainly killed soldiers until very recently. Now that enemy action predominates, faster and better control of bleeding and infection before and during evacuation spares ever more lives today. This essay focuses on psychological war wounds, placing them in the context of military casualties. The surgeon's concepts of 'primary' wounds in war, and of would 'complications' and 'contamination', serve as models for psychological and moral injury in war. 'Psychological injury' is explained and preferred to 'Post-Traumatic Stress Disorder', being less stigmatizing and more faithful to the phenomenon. Primary psychological injury equates to the direct damage done by a bullet; the complications - for example, alcohol abuse - equate to hemorrhage and infection. Two current senses of 'moral injury' equate to wound contamination. As with physical wounds, it is the complications and contamination of mental wounds that most often kill service members or veterans, or blight their lives. PMID:21898967

Shay, Jonathan

2011-01-01

35

Hepatitis B outbreak following a mass-casualty incident, Australia.  

PubMed

On 16 April 2009, a boat carrying 47 Afghan asylum seekers and 2 Indonesian crew exploded in Australian waters, resulting in mass casualties. Of these casualties, 23 persons who suffered significant burns were transferred to Royal Perth Hospital, Perth, Western Australia. One patient was subsequently shown to be a hepatitis B virus (HBV) carrier at the time of the explosion. Over the following months, 3 other patients received a diagnosis of acute hepatitis B, and an additional 4 patients showed serological evidence of recent HBV infection, including 1 patient who was transferred to another Australian city. Molecular typing determined that the strains from the HBV carrier and the acute and recent case patients formed a closely related cluster, and the investigation suggested that transmission occurred at or around the time of the boat explosion. This is the first report of confirmed transmission of HBV following a disaster, and it reinforces the importance of postexposure prophylaxis for HBV in mass casualty situations. PMID:21742838

Italiano, Claire M; Speers, David J; Chidlow, Glenys R; Dowse, Gary K; Robertson, Andrew G; Flexman, James P

2011-08-01

36

Portable ultrasonography in mass casualty incidents: The CAVEAT examination  

PubMed Central

Ultrasonography used by practicing clinicians has been shown to be of utility in the evaluation of time-sensitive and critical illnesses in a range of environments, including pre-hospital triage, emergency department, and critical care settings. The increasing availability of light-weight, robust, user-friendly, and low-cost portable ultrasound equipment is particularly suited for use in the physically and temporally challenging environment of a multiple casualty incident (MCI). Currently established ultrasound applications used to identify potentially lethal thoracic or abdominal conditions offer a base upon which rapid, focused protocols using hand-carried emergency ultrasonography could be developed. Following a detailed review of the current use of portable ultrasonography in military and civilian MCI settings, we propose a protocol for sonographic evaluation of the chest, abdomen, vena cava, and extremities for acute triage. The protocol is two-tiered, based on the urgency and technical difficulty of the sonographic examination. In addition to utilization of well-established bedside abdominal and thoracic sonography applications, this protocol incorporates extremity assessment for long-bone fractures. Studies of the proposed protocol will need to be conducted to determine its utility in simulated and actual MCI settings.

Stawicki, Stanislaw Peter; Howard, James M; Pryor, John P; Bahner, David P; Whitmill, Melissa L; Dean, Anthony J

2010-01-01

37

Planning for a Mass Casualty Incident in Arkansas Schools  

ERIC Educational Resources Information Center

School preparedness includes the possibility of a natural disaster, but recent events also confirm a need for preparedness and prevention efforts for intentional mass casualty incidents (MCIs). This survey examined the preparedness for the prevention and response for MCIs at public schools in Arkansas. This survey demonstrated that most school…

Patterson, Harry; Liggin, Rebecca; Shirm, Steve; Nation, Brian; Dick, Rhonda

2005-01-01

38

Loss of cabin pressure in a military transport: a mass casualty with decompression illnesses.  

PubMed

Presented here is the sudden cabin depressurization of a military C-130 aircraft carrying 66 personnel. They suffered a depressurization from 2134 to 7317 m, resulting in a potential 66-person mass casualty. The aircrew were able to descend to below 3049 m in less than 5 min. They landed in the Kingdom of Bahrain--the nearest hyperbaric recompression facility. Three cases of peripheral neurologic DCS and one case of spinal DCS were identified. Limited manning, unique host nation concerns, and limited available assets led to difficulties in triage, patient transport, and asset allocation. These led to difficult decisions regarding when and for whom to initiate ground level oxygen or hyperbaric recompression therapy. PMID:18457302

Johnston, Mickaila J

2008-04-01

39

Evacuation Priorities in Mass Casualty Terror-Related Events  

PubMed Central

Objective: To assess evacuation priorities during terror-related mass casualty incidents (MCIs) and their implications for hospital organization/contingency planning. Summary Background Data: Trauma guidelines recommend evacuation of critically injured patients to Level I trauma centers. The recent MCIs in Israel offered an opportunity to study the impositions placed on a prehospital emergency medical service (EMS) regarding evacuation priorities in these circumstances. Methods: A retrospective analysis of medical evacuations from MCIs (29.9.2000–31.9.2002) performed by the Israeli National EMS rescue teams. Results: Thirty-three MCIs yielded data on 1156 casualties. Only 57% (506) of the 1123 available and mobilized ambulances were needed to provide 612 evacuations. Rescue teams arrived on scene within <5 minutes and evacuated the last urgent casualty within 15–20 minutes. The majority of non-urgent and urgent patients were transported to medical centers close to the event. Less than half of the urgent casualties were evacuated to more distant trauma centers. Independent variables predicting evacuation to a trauma center were its being the hospital closest to the event (OR 249.2, P < 0.001), evacuation within <10 minutes of the event (OR 9.3, P = 0.003), and having an urgent patient on the ambulance (OR 5.6, P < 0.001). Conclusions: Hospitals nearby terror-induced MCIs play a major role in trauma patient care. Thus, all hospitals should be included in contingency plans for MCIs. Further research into the implications of evacuation of the most severely injured casualties to the nearest hospital while evacuating all other casualties to various hospitals in the area is needed. The challenges posed by terror-induced MCIs require consideration of a paradigm shift in trauma care.

Einav, Sharon; Feigenberg, Zvi; Weissman, Charles; Zaichik, Daniel; Caspi, Guy; Kotler, Doron; Freund, Herbert R.

2004-01-01

40

Organizing the orthopaedic trauma association mass casualty response team.  

PubMed

Physicians and surgeons in the United States have become increasingly aware of the requirement for an organized response to mass casualty and disaster situations. This has not always been the case. The terrorist acts in Oklahoma City in 1995 and at the World Trade Center in 1993 and 2001 showed the inefficiencies and confusion of the civilian managed disaster response. Trauma surgeons are uniquely suited to play a leadership role in the planning and coordination of disaster care because of their integration in prehospital emergency medical systems and trauma centers. The Orthopaedic Trauma Association has developed strategies to facilitate the orthopaedic response to mass casualties and to develop an educated approach to disaster management. The current initiatives include the establishment of a link with the American College of Surgeons Committee on Trauma in addition to the development of training programs for orthopaedic surgeons as responders to disaster and mass casualty situations. A team of volunteer orthopaedic traumatologists also has been credentialed to become part of the National Disaster Medical System's International Medical-Surgical Response Team. PMID:15187842

Born, Christopher T; DeLong, William G

2004-05-01

41

A burn mass casualty event due to boiler room explosion on a cruise ship: preparedness and outcomes.  

PubMed

The purpose of this study was to review our experience with a mass casualty incident resulting from a boiler room steam explosion aboard a cruise ship. Experience with major, moderate, and minor burns, steam inhalation, mass casualty response systems, and psychological sequelae will be discussed. Fifteen cruise ship employees were brought to the burn center after a boiler room explosion on a cruise ship. Eleven were triaged to the trauma resuscitation area and four to the surgical emergency room. Seven patients were intubated for respiratory distress or airway protection. Six patients had >80 per cent burns with steam inhalation, and all of these died. One of the 6 patients had 99 per cent burns with steam inhalation and died after withdrawal of support within the first several hours. All patients with major burns required escharotomy on arrival to trauma resuscitation. One patient died in the operating room, despite decompression by laparotomy for abdominal compartment syndrome and pericardiotomy via thoracotomy for cardiac tamponade. Four patients required crystalloid, 20,000 mls/m2-27,000 ml/m2 body surface area (BSA) in the first 48 hours to maintain blood pressure and urine output. Three of these four patients subsequently developed abdominal compartment syndrome and died in the first few days. The fourth patient of this group died after 26 days due to sepsis. Five patients had 13-20 per cent bums and four patients had less than 10 per cent burns. Two of the patients with 20 per cent burns developed edema of the vocal cords with mild hoarseness. They improved and recovered without intubation. The facility was prepared for the mass casualty event; having just completed a mass casualty drill several days earlier. Twenty-six beds were made available in 50 minutes for anticipated casualties. Fifteen physicians reported immediately to the trauma resuscitation area to assist in initial stabilization. The event occurred at shift change; thus, adequate support personnel were instantaneously to hand. Our mass casualty preparation proved useful in managing this event. Most of the patients who survived showed signs of post-traumatic stress syndrome, which was diagnosed and treated by the burn center psychology team. Despite our efforts at treating large burns (>80%) with steam inhalation, mortality was 100 per cent. Fluid requirements far exceeded those predicted by the Parkland (Baxter) formula. Abdominal compartment syndrome proved to be a significant complication of this fluid resuscitation. A coordinated effort by the facility and preparation for mass casualty events are needed to respond to such events. PMID:15869134

Tekin, Akin; Namias, Nicholas; O'Keeffe, Terence; Pizano, Louis; Lynn, Mauricio; Prater-Varas, Robin; Quintana, Olga Delia; Borges, Leda; Ishii, Mary; Lee, Seong; Lopez, Peter; Lessner-Eisenberg, Sharon; Alvarez, Angel; Ellison, Tom; Sapnas, Katherine; Lefton, Jennifer; Ward, Charles Gillon

2005-03-01

42

[Personality identification based on the outcomes of mass casualty events].  

PubMed

This study concerns the problem of personality identification based on the outcomes of mass casualty events. New organizational measures are proposed to optimize the work with cadaveric materials. Specifically, they envisage creation of four major working groups and organization of their cooperation along the following lines: collection and delivery of postmortem information, systematization of antemortal information, and functioning of the identification centre. DNA-technologies and computer-assisted data processing are shown to find the increasingly wider application for personality identification. PMID:22567959

Shcherbakov, V V; Shcherbakova, E V

43

Pediatric and neonatal interfacility transport medicine after mass casualty incidents.  

PubMed

Pediatric and neonatal interfacility transport medicine is a relatively young but a rapidly evolving specialty. Transport teams are essential for the safe interfacility movement of critically ill patients. A mass casualty incident (MCI) can present major challenges for a critical care transport team. This article will examine the capabilities and limitations of pediatric and neonatal critical care transport teams. The predicaments brought about by Hurricane Katrina that hindered the evacuation of pediatric and neonatal patients out of ravaged hospitals are also reviewed. From these experiences, recommendations to improve the efficiency and efficacy of interfacility transport of pediatric patients will be presented. PMID:19667853

Lowe, Calvin G

2009-08-01

44

A mass casualty incident involving children and chemical decontamination.  

PubMed

Mass casualty incidents involving contaminated children are a rare but ever-present possibility. In this article we outline one such event that resulted in 53 pediatric patients and 3 adults presenting to the emergency department of a children's hospital for decontamination and treatment. We pay special attention to the training that allowed this responses to occur. We also outline the institutional response with emphasis on incident command, communication, and resource utilization. Specific lessons learned are explored in detail. Finally, we set forth a series of recommendations to assist other institutions should they be called upon to care for and decontaminate pediatric patients. PMID:17517363

Timm, Nathan; Reeves, Scott

45

Mass casualties and health care following the release of toxic chemicals or radioactive material--contribution of modern biotechnology.  

PubMed

Catastrophic chemical or radiological events can cause thousands of casualties. Such disasters require triage procedures to identify the development of health consequences requiring medical intervention. Our objective is to analyze recent advancements in biotechnology for triage in mass emergency situations. In addition to identifying persons "at risk" of developing health problems, these technologies can aid in securing the unaffected or "worried well". We also highlight the need for public/private partnerships to engage in some of the underpinning sciences, such as patho-physiological mechanisms of chemical and radiological hazards, and for the necessary investment in the development of rapid assessment tools through identification of biochemical, molecular, and genetic biomarkers to predict health effects. For chemical agents, biomarkers of neurotoxicity, lung damage, and clinical and epidemiological databases are needed to assess acute and chronic effects of exposures. For radiological exposures, development of rapid, sensitive biomarkers using advanced biotechnologies are needed to sort exposed persons at risk of life-threatening effects from persons with long-term risk or no risk. The final implementation of rapid and portable diagnostics tools suitable for emergency care providers to guide triage and medical countermeasures use will need public support, since commercial incentives are lacking. PMID:22408587

Göransson Nyberg, Ann; Stricklin, Daniela; Sellström, Åke

2011-12-07

46

Mass Casualties and Health Care Following the Release of Toxic Chemicals or Radioactive Material--Contribution of Modern Biotechnology  

PubMed Central

Catastrophic chemical or radiological events can cause thousands of casualties. Such disasters require triage procedures to identify the development of health consequences requiring medical intervention. Our objective is to analyze recent advancements in biotechnology for triage in mass emergency situations. In addition to identifying persons “at risk” of developing health problems, these technologies can aid in securing the unaffected or “worried well”. We also highlight the need for public/private partnerships to engage in some of the underpinning sciences, such as patho-physiological mechanisms of chemical and radiological hazards, and for the necessary investment in the development of rapid assessment tools through identification of biochemical, molecular, and genetic biomarkers to predict health effects. For chemical agents, biomarkers of neurotoxicity, lung damage, and clinical and epidemiological databases are needed to assess acute and chronic effects of exposures. For radiological exposures, development of rapid, sensitive biomarkers using advanced biotechnologies are needed to sort exposed persons at risk of life-threatening effects from persons with long-term risk or no risk. The final implementation of rapid and portable diagnostics tools suitable for emergency care providers to guide triage and medical countermeasures use will need public support, since commercial incentives are lacking.

Goransson Nyberg, Ann; Stricklin, Daniela; Sellstrom, Ake

2011-01-01

47

Sample Tracking in an Automated Cytogenetic Biodosimetry Laboratory for Radiation Mass Casualties  

PubMed Central

Chromosome aberration-based dicentric assay is expected to be used after mass casualty life-threatening radiation exposures to assess radiation dose to individuals. This will require processing of a large number of samples for individual dose assessment and clinical triage to aid treatment decisions. We have established an automated, high-throughput, cytogenetic biodosimetry laboratory to process a large number of samples for conducting the dicentric assay using peripheral blood from exposed individuals according to internationally accepted laboratory protocols (i.e., within days following radiation exposures). The components of an automated cytogenetic biodosimetry laboratory include blood collection kits for sample shipment, a cell viability analyzer, a robotic liquid handler, an automated metaphase harvester, a metaphase spreader, high-throughput slide stainer and coverslipper, a high-throughput metaphase finder, multiple satellite chromosome-aberration analysis systems, and a computerized sample tracking system. Laboratory automation using commercially available, off-the-shelf technologies, customized technology integration, and implementation of a laboratory information management system (LIMS) for cytogenetic analysis will significantly increase throughput. This paper focuses on our efforts to eliminate data transcription errors, increase efficiency, and maintain samples’ positive chain-of-custody by sample tracking during sample processing and data analysis. This sample tracking system represents a “beta” version, which can be modeled elsewhere in a cytogenetic biodosimetry laboratory, and includes a customized LIMS with a central server, personal computer workstations, barcode printers, fixed station and wireless hand-held devices to scan barcodes at various critical steps, and data transmission over a private intra-laboratory computer network. Our studies will improve diagnostic biodosimetry response, aid confirmation of clinical triage, and medical management of radiation exposed individuals.

Martin, P.R.; Berdychevski, R.E.; Subramanian, U.; Blakely, W.F.; Prasanna, P.G.S.

2007-01-01

48

Management of pediatric trauma: Blast victims in a mass casualty incident  

Microsoft Academic Search

Mass casualty events are increasing both worldwide and domestically. The majority of our national experience with mass casualties has come from our military experience and several notable domestic events, including the Oklahoma City bombing and, more recently, the World Trade Center and Pentagon attacks. The objective of this paper is to review the lessons learned from these events and examine

R. Todd Maxson

2002-01-01

49

Improving hospital mass casualty preparedness through ongoing readiness evaluation.  

PubMed

The objective of this study was to investigate the effect of ongoing use of an evaluation tool on hospitals' emergency preparedness for mass casualty events (MCEs). Two cycles of evaluation of emergency preparedness were conducted based on measurable parameters. A significant increase was found in mean total scores between the 2 cycles (from 77.1 to 88.5). An increase was found in scores for standard operating procedures, training, and equipment, but the change was significant only in the training category. Relative increase was highest for hospitals that did not experience real MCEs. This study offers a structured and practical approach for ongoing improvement of emergency preparedness, based on validated, measurable benchmarks. Ongoing assessment of emergency preparedness motivates hospitals to improve capabilities and results in a more effective emergency response mechanism. Use of predetermined and measurable benchmarks allows the institutions being assessed to improve their level of performance in the areas evaluated. PMID:22326978

Adini, Bruria; Laor, Daniel; Hornik-Lurie, Tzipora; Schwartz, Dagan; Aharonson-Daniel, Limor

2012-02-10

50

Mass casualty following unprecedented tornadic events in the Southeast: natural disaster outcomes at a Level I trauma center.  

PubMed

On April 27, 2011, an EF4 (enhanced Fujita scale) tornado struck a 48-mile path across northwest Georgia and southeast Tennessee. Traumatic injuries sustained during this tornado and others in one of the largest tornado outbreaks in history presented to the regional Level I trauma center, Erlanger Health System, in Chattanooga, TN. Patients were triaged per mass casualty protocols through an incident command center and triage officer. Medical staffing was increased to anticipate a large patient load. Records of patients admitted as a result of tornado-related injury were retrospectively reviewed and characterized by the injury patterns, demographics, procedures performed, length of stay, and complications. One hundred four adult patients were treated in the emergency department; of these, 28 (27%) patients required admission to the trauma service. Of those admitted, 16 (57%) were male with an age range of 21 to 87 years old and an average length of stay of 10.9 ± 11.8 days. Eleven (39%) patients required intensive care unit admissions. The most common injuries seen were those of soft tissue, bony fractures, and the chest. Interventions included tube thoracostomies, exploratory laparotomies, orthopedic fixations, soft tissue reconstructions, and craniotomy. All 28 patients admitted survived to discharge. Nineteen (68%) patients were discharged home, six (21%) went to a rehabilitation hospital, and three (11%) were transferred to skilled nursing facilities. Emergency preparedness and organization are key elements in effectively treating victims of natural disasters. Those victims who survive the initial tornadic event and present to a Level I trauma center have low mortality. Like in our experience, triage protocols need to be implemented to quickly and effectively manage mass injuries. PMID:22748536

Hartmann, Elizabeth H; Creel, Nathan; Lepard, Jacob; Maxwell, Robert A

2012-07-01

51

[The role of patient flow and surge capacity for in-hospital response in mass casualty events].  

PubMed

Mass casualty events make demands on emergency services and disaster control. However, optimized in- hospital response defines the quality of definitive care. Therefore, German federal law governs the role of hospitals in mass casualty incidents. In hospital casualty surge is depending on resources that have to be expanded with a practicable alarm plan. Thus, in-hospital mass casualty management planning is recommended to be organized by specialized persons. To minimise inhospital patient overflow casualty surge principles have to be implemented in both, pre-hospital and in-hospital disaster planning. World soccer championship 2006 facilitated the initiation of surge and damage control principles in in-hospital disaster planning strategies for German hospitals. The presented concept of strict control of in-hospital patient flow using surge principles minimises the risk of in-hospital breakdown and increases definitive hospital treatment capacity in mass casualty incidents. PMID:18350477

Sefrin, Peter; Kuhnigk, Herbert

2008-03-01

52

An Intelligent 802.11 Triage Tag For Medical Response to Disasters  

PubMed Central

When medical care is initiated at a mass casualty event, the first activity is the triage of victims, which is the grouping by victims severity of injury. Paper triage tags are often used to mark victims’ triage status and to record information on injuries and treatments administered in the field. In this paper we describe the design and development of an“Intelligent Triage Tag” (ITT), an electronic device to coordinate patient field care. ITTs combine the basic functionality of a paper triage tag with sensors, nonvolatile memory, a microprocessor and 802.11 wireless transmission capabilities. ITTs not only display victims' triage status but also signal alerts, and mark patients for transport or immediate medical attention. ITTs record medical data for later access offsite and help organize care by relaying information on the location of the victims during field treatment. ITTs are a part of the Wireless Information System for Medical Response in Disasters (WIISARD) architecture.

Lenert, Leslie A.; Palmer, Douglas A.; Chan, Theodore C; Rao, Ramesh

2005-01-01

53

Anthropologist-Directed Triage: Three Distinct Mass Fatality Events Involving Fragmentation of Human Remains  

Microsoft Academic Search

Identifying victims from mass fatality events requires the synchronization of several processes including, but not limited to, recovery, antemortem information collection, mortuary processes, death certification, family assistance, and finally, repatriation. This chapter will discuss one small aspect of the mortuary process, triage, and its interplay with other aspects of the process of identifying highly fragmented remains. Specifically, this paper will

Amy Z. Mundorff

54

Suicide bombings: process of care of mass casualties in the developing world.  

PubMed

In recent times Pakistan's biggest city, Karachi, has witnessed numerous terrorist attacks. The city does not have an emergency response system and only one of the three public sector hospitals has a trauma centre. We describe the pattern of injuries and management of two terror-related mass casualty incidents involving suicide bombers in a developing nation with limited resources. The first incident occurred in May 2002 with 36 casualties, of whom 13 (36%) died immediately and 11 (30.5%) died at the primary receiving hospitals. The second incident was targeted against the local population in May 2004. The blast resulted in 104 casualties, of which 14 (13.46%) died at the site. All patients had their initial assessment and treatment based on Advanced Trauma and Life Support principles and documented on a trauma form. PMID:19624704

Umer, Masood; Sepah, Yasir J; Shahpurwala, Munira M; Zafar, Hasnain

2009-07-14

55

Effect of Hospital Staff Surge Capacity on Preparedness for a Conventional Mass Casualty Event  

PubMed Central

Objectives: To assess current medical staffing levels within the Hospital Referral System in the City of Cape Town Metropolitan Municipality, South Africa, and analyze the surge capacity needs to prepare for the potential of a conventional mass casualty incident during a planned mass gathering. Methods: Query of all available medical databases of both state employees and private medical personnel within the greater Cape Town area to determine current staffing levels and distribution of personnel across public and private domains. Analysis of the adequacy of available staff to manage a mass casualty incident. Results: There are 594 advanced pre-hospital personnel in Cape Town (17/100,000 population) and 142 basic pre-hospital personnel (4.6/100,000). The total number of hospital and clinic-based medical practitioners is 3097 (88.6/100,000), consisting of 1914 general physicians; 54.7/100,000 and 1183 specialist physicians; 33.8/100,000. Vacancy rates for all medical practitioners range from 23.5% to 25.5%. This includes: nursing post vacancies (26%), basic emergency care practitioners (39.3%), advanced emergency care personnel (66.8%), pharmacy assistants (42.6%), and pharmacists (33.1%). Conclusion: There are sufficient numbers and types of personnel to provide the expected ordinary healthcare needs at mass gathering sites in Cape Town; however, qualified staff are likely insufficient to manage a concurrent mass casualty event. Considering that adequate correctly skilled and trained staff form the backbone of disaster surge capacity, it appears that Cape Town is currently under resourced to manage a mass casualty event. With the increasing size and frequency of mass gathering events worldwide, adequate disaster surge capacity is an issue of global relevance.

Welzel, Tyson B.; Koenig, Kristi L.; Bey, Tareg; Visser, Errol

2010-01-01

56

Taking a Regional Healthcare Coalition Approach to Mitigating Surge Capacity Needs of Mass Casualty or Pandemic Events.  

National Technical Information Service (NTIS)

Hospitals and healthcare facilities are not able to singularly mitigate the patient surge from a mass-casualty incident or pandemic health event. The potential volume of patients demands that regional healthcare communities be able to respond as a unified...

J. A. McElwee

2012-01-01

57

Resource planning for ambulance services in mass casualty incidents: a DES-based policy model.  

PubMed

Due to an increasing number of mass casualty incidents, which are generally complex and unique in nature, we suggest that decision makers consider operations research-based policy models to help prepare emergency staff for improved planning and scheduling at the emergency site. We thus develop a discrete-event simulation policy model, which is currently being applied by disaster-responsive ambulance services in Austria. By evaluating realistic scenarios, our policy model is shown to enhance the scheduling and outcomes at operative and online levels. The proposed scenarios range from small, simple, and urban to rather large, complex, remote mass casualty emergencies. Furthermore, the organization of an advanced medical post can be improved on a strategic level to increase rescue quality, including enhanced survival of injured victims. In particular, we consider a realistic mass casualty incident at a brewery relative to other exemplary disasters. Based on a variety of such situations, we derive general policy implications at both the macro (e.g., strategic rescue policy) and micro (e.g., operative and online scheduling strategies at the emergency site) levels. PMID:22653522

Rauner, Marion S; Schaffhauser-Linzatti, Michaela M; Niessner, Helmut

2012-06-01

58

Explosive outbreak of gastroenteritis on an aircraft carrier: an infectious disease mass casualty situation.  

PubMed

An aircraft carrier experienced 777 cases of acute gastroenteritis while deployed in the eastern Mediterranean over a 16-d period. These cases were noted in the 5,000-man crew, suggesting a cumulative incidence rate of 15%, though many sailors did not seek medical care for their symptoms. The onboard medical department response included epidemiological investigation with unique shipboard facility considerations, development of a treatment plan, and implementation of preventive/educational programs. Implications for nontrauma related mass casualty situations are discussed. Flight surgeons and operational medicine physicians must have a solid foundation in general preventive medicine to fulfill their responsibilities. PMID:8357320

Bohnker, B; McEwen, G; Feeks, E; Palombaro, J

1993-07-01

59

Mass casualties: an organizational model of a hospital information center in Tel Aviv.  

PubMed

The article describes an organizational model of an information center, developed by the social work department of Tel Aviv Sourasky Medical Center. The information center is designed to provide information when mass casualties are brought to the hospital following terrorist attacks or other catastrophes. The information center is comprised of a number of interrelated units within the hospital and is in contact with a range of organizations in the community. The structure and activities of the various units is described. The article also discusses a number of aspects relevant to personnel organization in crisis intervention. PMID:9680656

Drory, M; Posen, J; Vilner, D; Ginzburg, K

1998-01-01

60

Enhancing Public Resilience to Mass-Casualty WMD Terrorism in the United States: Definitions, Challenges, and Recommendations.  

National Technical Information Service (NTIS)

This paper concerns how to enhance public resilience to mass-casualty terrorist attacks with weapons of mass destruction (WMD) in the United States. It aims to develop an actionable definition of public resilience, i.e., one that can be related to specifi...

J. D. Wood J. H. Pollack

2010-01-01

61

A pan-European study of capabilities to manage mass casualties from the release of chemical agents: the MASH project.  

PubMed

The European Union (EU) Mass Casualties and Health (MASH) project that ran between 2008 and 2010 was designed to study the management of mass casualties from chemical and radiological releases and associated health implications. One area of study for this project concerned arrangements within EU Member States for the management of mass casualties following a chemical release. This was undertaken via a confidential online questionnaire that was sent to selected points of contact throughout the EU. Responses were obtained from 18 states from respondents holding senior positions in chemical planning and incident response. Information gathered shows a lack of uniformity within the EU about the organization of responses to chemical releases and the provision of medical care. This article presents the overall findings of the study demonstrating differences between countries on planning and organization, decontamination, prehospital emergency medical responses, clinical diagnoses, and therapy and aftercare. Although there may be an understandable reluctance from national respondents to share information on security and other grounds, the findings, nevertheless, revealed substantial differences between current planning and operational responses within the EU states for the management of mass chemical casualties. The existing international networks for response to radiation incidents are not yet matched by equivalent networks for chemical responses yet sufficient information was available from the study to identify potential deficiencies, identify common casualty management pathways, and to make recommendations for future operations within the EU. Improvements in awareness and training and the application of modern information and communications will help to remedy this situation. Specialized advanced life support and other medical care for chemical casualties appear lacking in some countries. A program of specialized training and action are required to apply the findings revealed by the MASH study into a unified cross-border emergency medical response. PMID:23716370

Baker, David J; Murray, Virginia S G; Carli, Pierre A

2013-01-01

62

Oral and Enteral Resuscitation of Burn Shock The Historical Record and Implications for Mass Casualty Care  

PubMed Central

In the aftermath of a mass disaster, standard care methods for treatment of burn injury will often not be available for all victims. A method of fluid resuscitation for burns that has largely been forgotten by contemporary burn experts is enteral resuscitation. We identified 12 studies with over 700 patients treated with enteral resuscitation, defined as drinking or gastric infusion of salt solutions, from the literature. These studies suggest that enteral resuscitation can be an effective treatment for burn shock under conditions in which the standard IV therapy is unavailable or delayed, such as in mass disasters and combat casualties. Enteral resuscitation of burn shock was effective in patients with moderate (10–40% TBSA) and in some patients with more severe injuries. The data suggests that some hypovolemic burn and trauma patients can be treated exclusively with enteral resuscitation, and others might benefit from enteral resuscitation as an initial alternative and a supplement to IV therapy. A complication of enteral resuscitation was vomiting, which occurred less in children and much less when therapy was initiated within the first postburn hour. Enteral resuscitation is contra-indicated when the patient is in “peripheral circulatory collapse”. The optimal enteral solution and regimen has not yet been defined, nor has its efficacy been tested against modern IV resuscitation. The oldest studies used glucose-free solutions of buffered isotonic and hypotonic saline. Studies that are more recent show benefit of adding glucose to electrolyte solutions similar to those used in the treatment of cholera. If IV therapy for mass casualty care is delayed due to logistical constraints, enteral resuscitation should be considered.

Kramer, George C.; Michell, Michael W.; Oliveira, Hermes; Brown, Tim La H.; Herndon, David; Baker, R. David; Muller, Michael

2010-01-01

63

Dynamic 3D visual analytic tools: a method for maintaining situational awareness during high tempo warfare or mass casualty operations  

Microsoft Academic Search

Maintaining Situational Awareness (SA) is crucial to the success of high tempo operations, such as war fighting and mass casualty events (bioterrorism, natural disasters). Modern computer and software applications attempt to provide command and control manager's situational awareness via the collection, integration, interrogation and display of vast amounts of analytic data in real-time from a multitude of data sources and

Todd E. Lizotte

2010-01-01

64

An Engineer’s Mathematical Approach to Designing an Emergency Room Decontamination Area for Weapons of Mass Destruction Casualties  

Microsoft Academic Search

This study will focus on the potential requirements for an emergency response facility in case of weapons of mass destruction casualties proposing mathematical models. A complete emergency room layout will be designed taking the following analyses and requirements into consideration: quality function development (QFD) and product layout; average number of patients in the system, average time in the system, average

Eldo E. Frezza; Erica Fletcher; Veronica Flores; Ellen Popolo; Fay Tal Placido

2007-01-01

65

Mass casualty incident surveillance and monitoring using identity aware video analytics.  

PubMed

In this paper, we propose an identity aware video analytic system that can assist securing the perimeter of a mass casualty incident scene and generate identity annotated video records for forensics and training purposes. Establishing a secure incident scene perimeter and enforcing access control to different zones is a demanding task for current video surveillance systems which lack the ability to provide the identity of the target and its security clearance. Our system which combines active RFID sensors with video analytic tools recovers the identity of the target enabling the activation of suitable alert policies. The system also enables annotation of incident scene video with identity metadata, facilitating the incident response process reconstruction for forensics analysis and emergency response training. PMID:21096870

Yu, Xunyi; Ganz, Aura

2010-01-01

66

Factors influencing injury severity score regarding Thai military personnel injured in mass casualty incident April 10, 2010: lessons learned from armed conflict casualties: a retrospective study  

PubMed Central

Background Political conflicts in Bangkok, Thailand have caused mass casualties, especially the latest event April 10, 2010, in which many military personnel were injured. Most of them were transferred to Phramongkutklao Hospital, the largest military hospital in Thailand. The current study aimed to assess factors influencing Injury Severity Score (ISS) regarding Thai military personnel injured in the mass casualty incident (MCI) April 10, 2010. Methods A total of 728 injured soldiers transferred to Phramongkutklao Hospital were reviewed. Descriptive statistics was used to display characteristics of the injuries, relationship between mechanism of injury and injured body regions. Multiple logistic regressions were used to calculate the adjusted odds ratio (adjusted OR) of ISS comparing injured body region categories. Results In all, 153 subjects defined as major data category were enrolled in this study. Blast injury was the most common mechanism of injury (90.2%). These victims displayed 276 injured body regions. The most common injured body region was the extremities (48.5%). A total of 18 patients (11.7%) had an ISS revealing more than 16 points. Three victims who died were expected to die due to high Trauma and Injury Severity Score (TRISS). However, one with high TRISS survived. Factors influencing ISS were age (p = 0.04), abdomen injury (adjusted OR = 29.9; 95% CI, 5.8-153.5; P < 0.01), head & neck injury (adjusted OR = 13.8; 95% CI, 2.4-80.4; P < 0.01) and chest injury (adjusted OR = 9.9; 95% CI, 2.1-47.3; P < 0.01). Conclusions Blast injury was the most common mechanism of injury among Thai military personnel injured in the MCI April 10, 2010. Age and injured body region such as head & neck, chest and abdomen significantly influenced ISS. These factors should be investigated for effective medical treatment and preparing protective equipment to prevent such injuries in the future.

2012-01-01

67

Clinical review: The role of the intensive care physician in mass casualty incidents: planning, organisation, and leadership  

Microsoft Academic Search

There is a long-standing, broad assumption that hospitals will ably receive and efficiently provide comprehensive care to victims following a mass casualty event. Unfortunately, the majority of medical major incident plans are insufficiently focused on strategies and procedures that extend beyond the pre-hospital and early-hospital phases of care. Recent events underscore two important lessons: (a) the role of intensive care

Peter J Shirley; Gerlinde Mandersloot

2008-01-01

68

Family support and victim identification in mass casualty terrorist attacks: an integrative approach.  

PubMed

Terrorist bombing attacks in Israel between 2000 and 2004 caused mass casualties. After each attack in the north of Israel, Rambam Medical Center, the largest hospital in the region, absorbs the majority of injured, especially the more severely injured and unidentified victims. Immediately with the media reports of a terrorist attack, tens of relatives come to the hospital, looking for missing family members. This paper describes an assistance unit for families of unidentified victims. It is staffed by the hospital's social work department, and its tasks are to identify the unidentified victims, help relatives find and be united with them, and assist other relatives in the identification of bodies of deceased family members. The process involves gathering information from relatives and cross-checking it with data and pictures from the hospitals' emergency and operating rooms; and providing crisis intervention and psychological first aid to victims' relatives. The family assistance unit works with several other professional units in the hospital and in the community, and always adjusts its operations to the features of each event. Clearer guidelines for dynamic training of social workers and research-based interventions to prevent compassion fatigue among the workers must be further developed. PMID:16107044

Gagin, Roni; Cohen, Miri; Peled-Avram, Maya

2005-01-01

69

Expedited electronic entry: a new way to manage mass-casualty radiology order workflow.  

PubMed

One of the important tenets of emergency preparedness is that planning for disaster response should resemble standard operating procedure whenever possible. Electronic order entry has become part of the standard operating procedures of most institutions but many of these systems are either too cumbersome for use during a surge or can even be rendered non-functional during a sudden patient surge such as a mass-casualty incident (MCI). Presented here is an experience with delayed radiology order entry during a recent MCI and the after action programming of the system based on this real experience. In response to the after action analysis of the MCI, a task force was assigned to solve the MCI radiology order entry problem and a solution to streamline disaster image ordering was devised. A "browse page" was created that lists every x-ray and every CT scan that might be needed in such an event with all required information defaulted to "Disaster." This created a way to order multiple images for any one patient, with 40% time saving over standard electronic order entry. This disaster radiology order entry solution is an example of the surge preparedness needed to promote patient safety and efficient care delivery as the widespread deployment of electronic health records and order entry continues across the United States. PMID:23731567

Bookman, Kelly; Zane, Richard

2013-04-26

70

Radiologic diagnosis of explosion casualties.  

PubMed

The threat of terrorist events on domestic soil remains an ever-present risk. Despite the notoriety of unconventional weapons, the mainstay in the armament of the terrorist organization is the conventional explosive. Conventional explosives are easily weaponized and readily obtainable, and the recipes are widely available over the Internet. According to the US Department of State and the Federal Bureau of Investigation, over one half of the global terrorist events involve explosions, averaging two explosive events per day worldwide in 2005 (Terrorism Research Center. Available at www.terrorism.com. Accessed April 1, 2007). The Future of Emergency Care in the United States Health System: Emergency Medical Services at the Crossroads, published by the Institute of Medicine, states that explosions were the most common cause of injuries associated with terrorism (Institute of Medicine Report: The Future of Emergency Care in the United States Health System: Emergency Medical Services at the Crossroads. Washington DC: National Academic Press, 2007). Explosive events have the potential to inflict numerous casualties with multiple injuries. The complexity of this scenario is exacerbated by the fact that few providers or medical facilities have experience with mass casualty events in which human and material resources can be rapidly overwhelmed. Care of explosive-related injury is based on same principles as that of standard trauma management paradigms. The basic difference between explosion-related injury and other injury mechanisms are the number of patients and multiplicity of injuries, which require a higher allocation of resources. With this caveat, the appropriate utilization of radiology resources has the potential to impact in-hospital diagnosis and triage and is an essential element in optimizing the management of the explosive-injured patients. PMID:19069034

Eastridge, Brian J; Blackbourne, Lorne; Wade, Charles E; Holcomb, John B

71

Medical Treatment of Radiological Casualties: Current Concepts  

Microsoft Academic Search

The threat of radiologic or nuclear terrorism is increasing, yet many physicians are unfamiliar with basic treatment principles for radiologic casualties. Patients may present for care after a covert radiation exposure, requiring an elevated level of suspicion by the physician. Traditional medical and surgical triage criteria should always take precedence over radiation exposure management or decontamina- tion. External contamination from

Kristi L. Koenig; Ronald E. Goans; Richard J. Hatchett

2005-01-01

72

Death of an infant after contacting a telephone triage call centre: is telephone triage really safe?  

PubMed

The death of a previously well 13-month-old infant approximately 5 h after his mother contacted the Queensland Nurse led telephone triage call centre '13Health' for advice is the first Australian casualty of telephone triage. Experience from this case and another 'near miss' incident Australia highlight the potential of this model of care to harm patients using the service when it attempts to provide health advice compared with health information. PMID:22802265

Nocera, Antony

2010-12-13

73

National strategy for mass casualty situations and its effects on the hospital.  

PubMed

A mass-casualty situation (MCS) usually is short in duration and resolves itself. To minimize the risks to patients during MCS, planning is essential. This article summarizes the preparations needed at the hospital level, for a local MCS involving numerous trauma victims arriving to the Emergency Department at a short notice. Experiences and conclusions related to the implementation of the Israeli strategy in one hospital that combines the responsibilities of both the military and civilians are summarized. The Ministry of Health distributes the master MCS plan to each hospital where a local committee adapts it to the specific situation in a format of standing orders. After its approval by the Ministry of Health, an annual inspection is conducted to check the ability of the staff to manage a MCS. A full-scale drill is conducted every second year during which each site's readiness level and the continuity of the flow of care are tested. In building the strategy for treating trauma victims during a MCS, a few assumptions were taken into account. The goal of treatment in a MCS is to deliver an acceptable quality of care while preserving as many lives as is possible. In theory, the capacity of the hospital is its ability to manage a load of patients in the range of 20% of the hospital bed capacity. Planning and drilling are the ways to minimize deviations from the guidelines and to avoid management mistakes. Special attention should be paid to problems related to the initial phase of receiving the first message, outside communication, inside hospital communication, and staff recruitment. Other issues include: free access to the hospital; opening a public information center; and dealing with the media and very important persons (VIPs). A new method for creating the needed MCS plan in the hospital is suggested. It is based upon knowledge of management techniques that used multi-level documents, which are spread via Intranet between the different key figures. Using this method, it is possible to keep the strategy, the source documentation, and reasons for choosing it, as well as immediate release of checklists for each functions. This detailed, time consuming work is worthwhile in the long run, when the benefits of easy updating and better preparedness are apparent. PMID:12357558

Levi, Leon; Michaelson, Moshe; Admi, Hanna; Bregman, David; Bar-Nahor, Ronen

74

REPEAT TRIAGE IN DISASTER RELIEF: QUESTIONS FROM HAITI  

PubMed Central

During a mass casualty disaster, the acute imbalance between need for treatment and capacity to supply care poses difficult rationing problems. It is common to assume that such disasters call for “utilitarian” procedures that deliberately prioritize saving the most lives over other considerations. A group of medical responders to the 2010 Haitian earthquake faced particular challenges in determining how to allocate limited treatment, time and other resources between existing patients and potential patients not yet under care. We identified that rationing dilemmas points occurred at three points: when care had to be limited, when care had to be completed prematurely, and when care had to be withdrawn. “Repeat triage” refers to rationing challenges occurring at all these points, where the allocation of care is between existing and potential patients. By contrast, “initial triage” designates the allocation of access to treatment among new arrivals, all of whom are potential patients. Repeat and initial triage differ significantly. Several considerations make repeat triage special by supporting limited priority to existing patients, in transgression of pure “utilitarian” procedures: (1) Pragmatically, often it is more efficient to complete treatment on existing patients, for whom prognosis can be established with greater certainty and without added time, than to attempt to save new patients; (2) A fiduciary trust relationship has been formed between care-giver and existing patients, which may make the moral obligation towards them somewhat stronger than the one to potential patients; (3) Existing patients will have often arrived earlier, so when needs are equal, the “first come, first served” principle prioritizes them for care; (4) Withdrawal of care during repeat triage may constitute active rather than passive harm, and more often a serious transgression of patient autonomy; (5) Health providers should normally not be asked to behave in ways that profoundly violate their personal and professional integrity, and abandoning existing patients may do so. For these reasons, responders can permissibly give a degree of priority to existing patients over newcomers in disaster.

Eyal, Nir; Firth, Paul; Black, L; Cist, AFM; Curran, M; Dalal, AN; Goodman, AK; Le Roy, A; Sunder, N; Wilson, MC

2012-01-01

75

Clinical review: The role of the intensive care physician in mass casualty incidents: planning, organisation, and leadership  

PubMed Central

There is a long-standing, broad assumption that hospitals will ably receive and efficiently provide comprehensive care to victims following a mass casualty event. Unfortunately, the majority of medical major incident plans are insufficiently focused on strategies and procedures that extend beyond the pre-hospital and early-hospital phases of care. Recent events underscore two important lessons: (a) the role of intensive care specialists extends well beyond the intensive care unit during such events, and (b) non-intensive care hospital personnel must have the ability to provide basic critical care. The bombing of the London transport network, while highlighting some good practices in our major incident planning, also exposed weaknesses already described by others. Whilst this paper uses the events of the 7 July 2005 as its point of reference, the lessons learned and the changes incorporated in our planning have generic applications to mass casualty events. In the UK, the Department of Health convened an expert symposium in June 2007 to identify lessons learned from 7 July 2005 and disseminate them for the benefit of the wider medical community. The experiences of clinicians from critical care units in London made a large contribution to this process and are discussed in this paper.

Shirley, Peter J; Mandersloot, Gerlinde

2008-01-01

76

Telephone triage.  

PubMed

Nurses frequently provide advice and education over the phone. Telephone triage is an area of potential litigation for the nurse. Information must be clear, concise, and accurate. The nurse needs to ascertain that the patient understands the instructions provided and feels free to ask questions and receive clarification of any information that is confusing. Documentation needs to describe the nursing process of data collection, planning, intervention, and evaluation. In this way, patients will receive quality information that allows them to manage symptoms at home, understand when medical interventions are necessary, and avoid unnecessary delays in care. Telephone triage is an integral part of oncology care that covers a broad range of activities, including symptom management, medication renewal, coordination of care, education, and psychosocial support. As telephone triage becomes more "high risk, high volume," nurses must review the triage process used in their clinical settings. Areas to discuss and delineate include differentiation between medical, nursing, and secretarial responsibilities; technical support systems and access; documentation guidelines; telephone triage protocols; staff education; and patient satisfaction (Nauright, Moneyham, & Williamson, 1999). PMID:11899331

Preston, F A

77

Triage Services  

Microsoft Academic Search

With challenges continuing to be presented to health care delivery, inappropriate out-patient service utilization is of utmost concern to all health care service providers. This study is an examination of the utilization patterns of 189 veterans in an urban Veterans Administration Medical Center (VAMC). Factors found to be related to high utilization of ambulatory care triage clinic services for veterans

Maria Berg-Weger; Jane Gockel; Doris McGartland Rubio; Rachelle Douglas

1998-01-01

78

The Capability of Emergency Departments and Emergency Medical Systems in the United States to Respond to Mass Casualty Events Resulting from Terrorist Attacks  

Microsoft Academic Search

Despite the potential array of atypical medical contingencies that the U.S. health system could face if confronted with mass-casualty events (MCE) resulting from terrorist attacks using conventional explosives, American hospitals are neither sufficiently funded nor prepared to effectively respond to such potentialities. Historically, the bias in most MCE planning has been toward the worst case scenarios, often entailing weapons of

Bruce Hoffman

2009-01-01

79

Evolving need for alternative triage management in public health emergencies: a Hurricane Katrina case study.  

PubMed

In many countries, traditional medical planning for disasters developed largely in response to battlefield and multiple casualty incidents, generally involving corporal injuries. The mass evacuation of a metropolitan population in the aftermath of Hurricane Katrina evolved into life-and-death triage scenarios involving thousands of patients with nontraumatic illnesses and special medical needs. Although unprecedented in the United States, triage management needs for this disaster were similar to other large-scale public health emergencies, both natural and human-generated, that occurred globally in the past half-century. The need for alternative triage-management processes similar to the methodologies of other global mass public health emergencies is illustrated through the experience of disaster medical assistance teams in the first 3 days following Katrina's landfall. The immediate establishment of disaster-specific, consensus-based, public health emergency-related triage protocols-developed with ethical and legal expertise and a renewed focus on multidimensional, multifactorial matrix decision-making processes-is strongly recommended. PMID:18769266

Klein, Kelly R; Pepe, Paul E; Burkle, Frederick M; Nagel, Nanci E; Swienton, Raymond E

2008-09-01

80

Development and organization for casualty management on a 1,000-bed hospital ship in the Persian Gulf.  

PubMed

A 1,000-bed hospital ship designed for trauma patients was deployed to the Middle East with the objectives of preparing for large numbers of casualties resulting from Operation Desert Storm from conventional, chemical, and biological weapons. Plans for receipt and decontamination of casualties, triage, and optimal utilization of the 1,000-bed facility were developed. Mass casualty drills were conducted, involving all aspects of patient care from the flight deck to the wards. Trauma and critical care registries were developed to collect casualty data that could then be analyzed for specific military purposes and compared with current civilian registries. Attempts were made to identify the advances in shock resuscitation, systems management, and operative treatment from the civilian community that could be applied to care of combat casualties. Difficulties with accomplishing these objectives included limited trauma experience and supplies and poorly defined medical regulating and evacuation policies. The development of these programs, as well as the unique difficulties encountered, are discussed. PMID:1569624

Ochsner, M G; Harviel, J D; Stafford, P W; Blankenship, C; Bosse, M J; Timberlake, G A; McSwain, N E

1992-04-01

81

Analysis of responses of radiology personnel to a simulated mass casualty incident after the implementation of an automated alarm system in hospital emergency planning  

Microsoft Academic Search

The purpose of this study was to evaluate the response to an automated alarm system of a radiology department during a mass\\u000a casualty incident simulation. An automated alarm system provided by an external telecommunications provider handling up to\\u000a 480 ISDN lines was used at a level I trauma center. During the exercise, accessibility, availability, and estimated time of\\u000a arrival (ETA)

Markus Körner; Lucas L. Geyer; Stefan Wirth; Claus-Dieter Meisel; Maximilian F. Reiser; Ulrich Linsenmaier

2011-01-01

82

Hospital management of mass radiological casualties : reassessing exposures from contaminated victims of an exploded radiological dispersal device (RDD).  

SciTech Connect

One of the key issues in the aftermath of an exploded radiological dispersal device from a terrorist event is that of the contaminated victim and the concern among healthcare providers for the harmful exposures they may receive in treating patients, especially if the patient has not been thoroughly decontaminated. This is critically important in the event of mass casualties from a nuclear or radiological incident because of the essential rapidity of acute medical decisions and that those who have life- or limb-threatening injuries may have treatment unduly delayed by a decontamination process that may be unnecessary for protecting the health and safety of the patient or the healthcare provider. To estimate potential contamination of those exposed in a radiological dispersal device event, results were used from explosive aerosolization tests of surrogate radionuclides detonated with high explosives at the Sandia National Laboratories. Computer modeling was also used to assess radiation dose rates to surgical personnel treating patients with blast injuries who are contaminated with any of a variety of common radionuclides. It is demonstrated that exceptional but plausible cases may require special precautions by the healthcare provider, even while managing life-threatening injuries of a contaminated victim from a radiological dispersal device event.

Ansari, Armin (National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA); Harper, Frederick Taylor; Smith, James M. (National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA)

2005-04-01

83

Management of casualties from the bombing at the Centennial Olympics  

Microsoft Academic Search

Background: The explosion of a bomb 75 to 100 yards away from attendees at a concert who were in the process of being evacuated from Centennial Olympic Park at approximately 1:25 am on July 27, 1996, resulted in a multiple-casualty event involving primarily four hospitals in proximity to the blast. The purpose of this study was to review triage and

DavidV Feliciano; GailV Anderson; GraceS Rozycki; WalterL Ingram; JosephP Ansley; Nicholas Namias; JeffreyP Salomone; JohnD Cantwell

1998-01-01

84

TRIAGE DOSE ASSESSMENT FOR PARTIAL-BODY EXPOSURE: DICENTRIC ANALYSIS  

PubMed Central

Partial-body biodosimetry is likely to be required after a radiological or nuclear exposure. Clinical signs and symptoms, distribution of dicentrics in circulating blood cells, organ-specific biomarkers, physical signals in teeth and nails all can provide indications of non-homogeneous exposures. Organ specific biomarkers may provide early warning regarding physiological systems at risk after radiation injury. Use of a combination of markers and symptoms will be needed for clinical insights for therapeutic approaches. Analysis of dicentrics, a marker specific for radiation injury, is the “Gold standard” of biodosimetry and can reveal partial-body exposures. Automation of sample processing for dicentric analysis can increase throughput with customization of off-the-shelf technologies for cytogenetic sample processing and information management. Automated analysis of the metaphase spreads is currently limited but improvements are in development. Our efforts bridge the technological gaps to allow the use of dicentric chromosome assay (DCA) for risk-based stratification of mass casualties. This article summarizes current knowledge on partial-body cytogenetic dose assessment synthesizing information leading to the proposal of an approach to triage dose prediction in radiation mass casualties, based on equivalent whole-body doses under partial-body exposure conditions and assesses the validity of using this model. An initial screening using only 20 metaphase spreads per subject can confirm irradiation above 2-Gy. A subsequent increase to 50 metaphases improves dose determination to allow risk stratification for clinical triage. Metaphases evaluated for inhomogeneous distribution of dicentrics can reveal partial-body exposures. We tested the validity of this approach in an in vitro model that simulates partial-body irradiation by mixing irradiated and un-irradiated lymphocytes in various proportions. Our preliminary results support the notion that this approach will be effective under a range of conditions including some partial-body exposures, but may have limitations with low doses or small proportions of irradiated body. Our studies address an important problem in the diagnosis of partial-body irradiation and dose assessment in mass casualties and propose a solution. However, additional work is needed to fully develop and validate the application of DCA to partial-body exposures.

Moroni, Maria; Pellmar, Terry C.

2009-01-01

85

Dynamic 3D visual analytic tools: a method for maintaining situational awareness during high tempo warfare or mass casualty operations  

NASA Astrophysics Data System (ADS)

Maintaining Situational Awareness (SA) is crucial to the success of high tempo operations, such as war fighting and mass casualty events (bioterrorism, natural disasters). Modern computer and software applications attempt to provide command and control manager's situational awareness via the collection, integration, interrogation and display of vast amounts of analytic data in real-time from a multitude of data sources and formats [1]. At what point does the data volume and displays begin to erode the hierarchical distributive intelligence, command and control structure of the operation taking place? In many cases, people tasked with making decisions, have insufficient experience in SA of high tempo operations and become overwhelmed easily as vast amounts of data begin to be displayed in real-time as an operation unfolds. In these situations, where data is plentiful and the relevance of the data changes rapidly, there is a chance for individuals to target fixate on those data sources they are most familiar. If these individuals fall into this type of pitfall, they will exclude other data that might be just as important to the success of the operation. To counter these issues, it is important that the computer and software applications provide a means for prompting its users to take notice of adverse conditions or trends that are critical to the operation. This paper will discuss a new method of displaying data called a Crisis ViewTM, that monitors critical variables that are dynamically changing and allows preset thresholds to be created to prompt the user when decisions need to be made and when adverse or positive trends are detected. The new method will be explained in basic terms, with examples of its attributes and how it can be implemented.

Lizotte, Todd E.

2010-04-01

86

Developing and organizing a trauma system and mass casualty management: some useful observations from the israeli trauma model.  

PubMed

A trauma system is a chain of arrangements and preparedness to provide quality response to injured from the site of injury to the appropriate hospital for the full range of care. Israel has a unique trauma system developed from the experience gained in peace and in war. The system is designed to fit the state's current health system, which is different from the European and American systems. An effective trauma system may potentially manage mass casualty incidence better. The aim of this paper is to discuss learning points to develop a trauma system based on the Israeli trauma model. After participating in a course on developing a trauma system organized by a top Israeli trauma center, a literature search on the topic on the Internet was done using relevant key words like trauma system and disaster management in Israel using the Google search engine in the pubmed, open access journals and websites of trauma organizations. Israel has a unique trauma system of organizing and managing an emergency event, characterized by a central national organization responsible for management, coordination and ongoing quality control. Because of its unique geopolitical situation, the armed forces has a significant role in the system. Investing adequate resources on continuous education, manpower training, motivation, team-work and creation of public volunteers through advocacy is important for capacity building to develop a trauma system. Wisdom, motivation and pragmatism of the Israeli model may be useful to streamline work in skeletal trauma services of developing countries having fewer resources to bring consistency and acceptable standards in trauma care. PMID:23634336

Borgohain, B; Khonglah, T

2013-01-01

87

Developing and Organizing a Trauma System and Mass Casualty Management: Some Useful Observations from the Israeli Trauma Model  

PubMed Central

A trauma system is a chain of arrangements and preparedness to provide quality response to injured from the site of injury to the appropriate hospital for the full range of care. Israel has a unique trauma system developed from the experience gained in peace and in war. The system is designed to fit the state's current health system, which is different from the European and American systems. An effective trauma system may potentially manage mass casualty incidence better. The aim of this paper is to discuss learning points to develop a trauma system based on the Israeli trauma model. After participating in a course on developing a trauma system organized by a top Israeli trauma center, a literature search on the topic on the Internet was done using relevant key words like trauma system and disaster management in Israel using the Google search engine in the pubmed, open access journals and websites of trauma organizations. Israel has a unique trauma system of organizing and managing an emergency event, characterized by a central national organization responsible for management, coordination and ongoing quality control. Because of its unique geopolitical situation, the armed forces has a significant role in the system. Investing adequate resources on continuous education, manpower training, motivation, team-work and creation of public volunteers through advocacy is important for capacity building to develop a trauma system. Wisdom, motivation and pragmatism of the Israeli model may be useful to streamline work in skeletal trauma services of developing countries having fewer resources to bring consistency and acceptable standards in trauma care.

Borgohain, B; Khonglah, T

2013-01-01

88

Chapter 7. Critical care triage  

Microsoft Academic Search

Purpose  To provide recommendations and standard operating procedures for intensive care unit (ICU) and hospital preparations for an\\u000a influenza pandemic or mass disaster with a specific focus on critical care triage.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Based on a literature review and expert opinion, a Delphi process was used to define the essential topics including critical\\u000a care triage.\\u000a \\u000a \\u000a \\u000a \\u000a Results  Key recommendations include: (1) establish an Incident Management

Michael D. Christian; Gavin M. Joynt; John L. Hick; John Colvin; Marion Danis; Charles L. Sprung

2010-01-01

89

Emergency department triage revisited  

Microsoft Academic Search

Triage is a process that is critical to the effective management of modern emergency departments. Triage systems aim, not only to ensure clinical justice for the patient, but also to provide an effective tool for departmental organisation, monitoring and evaluation. Over the last 20 years, triage systems have been standardised in a number of countries and efforts made to ensure

Gerard FitzGerald; George A Jelinek; Deborah Scott; Marie Frances Gerdtz

2010-01-01

90

Electronic Mass Casualty Assessment and Planning Scenarios (EMCAPS): development and application of computer modeling to selected National Planning Scenarios for high-consequence events.  

PubMed

Few tools exist that are sufficiently robust to allow manipulation of key input variables to produce casualty estimates resulting from high-consequence events reflecting local or specific regions of concern. This article describes the design and utility of a computerized modeling simulation tool, Electronic Mass Casualty Assessment and Planning Scenarios (EMCAPS), developed to have broad application across emergency management and public health fields as part of a catastrophic events preparedness planning process. As a scalable, flexible tool, EMCAPS is intended to support emergency preparedness planning efforts at multiple levels ranging from local health systems to regional and state public health departments to Metropolitan Medical Response System jurisdictions. Designed around the subset of the National Planning Scenarios with health effects, advanced by the US Department of Homeland Security, the tool's platform is supported by the detailed descriptions and readily retrievable evidence-based assumptions of each scenario. The EMCAPS program allows the user to manipulate key scenario-based input variables that would best reflect the region or locale of interest. Inputs include population density, vulnerabilities, event size, and potency, as applicable. Using these inputs, EMCAPS generates the anticipated population-based health surge influence of the hazard scenario. Casualty estimates are stratified by injury severity/types where appropriate. Outputs are graph and table tabulations of surge estimates. The data can then be used to assess and tailor response capabilities for specific jurisdictions, organizations, and health care systems. EMCAPS may be downloaded without cost from http://www.hopkins-cepar.org/EMCAPS/EMCAPS.html as shareware. PMID:18986730

Scheulen, James J; Thanner, Meridith H; Hsu, Edbert B; Latimer, Christian K; Brown, Jeffrey; Kelen, Gabor D

2008-11-04

91

Biological dosimetry intercomparison exercise: an evaluation of triage and routine mode results by robust methods.  

PubMed

Well-defined protocols and quality management standards are indispensable for biological dosimetry laboratories. Participation in periodic proficiency testing by interlaboratory comparisons is also required. This harmonization is essential if a cooperative network is used to respond to a mass casualty event. Here we present an international intercomparison based on dicentric chromosome analysis for dose assessment performed in the framework of the IAEA Regional Latin American RLA/9/054 Project. The exercise involved 14 laboratories, 8 from Latin America and 6 from Europe. The performance of each laboratory and the reproducibility of the exercise were evaluated using robust methods described in ISO standards. The study was based on the analysis of slides from samples irradiated with 0.75 (DI) and 2.5 Gy (DII). Laboratories were required to score the frequency of dicentrics and convert them to estimated doses, using their own dose-effect curves, after the analysis of 50 or 100 cells (triage mode) and after conventional scoring of 500 cells or 100 dicentrics. In the conntional scoring, at both doses, all reported frequencies were considered as satisfactory, and two reported doses were considered as questionable. The analysis of the data dispersion among the dicentric frequencies and among doses indicated a better reproducibility for estimated doses (15.6% for DI and 8.8% for DII) than for frequencies (24.4% for DI and 11.4% for DII), expressed by the coefficient of variation. In the two triage modes, although robust analysis classified some reported frequencies or doses as unsatisfactory or questionable, all estimated doses were in agreement with the accepted error of ±0.5 Gy. However, at the DI dose and for 50 scored cells, 5 out of the 14 reported confidence intervals that included zero dose and could be interpreted as false negatives. This improved with 100 cells, where only one confidence interval included zero dose. At the DII dose, all estimations fell within ±0.5 Gy of the reference dose interval. The results obtained in this triage exercise indicated that it is better to report doses than frequencies. Overall, in both triage and conventional scoring modes, the laboratory performances were satisfactory for mutual cooperation purposes. These data reinforce the view that collaborative networking in the case of a mass casualty event can be successful. PMID:21306200

Di Giorgio, M; Barquinero, J F; Vallerga, M B; Radl, A; Taja, M R; Seoane, A; De Luca, J; Oliveira, M Stuck; Valdivia, P; Lima, O García; Lamadrid, A; Mesa, J González; Aguilera, I Romero; Cardoso, T Mandina; Carvajal, Y C Guerrero; Maldonado, C Arceo; Espinoza, M E; Martínez-López, W; Méndez-Acuña, L; Di Tomaso, M V; Roy, L; Lindholm, C; Romm, H; Güçlü, I; Lloyd, D C

2011-02-09

92

Development of a national burn network: providing a co-ordinated response to a burn mass casualty disaster within the Australian health system  

PubMed Central

With the threat of terrorist activity ever present since the incidents in Bali and Jakarta, the Australian health system must be prepared to manage another mass burn casualty disaster. The Australian and New Zealand Burns Association (ANZBA) highlighted the lack of a national burn disaster response before the 2000 Olympics. With the limited number of burn beds available and the protracted length of stay after such injuries, any state or territory could be overwhelmed with relatively few patient admissions. In 2002, the Australian Health Minister's Conference called for a solution. The objective of this paper is to provide an overview of the process and development of the Australian National Burn Network, which underpins the National Burn Disaster Response (AUSBURNPLAN).

Wood, F; Edgar, D; Robertson, AG

2008-01-01

93

Orthopaedic management in a mega mass casualty situation. The Israel Defence Forces Field Hospital in Haiti following the January 2010 earthquake.  

PubMed

Following the January 2010 earthquake in Haiti, the Israel Defence Forces (IDF) established a field hospital in Port au Prince. The hospital started operating 89 h after the earthquake. We describe the experience of the orthopaedic department in a field hospital operating in an extreme mass casualty situation. The hospital contained 4 operating table and 72 hospitalization beds. The orthopaedic department included 8 orthopaedic surgeons and 3 residents. 1111 patients were treated in the hospital, 1041 of them had adequate records for inclusion. 684 patients were admitted due to trauma with a total of 841 injuries. 320 patients sustained 360 fractures, 18 had joint dislocations and 22 patients were admitted after amputations. 207 patients suffered 315 soft tissue injuries. 221 patients were operated on under general or regional anaesthesia. External fixation was used for stabilization of 48 adult femoral shaft fractures, 24 open tibial fractures and 1 open humeral fracture. All none femoral closed fractures were treated non-operatively. 18 joint reductions and 23 amputations were performed. Appropriate planning, training, operational versatility, and adjustment of therapeutic guidelines according to a constantly changing situation, enabled us to deliver optimal care to the maximal number of patients, in an overwhelming mass trauma situation. PMID:21507401

Bar-On, Elhanan; Lebel, Ehud; Kreiss, Yitshak; Merin, Ofer; Benedict, Shaike; Gill, Amit; Lee, Evgeny; Pirotsky, Anatoly; Shirov, Taras; Blumberg, Nehemia

2011-04-19

94

Biological Dosimetry by the Triage Dicentric Chromosome Assay - Further validation of International Networking  

PubMed Central

Biological dosimetry is an essential tool for estimating radiation doses received to personnel when physical dosimetry is not available or inadequate. The current preferred biodosimetry method is based on the measurement of radiation-specific dicentric chromosomes in exposed individuals' peripheral blood lymphocytes. However, this method is labour-, time- and expertise-demanding. Consequently, for mass casualty applications, strategies have been developed to increase its throughput. One such strategy is to develop validated cytogenetic biodosimetry laboratory networks, both national and international. In a previous study, the dicentric chromosome assay (DCA) was validated in our cytogenetic biodosimetry network involving five geographically dispersed laboratories. A complementary strategy to further enhance the throughput of the DCA among inter-laboratory networks is to use a triage DCA where dose assessments are made by truncating the labour-demanding and time-consuming metaphase-spread analysis to 20 to 50 metaphase spreads instead of routine 500 to 1000 metaphase spread analysis. Our laboratory network also validated this triage DCA, however, these dose estimates were made using calibration curves generated in each laboratory from the blood samples irradiated in a single laboratory. In an emergency situation, dose estimates made using pre-existing calibration curves which may vary according to radiation type and dose rate and therefore influence the assessed dose. Here, we analyze the effect of using a pre-existing calibration curve on assessed dose among our network laboratories. The dose estimates were made by analyzing 1000 metaphase spreads as well as triage quality scoring and compared to actual physical doses applied to the samples for validation. The dose estimates in the laboratory partners were in good agreement with the applied physical doses and determined to be adequate for guidance in the treatment of acute radiation syndrome.

Wilkins, Ruth C.; Romm, Horst; Oestreicher, Ursula; Marro, Leonora; Yoshida, Mitsuaki A.; Suto, Y.; Prasanna, Pataje G.S.

2011-01-01

95

Collateral Casualties of Consumerism  

Microsoft Academic Search

Collateral victims of consumerism are the ‘flawed consumers’ - lacking resources that socially approved consumer activity requires. Collateral damages refer to the new frailty of inter-human bonds resulting from the transfer of consumerist patterns upon relations between humans. Collateral casualties of consumerism are all men and women affected by either of these and thereby confronted by a series of unfamiliar

Zygmunt Bauman

2007-01-01

96

Team triage improves emergency department efficiency  

Microsoft Academic Search

Objective: To see whether three hours of combined doctor and nurse triage would lead to earlier medical assessment and treatment and whether this benefit would carry on for the rest of the day when normal triage had resumed.Method: Eight days were randomly selected; four for team triage and four for the normal nurse led triage. Team triage was coordinated by

F Subash; F Dunn; B McNicholl; J Marlow

2004-01-01

97

Inconsistency of Emergency Department Triage  

Microsoft Academic Search

Study objective: To measure the interrater and intrarater agreement of existing emergency department triage systems. Methods: This 2-phase experimental study of triage nurses’ and EMTs’ ratings for 5 scripted patient scenarios used in-person interviews and follow-up written surveys. Results: Eighty-seven participants (>90% of those eligible) with 55 (63%) completed both phases of the study. Interrater agreement on triage category was

Richard Wuerz; Christopher MB Fernandes; Joe Alarcon

1998-01-01

98

The triage of stroke rehabilitation  

Microsoft Academic Search

In this paper we describe the use of triage to select patients for a trial in which a comparison was made of the effectiveness of a stroke unit and medical units in the rehabilitation of acute stroke. Completing the triage for hospital admission of stroke enabled an estimate to be made of the size of a stroke unit per unit

W M Garraway; A J Akhtar; D L Smith; M E Smith

1981-01-01

99

Operation Desert Shield: Medical aspects of weapons of mass destruction  

SciTech Connect

The authors concern over possible use of weapons of mass destruction against U.S. forces in the Middle East has increased because Iraq has violated the Geneva Protocol of 1925 and the 1972 Biological Weapons Convention, attempted to acquire nuclear capability and delivery systems, and is reported to be developing biological weapons. The Army Medical Department has had no experience, since World War I, in the management and treatment of mass casualties contaminated by chemical agents, and has never treated casualties resulting from the use of nuclear or biological weapons used against our soldiers. Management and diagnosis of casualties will be complicated by their possible exposure to a mixture of chemical warfare and biological warfare agents. Triage is an essential aspect in the management of mass casualties since the number of injured patients will exceed the maximum medical capability to treat each patient on arrival. All levels of medical support must be prepared to protect themselves, their equipment and supplies, and their patients from contamination. In contaminated operations on the integrated battlefield, it will be of utmost importance to incorporate flexibility and innovation to match the medical and tactical situation.

Knudson, G.B. (Department of Pathology, Letterman Army Medical Center, Presidio of San Francisco, CA (USA))

1991-06-01

100

Hospital preparedness for possible nonconventional casualties: an Israeli experience  

Microsoft Academic Search

Since 9\\/11, hospitals and health authorities have been preparing medical response in case of various mass terror attacks. The experience of Tel Aviv Sourasky Medical Center in treating suicide-bombing mass casualties served, in the time leading up to the war in Iraq, as a platform for launching a preparedness program for possible attacks with biological and chemical agents of mass

Shaul Schreiber; Naomi Yoeli; Gedalia Paz; Gabriel I. Barbash; David Varssano; Nurit Fertel; Avi Hassner; Margalit Drory; Pinchas Halpern

2004-01-01

101

Medical treatment of radiological casualties: current concepts.  

PubMed

The threat of radiologic or nuclear terrorism is increasing, yet many physicians are unfamiliar with basic treatment principles for radiologic casualties. Patients may present for care after a covert radiation exposure, requiring an elevated level of suspicion by the physician. Traditional medical and surgical triage criteria should always take precedence over radiation exposure management or decontamination. External contamination from a radioactive cloud is easily evaluated using a simple Geiger-Muller counter and decontamination accomplished by prompt removal of clothing and traditional showering. Management of surgical conditions in the presence of persistent radioactive contamination should be dealt with in a conventional manner with health physics guidance. To be most effective in the medical management of a terrorist event involving high-level radiation, physicians should understand basic manifestations of the acute radiation syndrome, the available medical countermeasures, and the psychosocial implications of radiation incidents. Health policy considerations include stockpiling strategies, effective use of risk communications, and decisionmaking for shelter-in-place versus evacuation after a radiologic incident. PMID:15940101

Koenig, Kristi L; Goans, Ronald E; Hatchett, Richard J; Mettler, Fred A; Schumacher, Thomas A; Noji, Eric K; Jarrett, David G

2005-06-01

102

Battlefield triage life signs detection techniques  

NASA Astrophysics Data System (ADS)

Getting to wounded soldiers on the battlefield is a precarious task, and medics have a very high casualty rate. It is therefore a vital importance to prioritize which soldiers to attend to first. The first step is to detect life signs - if a soldier is dead or alive, and prioritize recovery of live soldiers. The second step is to obtain vital signs from live soldiers, and use this to prioritize which are in most urgent need of attention. Our team at Kai Sensors, University of Hawaii and University of Florida is developing Doppler radar heart sensing technology that provides the means to detect life signs, respiration and/or heart beat, at a distance, even for subjects lying motionless, e.g., unconscious subjects, wearing body armor, and hidden from direct view. Since this technology can deliver heart rate information with high accuracy, it may also enable the assessment of a subject's physiological and psychological state based on heart rate variability (HRV) analysis. Thus, the degree of a subject's injury may also be determined. The software and hardware developments and challenges for life signs detection and monitoring for battlefield triage will be discussed, including heart signal detection from all four sides of the human body, detection in the presence of body armor, and the feasibility of HRV parameter extraction.

Boric-Lubecke, Olga; Lin, Jenshan; Park, Byung-Kwon; Li, Changzhi; Massagram, Wansuree; Lubecke, Victor M.; Host-Madsen, Anders

2008-05-01

103

Triage nurses’ decisions using the National Triage Scale for Australian emergency departments  

Microsoft Academic Search

The initiation of emergency care primarily depends on the decisions made by the triage nurse. Triage decisions can therefore have a profound effect on the health outcomes of patients who present for emergency care. If the National Triage Scale (NTS) was effective in providing a standardized approach to triage, a patient with a specific problem should be allocated to the

J. Considine; L. Ung; S. Thomas

2000-01-01

104

An Arm Mounted "Scratch and Sniff" Sample Triage Sensor  

NASA Astrophysics Data System (ADS)

A sample triage system based on the detection of volatiles released by mechanical abrasion is proposed. The instrument will be capable of detecting trace compounds found in Mars rock and soils. The instrument mass will be approximately 2.8 kg.

Darrach, M. R.; Kidd, R.; Shiraishi, L.

2012-06-01

105

User-managed inventory: an approach to forward-deployment of urgently needed medical countermeasures for mass-casualty and terrorism incidents.  

PubMed

The user-managed inventory (UMI) is an emerging idea for enhancing the current distribution and maintenance system for emergency medical countermeasures (MCMs). It increases current capabilities for the dispensing and distribution of MCMs and enhances local/regional preparedness and resilience. In the UMI, critical MCMs, especially those in routine medical use ("dual utility") and those that must be administered soon after an incident before outside supplies can arrive, are stored at multiple medical facilities (including medical supply or distribution networks) across the United States. The medical facilities store a sufficient cache to meet part of the surge needs but not so much that the resources expire before they would be used in the normal course of business. In an emergency, these extra supplies can be used locally to treat casualties, including evacuees from incidents in other localities. This system, which is at the interface of local/regional and federal response, provides response capacity before the arrival of supplies from the Strategic National Stockpile (SNS) and thus enhances the local/regional medical responders' ability to provide life-saving MCMs that otherwise would be delayed. The UMI can be more cost-effective than stockpiling by avoiding costs due to drug expiration, disposal of expired stockpiled supplies, and repurchase for replacement. PMID:23241473

Coleman, C Norman; Hrdina, Chad; Casagrande, Rocco; Cliffer, Kenneth D; Mansoura, Monique K; Nystrom, Scott; Hatchett, Richard; Caro, J Jaime; Knebel, Ann R; Wallace, Katherine S; Adams, Steven A

2012-12-01

106

46 CFR 28.80 - Report of casualty.  

Code of Federal Regulations, 2011 CFR

...from the casualty. Initial reports must be in accordance with...of this section. Subsequent reports must contain sufficient information...identify the casualty and any new or corrected casualty data. (c) Each report of casualty must include...

2011-10-01

107

46 CFR 28.80 - Report of casualty.  

Code of Federal Regulations, 2012 CFR

...from the casualty. Initial reports must be in accordance with...of this section. Subsequent reports must contain sufficient information...identify the casualty and any new or corrected casualty data. (c) Each report of casualty must include...

2012-10-01

108

Effect of vital signs on triage decisions  

Microsoft Academic Search

Study Objective: We sought to determine whether knowledge of vital signs changes nurse triage designations (TDs). We also sought to determine whether patient age and ability to communicate modify the effect of vital signs on triage decisions. Methods: We performed a prospective observational study, in 24 emergency departments, of nurse-assigned TDs of all ED patients undergoing triage. Nurses performed their

Richelle J. Cooper; David L. Schriger; Heather L. Flaherty; Edward J. Lin; Kelly A. Hubbell

2002-01-01

109

Mental Health Triage in Emergency Medicine  

Microsoft Academic Search

Objective: The aim of this study was to: (i) develop a triage scale consistent with the National Triage Scale (NTS) for patients with mental health problems attending emergency departments; and (ii) to reduce emergency waiting times, transit times and improve skills assessing mental health problems.Method: We developed a Mental Health Triage Scale (MHTS) consistent with the NTS. The MHTS was

David Smart; Cecily Pollard; Bryan Walpole

1999-01-01

110

Republished paper: Emergency department triage revisited  

Microsoft Academic Search

Triage is a process that is critical to the effective management of modern emergency departments. Triage systems aim, not only to ensure clinical justice for the patient, but also to provide an effective tool for departmental organisation, monitoring and evaluation. Over the last 20 years, triage systems have been standardised in a number of countries and efforts made to ensure

Gerard FitzGerald; George A Jelinek; Deborah Scott; Marie Frances Gerdtz

2010-01-01

111

Afghanistan Casualties: Military Forces and Civilians.  

National Technical Information Service (NTIS)

This report collects statistics from a variety of sources on casualties sustained during Operation Enduring Freedom (OEF), which began on October 7, 2001, and is ongoing. OEF actions take place primarily in Afghanistan; however, OEF casualties also includ...

S. G. Chesser

2010-01-01

112

Afghanistan Casualties: Military Forces and Civilians.  

National Technical Information Service (NTIS)

This report collects statistics from a variety of sources on casualties sustained during Operation Enduring Freedom (OEF), which began on October 7, 2001, and is ongoing. OEF actions take place primarily in Afghanistan; however, OEF casualties also includ...

S. G. Chesser

2012-01-01

113

Communication and compliance in eye casualty  

Microsoft Academic Search

Purpose: This study aimed to assess patients' perceptions and priorities when consulting doctors in eye casualty, to assess their satisfaction with eye casualty and to evaluate and improve patients' level of knowledge and understanding of their treatment.Methods: A selected consecutive group of 130 patients presenting to eye casualty between 1 July and 15 September 1995 was interviewed by two of

Beth Edmunds; Peter J Francis; Andrew R Elkington

1997-01-01

114

Iraq: U.S. Casualties.  

National Technical Information Service (NTIS)

The following casualty data were compiled by the Department of Defense (DOD), as tallied from the agency's press releases. Table 1 provides statistics on fatalities during Operation Iraqi Freedom, which began on March 19, 2003, and is ongoing, as well as ...

S. G. Chesser

2009-01-01

115

Trauma triage: New York experience.  

PubMed

New York State developed a statewide trauma program in the early 1990s. Designation of trauma centers and prehospital triage of patients by emergency medical services are pillars of the system. Outcomes are evaluated as part of the quality improvement system. New York has a statewide trauma registry with population-based data for all of the state but New York City. Studies made possible because of the trauma registry provided evidence to guide revision of the emergency medical services trauma triage protocol for adult patients. For example, pulse < 50 or > 120 beats/min was retained as a physiologic criteria, while crumple zone and crash speed were eliminated as mechanism criteria. Patients with certain physiologic criteria treated in regional centers showed a considerably reduced mortality rate when compared with patients treated in area trauma centers and noncenters. Other "high-risk" populations were identified for special consideration by emergency medical technicians for trauma center transport because of their associated higher mortality. One "high-risk" group, patients older than 55 years or younger than 5 years, has associated 11% mortality (compare with a statewide average of 7.43%) and represents 41% of all registry patients. Population-based trauma registries and structured prehospital trauma records that accurately record the presence or absence of trauma criteria are essential to evaluate trauma triage criteria; improve quality, efficiency, and access; and guide care. PMID:16801264

Henry, Mark C

116

Casualty rates among naval forces ashore.  

PubMed

Casualty rates for naval forces ashore across varying battle intensities are needed as input to medical and manpower planning models. Casualty data of medical and construction battalions participating in World War II amphibious assaults, Korea, and Vietnam were extracted from archival sources. Casualty rates among naval ashore forces fluctuated with battle intensity. The rate during intense combat was 15 per 1,000 per day among hospital corpsmen organic to infantry units, 7.5 for medical battalion personnel, and 2.1 among construction forces. Casualty rates dropped dramatically with decreasing battle intensity, especially among construction and medical battalions. PMID:8108016

Blood, C G; Anderson, M E; Gauker, E D

1993-12-01

117

Using 'reverse triage' to create hospital surge capacity: Royal Darwin Hospital's response to the Ashmore Reef disaster.  

PubMed

This report analyses the impact of reverse triage, as described by Kelen, to rapidly assess the need for continuing inpatient care and to expedite patient discharge to create surge capacity for disaster victims. The Royal Darwin Hospital was asked to take up to 30 casualties suffering from blast injuries from a boat carrying asylum seekers that had exploded 840 km west of Darwin. The hospital was full, with a backlog of cases awaiting admission in the emergency department. The Disaster Response Team convened at 10:00 to develop the surge capacity to admit up to 30 casualties. By 14:00, 56 beds (16% of capacity) were predicted to be available by 18:00. The special circumstances of a disaster enabled staff to suspend their usual activities and place a priority on triaging inpatients' suitability for discharge. The External Disaster Plan was activated and response protocols were followed. Normal elective activity was suspended. Multidisciplinary teams immediately assessed patients and completed the necessary clinical and administrative requirements to discharge them quickly. As per the Plan there was increased use of community care options: respite nursing home beds and community nursing services. Through a combination of cancellation of all planned admissions, discharging 19 patients at least 1 day earlier than planned and discharging all patients earlier in the day surge capacity was made available in Royal Darwin Hospital to accommodate blast victims. Notably, reverse triage resulted in no increase in clinical risk with only one patient who was discharged early returning for further treatment. PMID:21030549

Satterthwaite, Peter S; Atkinson, Carol J

2010-10-28

118

Emergency department triage: an ethical analysis  

PubMed Central

Background Emergency departments across the globe follow a triage system in order to cope with overcrowding. The intention behind triage is to improve the emergency care and to prioritize cases in terms of clinical urgency. Discussion In emergency department triage, medical care might lead to adverse consequences like delay in providing care, compromise in privacy and confidentiality, poor physician-patient communication, failing to provide the necessary care altogether, or even having to decide whose life to save when not everyone can be saved. These consequences challenge the ethical quality of emergency care. This article provides an ethical analysis of "routine" emergency department triage. The four principles of biomedical ethics - viz. respect for autonomy, beneficence, nonmaleficence and justice provide the starting point and help us to identify the ethical challenges of emergency department triage. However, they do not offer a comprehensive ethical view. To address the ethical issues of emergency department triage from a more comprehensive ethical view, the care ethics perspective offers additional insights. Summary We integrate the results from the analysis using four principles of biomedical ethics into care ethics perspective on triage and propose an integrated clinically and ethically based framework of emergency department triage planning, as seen from a comprehensive ethics perspective that incorporates both the principles-based and care-oriented approach.

2011-01-01

119

Nurse triage in theory and in practice  

Microsoft Academic Search

'Nurse Triage' refers to the formal process of early assessment of patients attending an accident and emergency (A&E) department by a trained nurse, to ensure that they receive appropriate attention, in a suitable location, with the requisite degree of urgency. The benefits claimed for nurse triage include better patient outcomes, through clinical management reaching those in greatest need of it

S George; S Read; L Westlake; B Williams; P Pritty; A Fraser-Moodie

1993-01-01

120

How Reliable Is Emergency Department Triage?  

Microsoft Academic Search

Study objective: To measure interrater and intrarater agreement for an emergency department triage system. Methods: A 2-phase experimental study was conducted using previously described in-person scripted encounters with emergency nurses who perform patient triage and attending emergency physicians at a tertiary referral center. Standardized patient scenarios were presented twice over 6 weeks. Participants rated severity for each patient using a

Christopher MB Fernandes; Richard Wuerz; Steven Clark; Ognjenka Djurdjev

1999-01-01

121

Does a physician visual assessment change triage?  

Microsoft Academic Search

A prospective comparative trial was conducted to determine the effect of a physician's visual assessment of emergency patients on triage categorization and ability at triage to predict admission. The setting was a university, county, referral center and residency training site. Participants were a consecutive sample of emergency department patients presenting between the times of 0700 and 2300 hours for 5

Judith C Brillman; David Doezema; Dan Tandberg; David P Sklar; Betty J Skipper

1997-01-01

122

From the battlefields to the states: the road to recovery. The role of Landstuhl Regional Medical Center in US military casualty care.  

PubMed

The transformation of the modern battlefield with respect to weaponry, modes of transportation, enemy capabilities and location, as well as technological advances, has greatly altered the tactical approach to the mission. Combat casualty care must continually evolve in response to the differences in types of injury, the number and triage of casualties, timing of treatment, and location of care. These battlefield changes have been demonstrated on a large scale in the global war on terrorism, which includes the military operations in Afghanistan and Iraq. The medical response has kept pace with this 21st-century conflict. Even in the new environment of armed conflict and with the advent of new technologies, the principles of managing orthopaedic combat casualties remain clear: preservation of life and limb, skeletal stabilization, and aggressive wound débridement. For United States service members wounded in the current conflicts, Landstuhl Regional Medical Center is a crucial stop along the road to recovery. PMID:17003206

Tenuta, Joachim J

2006-01-01

123

Revising the rural hospital disaster plan: a role for the EMS system in managing the multiple casualty incident.  

PubMed

Much of the effort in disaster planning has been directed toward large-scale, war-related, or major natural disasters. We helped test a rural community's disaster plan in a simulated airport accident, and concluded that this plan was not the most effective for providing the triage and stabilization in the field that are essential to the management of this type of accident. This communication argues for the development of an alternative model of response involving the "escalation" of the everyday emergency medical services system. We believe this will provide more rapid and effective allocation of the rural community's limited medical resources in the management of the multiple casualty incident. PMID:7458031

Melton, R J; Riner, R M

1981-01-01

124

Analysis of driver casualty risk for different work zone types  

Microsoft Academic Search

Using driver casualty data from the Fatality Analysis Report System, this study examines driver casualty risk and investigates the risk contributing factors in the construction, maintenance and utility work zones. The multiple t-tests results show that the driver casualty risk is statistically different depending on the work zone type. Moreover, construction work zones have the largest driver casualty risk, followed

Jinxian Weng; Qiang Meng

2011-01-01

125

Evaluation of Aide Triage of Ambulatory Patients.  

National Technical Information Service (NTIS)

Anticipating an ambulatory facility in which paraprofessional personnel preside at some visits, presenting patients must be classified into categories according to their needs. This report describes a triage process which distinguishes between emergency a...

F. E. Bragg K. Streiff L. Goodstine

1971-01-01

126

Casualty Estimates for Contingencies. Volume 2. Appendices.  

National Technical Information Service (NTIS)

This volume of the final report contains tables presenting composite data on environmental and operational variables of the 73 engagements (45 minor contingency and 28 extended insurgency) used for calculating casualty rates. Tables presenting the casualt...

J. R. Brinkerhoff T. N. Dupuy C. C. Johnson B. R. Bader

1985-01-01

127

Reducing and Mitigating Civilian Casualties: Enduring Lessons.  

National Technical Information Service (NTIS)

The United States has long been committed to upholding the Law of Armed Conflict (LOAC) and minimizing collateral damage, which includes civilian casualties (CIVCAS) and unintended damage to civilian objects (facilities, equipment, or other property that ...

L. Lewis

2013-01-01

128

Blood bank protocols for large-scale civilian casualty events: experience from terrorist bombing in Israel.  

PubMed

Terrorist attacks in crowded places cause multiple casualties that are evacuated by quick succession to nearby hospitals. The study goals were to analyse the issues of patient misidentification and excessive blood request and to develop recommendations for the management of such episodes. A retrospective analysis of nine explosion attacks was performed. In nine consecutive events, 450 casualties were reported by the National Ambulance Service, 82 of whom (18%) died on the explosion site and 368 were admitted to nearby trauma centres. Red blood cell units were typed and cross-matched for 70 patients. Seventy-three per cent of the blood supplied over the first 24 h was administered during the first 2 h. The cross-matched/transfused ratio was 2.52 +/- 1.42, reflecting the overestimation of blood requirement in mass casualty episodes. In the mass casualty setup, blood bank personnel should be alert to a potential mistransfusion or a blood collection error. Unidentified patients are subjected to errors due to only one-digit difference in their temporary identification number. Application of the system using an additional sequential four-digit number printed in bold and large size font for patients at admission reduced the possibility of misidentification. Modern technologies, including error-reduction design wristbands, barcode-based system or radiofrequency identification tags may also increase reliability of patient identification in the mass casualty setup. PMID:17430470

Dann, E J; Bonstein, L; Arbov, L; Kornberg, A; Rahimi-Levene, N

2007-04-01

129

Recommendations for postexposure interventions to prevent infection with hepatitis B virus, hepatitis C virus, or human immunodeficiency virus, and tetanus in persons wounded during bombings and other mass-casualty events--United States, 2008: recommendations of the Centers for Disease Control and Prevention (CDC).  

PubMed

This report outlines recommendations for postexposure interventions to prevent infection with hepatitis B virus, hepatitis C virus, or human immunodeficiency virus, and tetanus in persons wounded during bombings or other events resulting in mass casualties. Persons wounded during such events or in conjunction with the resulting emergency response might be exposed to blood, body fluids, or tissue from other injured persons and thus be at risk for bloodborne infections. This report adapts existing general recommendations on the use of immunization and postexposure prophylaxis for tetanus and for occupational and nonoccupational exposures to bloodborne pathogens to the specific situation of a mass-casualty event. Decisions regarding the implementation of prophylaxis are complex, and drawing parallels from existing guidelines is difficult. For any prophylactic intervention to be implemented effectively, guidance must be simple, straightforward, and logistically undemanding. Critical review during development of this guidance was provided by representatives of the National Association of County and City Health Officials, the Council of State and Territorial Epidemiologists, and representatives of the acute injury care, trauma and emergency response medical communities participating in CDC's Terrorism Injuries: Information, Dissemination and Exchange (TIIDE) project. The recommendations contained in this report represent the consensus of U.S. federal public health officials and reflect the experience and input of public health officials at all levels of government and the acute injury response community. PMID:18668022

Chapman, Louisa E; Sullivent, Ernest E; Grohskopf, Lisa A; Beltrami, Elise M; Perz, Joseph F; Kretsinger, Katrina; Panlilio, Adelisa L; Thompson, Nicola D; Ehrenberg, Richard L; Gensheimer, Kathleen F; Duchin, Jeffrey S; Kilmarx, Peter H; Hunt, Richard C

2008-08-01

130

Postexposure interventions to prevent infection with HBV, HCV, or HIV, and tetanus in people wounded during bombings and other mass casualty events--United States, 2008: recommendations of the Centers for Disease Control and Prevention and Disaster Medicine and Public Health Preparedness.  

PubMed

People wounded during bombings or other events resulting in mass casualties or in conjunction with the resulting emergency response may be exposed to blood, body fluids, or tissue from other injured people and thus be at risk for bloodborne infections such as hepatitis B virus, hepatitis C virus, human immunodeficiency virus, or tetanus. This report adapts existing general recommendations on the use of immunization and postexposure prophylaxis for tetanus and for occupational and nonoccupational exposures to bloodborne pathogens to the specific situation of a mass casualty event. Decisions regarding the implementation of prophylaxis are complex, and drawing parallels from existing guidelines is difficult. For any prophylactic intervention to be implemented effectively, guidance must be simple, straightforward, and logistically undemanding. Critical review during development of this guidance was provided by representatives of the National Association of County and City Health Officials, the Council of State and Territorial Epidemiologists, and representatives of the acute injury care, trauma, and emergency response medical communities participating in the Centers for Disease Control and Prevention's Terrorism Injuries: Information, Dissemination and Exchange project. There recommendations contained in this report represent the consensus of US federal public health officials and reflect the experience and input of public health officials at all levels of government and the acute injury response community. PMID:18677271

Chapman, Louisa E; Sullivent, Ernest E; Grohskopf, Lisa A; Beltrami, Elise M; Perz, Joseph F; Kretsinger, Katrina; Panlilio, Adelisa L; Thompson, Nicola D; Ehrenberg, Richard L; Gensheimer, Kathleen F; Duchin, Jeffrey S; Kilmarx, Peter H; Hunt, Richard C

2008-10-01

131

Value of the multi-service casualty processing unit in Operation Desert Storm: teamwork and flexibility.  

PubMed

This paper examines the role and implementation of a casualty processing unit (CPU) developed by a multi-service group during Operation Desert Storm in Saudi Arabia. Data were obtained from review of flight manifests, fleet hospital admission records, 24-hour follow-up of patients admitted to Fleet Hospital 15, and patient chart reviews following Desert Storm. The data indicate the CPU proved to be an effective and practical approach to health care in a combat zone, and provided an increased number of returned-to-duty personnel and timely triage of most seriously wounded combatants. In addition, it provided an opportunity for medical personnel of all branches of the armed services to participate as a team. As a result of this study, we propose consideration be given to use of this type of multi-service facility in future combat arenas. PMID:9121660

Crawford, P E; Armstrong, J F; Kerstein, M D; Oxler, S; Draude, T V

1997-03-01

132

Nature, correlates, and consequences of stress-related biological reactivity and regulation in Army nurses during combat casualty simulation.  

PubMed

This study examined the nature, concomitants, and consequences of stress-related biological reactivity and regulation among Army nurses. Saliva was collected, heart rate (HR) and blood pressure (BP) recorded from 38 Army nurses (74% female; mean age 28.5 years [SD=6.5]) before, during, and after participation in the Combat Casualty Stress Scenario (CCSS). Saliva was assayed for cortisol and alpha-amylase (sAA). The CCSS simulates emergency combat rescue, employing two simulated combat casualties, aversive body odors, recorded battlefield sounds, and smoke in a low light environment. Participants locate and conduct preliminary assessments of the simulated patients, triage based on injury severity, initiate treatment, and coordinate medical evacuation by radio. Results revealed large magnitude increases in cortisol, sAA, HR, systolic BP and diastolic BP in response to the CCSS, followed by recovery to baseline levels 30min after the task for all physiological parameters except cortisol. Age, gender, perceived difficulty of the CCSS, and previous nursing experience were associated with individual differences in the magnitude of the physiological responses. Lower levels of performance related to triage and treatment were associated with higher levels of reactivity and slower recovery for some of the physiological measures. The findings raise important questions regarding the utility of integrating measures of the psychobiology of the stress response into training programs designed to prepare first responders to handle highly complex and chaotic rescue situations. PMID:22710003

McGraw, Leigh K; Out, Dorothée; Hammermeister, Jon J; Ohlson, Carl J; Pickering, Michael A; Granger, Douglas A

2012-06-17

133

Development and Evaluation of a Triage Index for Penetrating Trauma.  

National Technical Information Service (NTIS)

Several new severity scores, the Triage Score, the Triage Index, and Trauma Score, were evaluated for patients with penetrating injuries. The scores, are composed of measures easily obtained by either medical or paramedical personnel using noninvasive tec...

W. J. Sacco H. R. Champion

1981-01-01

134

Deployed Assessment and Management of mTBI Casualties.  

PubMed

The wars in Afghanistan and Iraq have placed a spotlight on screening, evaluation, and treatment of mild traumatic brain injury, otherwise known as concussion. The author presents a mass casualty case in which a Ranger company medical section assessed and managed 30 Servicemembers (SM) diagnosed with concussion. Through the process of treating these Servicemembers, a consolidated checklist was created based on existing Department of Defense, United States Special Operations Command (USSOCOM), and United States Army Special Operations Command (USASOC) guidelines. During this and subsequent clinical encounters, utilization of this checklist resulted in efficient identification of concussed personnel, appropriate treatment, and documentation. PMID:24048990

Garfin, Benjamin

2013-01-01

135

Decision making by emergency nurses in triage assessments  

Microsoft Academic Search

Triage assessment of patients on arrival at emergency departments involves complex decision making, resulting in categories being assigned to prioritize patients' needs for attention. The actual process of triage decision making has received limited attention. The aims of this study were to describe aspects of the triage decision-making process used by both more and less experienced nurses (n = 20)

J. Cioffi

1998-01-01

136

Mobile Decision Support for Triage in Emergency Departments  

Microsoft Academic Search

Triage in emergency departments is often complex and subject to conditions of uncertainty. The need for timely and accurate clinical assessment based on restricted and ambiguous information; the need to be consistent with standard triage scale and the stressful environment contribute to complexity and uncertainty of triage decision-making. This paper proposes a model for mobile decision support that aims at

Jocelyn San Pedro; Frada Burstein; Patrick Cao; Leonid Churilov; Arkady Zaslavsky; Jeff Wassertheil

137

Factors that affect the flow of patients through triage  

Microsoft Academic Search

Objective: To use observational methods to objectively evaluate the organisation of triage and what issues may affect the effectiveness of the process.Design: A two-phase study comprising observation of 16 h of triage in a London hospital emergency department and interviews with the triage staff to build a qualitative task analysis and study protocol for phase 2; observation and timing in

Melinda Lyons; Ruth Brown; Robert Wears

2007-01-01

138

Reliability and validity of emergency department triage systems  

Microsoft Academic Search

Reliability and validity of triage systems is important because this can affect patient safety. In this thesis, these aspects of two emergency department (ED) triage systems were studied as well as methodological aspects in these types of studies. The consistency, reproducibility, and criterion validity of the Manchester Triage System (MTS) were studied in chapter 2. The consistency and reproducibility appeared

I. van der Wulp

2010-01-01

139

Reliability and validity of triage systems in paediatric emergency care  

Microsoft Academic Search

BACKGROUND: Triage in paediatric emergency care is an important tool to prioritize seriously ill children. Triage can also be used to identify patients who do not need urgent care and who can safely wait. The aim of this review was to provide an overview of the literature on reliability and validity of current triage systems in paediatric emergency care METHODS:

Mirjam van Veen; Henriette A Moll

2009-01-01

140

26 CFR 1.165-7 - Casualty losses.  

Code of Federal Regulations, 2013 CFR

...4) and (c) of this section, any loss arising from fire, storm, shipwreck, or other casualty is allowable as...generally give rise to a single casualty. For example, if a storm damages a taxpayer's residence and his automobile...

2013-04-01

141

46 CFR 197.484 - Notice of casualty.  

Code of Federal Regulations, 2011 CFR

...STANDARDS GENERAL PROVISIONS Commercial Diving Operations Records § 197.484 ...Inspection, as soon as possible after a diving casualty occurs, if the casualty involves...following: (1) Loss of life. (2) Diving-related injury to any person...

2012-10-01

142

American War and Military Operations Casualties: Lists and Statistics.  

National Technical Information Service (NTIS)

This report is written in response to numerous requests for war casualty statistics and lists of war dead. It provides tables, compiled by sources at the Department of Defense, indicating the number of casualties among American military personnel serving ...

H. Fischer

2005-01-01

143

Multiple casualty incidents: the prehospital role of the anesthesiologist in Europe.  

PubMed

The recent increase in incidents involving mass casualties has emphasized the need for a planned and coordinated prehospital emergency medical response, with medical teams on-site to provide advanced trauma life support. The special skills of the anesthesiologist make his/her contribution to prehospital emergency care particularly valuable. The United Kingdom's emergency medical services system is operated paramedically like that in the United States, and is based on rapid evacuation of casualties to hospital emergency medical facilities. In contrast, the French approach is based on the use of its emergency care system SAMU, where both structured dispatching and on-site medical care is provided by physicians, including anesthesiologists. In this article, the lessons learned from multiple casualty incidents in Europe during the past 2 decades are considered from the standpoint of the anesthesiologist. PMID:17400164

Baker, David J; Telion, Caroline; Carli, Pierre

2007-03-01

144

The Use of Advanced Simulation in the Training of Anesthesiologists to Treat Chemical Warfare Casualties  

Microsoft Academic Search

Training anesthesiologists to treat nerve gas intoxica- tion in a mass casualty scenario is a complicated task. The scenario is an unfamiliar medical situation involv- ing the need to decontaminate patients before provid- ing definitive medical treatment, and the need for phys- ical protection to the medical team before decontamination. We describe the development of a simulation-based training program. In

RONALD D. MILLER

145

48 CFR 552.270-7 - Fire and Casualty Damage.  

Code of Federal Regulations, 2011 CFR

...2011-10-01 2011-10-01 false Fire and Casualty Damage. 552.270-7...Provisions and Clauses 552.270-7 Fire and Casualty Damage. As prescribed in 570.703, insert the following clause: Fire and Casualty Damage (JUN 2011)...

2011-10-01

146

The Advanced Health and Disaster Aid Network: A LightWeight Wireless Medical System for Triage  

Microsoft Academic Search

Advances in semiconductor technology have resulted in the creation of miniature medical embedded systems that can wirelessly monitor the vital signs of patients. These lightweight medical systems can aid providers in large disasters who become overwhelmed with the large number of patients, limited resources, and insufficient information. In a mass casualty incident, small embedded medical systems facilitate patient care, resource

Tia Gao; Tammara Massey; Leo Selavo; David Crawford; Bor-rong Chen; Konrad Lorincz; Victor Shnayder; Logan Hauenstein; Foad Dabiri; James Jeng; Arjun Chanmugam; David White; Majid Sarrafzadeh; Matt Welsh

2007-01-01

147

Accountability Incentives: Do Schools Practice Educational Triage?  

ERIC Educational Resources Information Center

|Increasingly frequent journalistic accounts report that schools are responding to No Child Left Behind (NCLB) by engaging in what has come to be known as "educational triage." Although these accounts rely almost entirely on anecdotal evidence, the prospect is of real concern. The NCLB accountability system divides schools into those in which a…

Springer, Matthew G.

2008-01-01

148

Field triage systems: Methodologies from the literature  

Microsoft Academic Search

The primary goal of the Neely Conference project is to work toward defining a set of research criteria for medical necessity in emergency medical services (EMS). This paper reviews the extant literature on triage and nontransport decisions made in the field by EMS personnel, with emphasis on the methodologies that have been used to date. Two types of medical necessity

David C Cone; Robert Benson; Terri A Schmidt; N. Clay Mann

2004-01-01

149

Triage Nurse Prediction of Hospital Admission  

Microsoft Academic Search

Introduction: Numerous factors impact patient flow in the emergency department (ED). One important factor that has a negative impact on flow is ED patients waiting for an in-patient bed. It currently takes approximately 5 hours from triage to request for an in-patient bed in our emergency department. Knowledge of patients requiring admission early in their ED evaluation could speed up

Blythe Stover-Baker; Barbara Stahlman; Marc Pollack

150

Hyperglycemic Response to Trauma in Combat Casualties.  

National Technical Information Service (NTIS)

Studies of 67 battle casualties confirmed the occurrence of a hyperglycemic response to trauma. The magnitude of hyperglycemia was related to the severity of injury and correlated with serum lactate levels, but not with arterial pH or PO2. Though of less ...

H. K. Sleeman J. J. McNamara J. J. Stremple M. Malot

1971-01-01

151

Bushfire disaster burn casualty management: the Australian "Black Saturday" bushfire experience.  

PubMed

Mass burn disasters are among the most difficult disasters to manage, with major burns requiring complex management in a multidisciplinary setting and specialist burns services having limited capacity to deal with large numbers of complex patients. There is a paucity of literature addressing health system responses to mass burn disasters resulting from wildfires, with the events of the "Black Saturday" disaster in the state of Victoria, Australia, able to provide a unique opportunity to draw lessons and increase awareness of key management issues arising in mass burn casualty disasters. The event comprised the worst natural disaster in the state's history and one of the worst wildfire disasters in world history, claiming 173 lives and costing more than AUD 4 billion. This article draws on the national burns disaster plan instituted, Australian Mass Casualty Burn Disaster Plan (AUSBURNPLAN), and details the management of mass burn cases through a systems-based perspective. PMID:22001422

Seifman, Marc; Ek, Edmund W; Menezes, Hana; Rozen, Warren M; Whitaker, Iain S; Cleland, Heather J

2011-11-01

152

Risk Analysis for Environmental Health Triage  

Microsoft Academic Search

The Homeland Security Act mandates the development of a national, risk-based system to support planning for, response to, and recovery from emergency situations involving large-scale toxic exposures. To prepare for and manage consequences effectively, planners and responders need not only to identify zones of potentially elevated individual risk but also to predict expected casualties. Emergency response support systems now define

Kenneth T. Bogen

2005-01-01

153

Battlefield triage life signs detection techniques  

Microsoft Academic Search

Getting to wounded soldiers on the battlefield is a precarious task, and medics have a very high casualty rate. It is therefore a vital importance to prioritize which soldiers to attend to first. The first step is to detect life signs - if a soldier is dead or alive, and prioritize recovery of live soldiers. The second step is to

Olga Boric-Lubecke; Jenshan Lin; Byung-Kwon Park; Changzhi Li; Wansuree Massagram; Victor M. Lubecke; Anders Host-Madsen

2008-01-01

154

Availability of a pediatric trauma center in a disaster surge decreases triage time of the pediatric surge population: a population kinetics model  

PubMed Central

Background The concept of disaster surge has arisen in recent years to describe the phenomenon of severely increased demands on healthcare systems resulting from catastrophic mass casualty events (MCEs) such as natural disasters and terrorist attacks. The major challenge in dealing with a disaster surge is the efficient triage and utilization of the healthcare resources appropriate to the magnitude and character of the affected population in terms of its demographics and the types of injuries that have been sustained. Results In this paper a deterministic population kinetics model is used to predict the effect of the availability of a pediatric trauma center (PTC) upon the response to an arbitrary disaster surge as a function of the rates of pediatric patients' admission to adult and pediatric centers and the corresponding discharge rates of these centers. We find that adding a hypothetical pediatric trauma center to the response documented in an historical example (the Israeli Defense Forces field hospital that responded to the Haiti earthquake of 2010) would have allowed for a significant increase in the overall rate of admission of the pediatric surge cohort. This would have reduced the time to treatment in this example by approximately half. The time needed to completely treat all children affected by the disaster would have decreased by slightly more than a third, with the caveat that the PTC would have to have been approximately as fast as the adult center in discharging its patients. Lastly, if disaster death rates from other events reported in the literature are included in the model, availability of a PTC would result in a relative mortality risk reduction of 37%. Conclusions Our model provides a mathematical justification for aggressive inclusion of PTCs in planning for disasters by public health agencies.

2011-01-01

155

Westinghouse GOCO conduct of casualty drills  

SciTech Connect

Purpose of this document is to provide Westinghouse Government Owned Contractor Operated (GOCO) Facilities with information that can be used to implement or improve drill programs. Elements of this guide are highly recommended for use when implementing a new drill program or when assessing an existing program. Casualty drills focus on response to abnormal conditions presenting a hazard to personnel, environment, or equipment; they are distinct from Emergency Response Exercises in which the training emphasis is on site, field office, and emergency management team interaction. The DOE documents which require team training and conducting drills in nuclear facilities and should be used as guidance in non-nuclear facilities are: DOE 5480.19 (Chapter 1 of Attachment I) and DOE 5480.20 (Chapter 1, paragraphs 7 a. and d. of continuing training). Casualty drills should be an integral part of the qualification and training program at every DOE facility.

Ames, C.P.

1996-02-01

156

Boston bombings: a surgical view of lessons learned from combat casualty care and the applicability to Boston's terrorist attack.  

PubMed

The Boston bombing incident was a recent civilian mass casualty terrorist event that demonstrated effective transfer of the lessons of combat casualty care to inform effective civilian medical care. Thirty-nine patients were seen at Brigham and Women's Hospital and thirteen patients received emergency surgery in the first few hours after the event. The subsequent management, total hospital days 181, total number of operative procedures 72, and discharging service listing of these thirteen patients illustrate the intensive surgical resources necessary after a civilian bomb attack. Plastic surgery played a role in the multidisciplinary collaboration of the limb salvage efforts and this role can inform the importance of other plastic surgery contributions within mass casualty surgical management. We believe that prepositioned collaborative relationships of plastic surgery, vascular surgery, trauma surgery and orthopedic surgery may offer a model of collaboration for limb salvage that can be applied in military and mass casualty medical care if resources permit. In this attack, effective use of tourniquets was implemented by prehospital medical providers that saved lives and limbs and these actions reaffirm the important lessons learned from combat casualty care. Unfortunately, it is likely that more centers will deal with similar events in the future and it is imperative that we as a community of providers take what lessons we can from battlefield medicine and that we collectively prepare for and engage this future. PMID:23851738

Caterson, E J; Carty, Matthew J; Weaver, Michael J; Holt, Eric F

2013-07-01

157

Using a theory to understand triage decision making.  

PubMed

The purpose of this discussion is to present triage decision making research within the context of the Revised Cognitive Continuum Theory. Triage is an essential clinical skill in emergency nursing. Understanding the best way to facilitate this skill is vital when educating new nurses or providing continuing education to practicing nurses. Delineating research evidence within a theory allows clinical educators to understand practices that foster successful triage skills and permits the grounding of educational strategies within a theoretical framework. PMID:23615518

Smith, Anita

2012-04-05

158

Triage issues in an out-of-hospital birth center  

Microsoft Academic Search

Effective triage in an out-of-hospital birth center helps low-risk women avoid high-risk care. Background issues include the contributions of evidence-based practice, informed consent, patient education, problem-focused documentation, after-hours access to client data, and the value of intuition. Telephone triage, immediate referral, birth center management, and follow-up with counseling are outlined for common out-of-hospital triage problems: first trimester bleeding, nausea and

Patricia M Barnes; Melanie S Dossey

1999-01-01

159

Identifying the core competencies of mental health telephone triage.  

PubMed

Aims and objectives.? The primary aim of this study was to identify the core competencies of mental health telephone triage, including key role tasks, skills, knowledge and responsibilities, in which clinicians are required to be competent to perform safe and effective triage. Background.? Recent global trends indicate an increased reliance on telephone-based health services to facilitate access to health care across large populations. The trend towards telephone-based health services has also extended to mental health settings, evidenced by the growing number of mental health telephone triage services providing 24-hour access to specialist mental health assessment and treatment. Mental health telephone triage services are critical to the early identification of mental health problems and the provision of timely, appropriate interventions. In spite of the rapid growth in mental health telephone triage and the important role these services play in the assessment and management of mental illness and related risks, there has been very little research investigating this area of practice. Design.? An observational design was employed to address the research aims. Methods.? Structured observations (using dual wireless headphones) were undertaken on 197 occasions of mental health telephone triage over a three-month period from January to March 2011. Results.? The research identified seven core areas of mental health telephone triage practice in which clinicians are required to be competent in to perform effective mental health telephone triage, including opening the call; performing mental status examination; risk assessment; planning and action; termination of call; referral and reporting; and documentation. Conclusions.? The findings of this research contribute to the evidence base for mental health telephone triage by articulating the core competencies for practice. Relevance to clinical practice.? The mental health telephone triage competencies identified in this research may be used to define an evidence-based framework for mental health telephone triage practice that aims to improve the quality, consistency and accuracy of telephone-based mental health triage assessment. PMID:22860919

Sands, Natisha; Elsom, Stephen; Gerdtz, Marie; Henderson, Kathryn; Keppich-Arnold, Sandra; Droste, Nicolas; Prematunga, Roshani K; Wereta, Zewdu W

2012-08-02

160

Optimizing triage and hospitalization in adult general medical emergency patients: the triage project  

PubMed Central

Background Patients presenting to the emergency department (ED) currently face inacceptable delays in initial treatment, and long, costly hospital stays due to suboptimal initial triage and site-of-care decisions. Accurate ED triage should focus not only on initial treatment priority, but also on prediction of medical risk and nursing needs to improve site-of-care decisions and to simplify early discharge management. Different triage scores have been proposed, such as the Manchester triage system (MTS). Yet, these scores focus only on treatment priority, have suboptimal performance and lack validation in the Swiss health care system. Because the MTS will be introduced into clinical routine at the Kantonsspital Aarau, we propose a large prospective cohort study to optimize initial patient triage. Specifically, the aim of this trial is to derive a three-part triage algorithm to better predict (a) treatment priority; (b) medical risk and thus need for in-hospital treatment; (c) post-acute care needs of patients at the most proximal time point of ED admission. Methods/design Prospective, observational, multicenter, multi-national cohort study. We will include all consecutive medical patients seeking ED care into this observational registry. There will be no exclusions except for non-adult and non-medical patients. Vital signs will be recorded and left over blood samples will be stored for later batch analysis of blood markers. Upon ED admission, the post-acute care discharge score (PACD) will be recorded. Attending ED physicians will adjudicate triage priority based on all available results at the time of ED discharge to the medical ward. Patients will be reassessed daily during the hospital course for medical stability and readiness for discharge from the nurses and if involved social workers perspective. To assess outcomes, data from electronic medical records will be used and all patients will be contacted 30 days after hospital admission to assess vital and functional status, re-hospitalization, satisfaction with care and quality of life measures. We aim to include between 5000 and 7000 patients over one year of recruitment to derive the three-part triage algorithm. The respective main endpoints were defined as (a) initial triage priority (high vs. low priority) adjudicated by the attending ED physician at ED discharge, (b) adverse 30 day outcome (death or intensive care unit admission) within 30 days following ED admission to assess patients risk and thus need for in-hospital treatment and (c) post acute care needs after hospital discharge, defined as transfer of patients to a post-acute care institution, for early recognition and planning of post-acute care needs. Other outcomes are time to first physician contact, time to initiation of adequate medical therapy, time to social worker involvement, length of hospital stay, reasons for discharge delays, patient’s satisfaction with care, overall hospital costs and patients care needs after returning home. Discussion Using a reliable initial triage system for estimating initial treatment priority, need for in-hospital treatment and post-acute care needs is an innovative and persuasive approach for a more targeted and efficient management of medical patients in the ED. The proposed interdisciplinary , multi-national project has unprecedented potential to improve initial triage decisions and optimize resource allocation to the sickest patients from admission to discharge. The algorithms derived in this study will be compared in a later randomized controlled trial against a usual care control group in terms of resource use, length of hospital stay, overall costs and patient’s outcomes in terms of mortality, re-hospitalization, quality of life and satisfaction with care. Trial registration ClinicalTrials.gov Identifier, NCT01768494

2013-01-01

161

Protection Against Means of Mass Destruction.  

National Technical Information Service (NTIS)

Contents: Detection of chemical toxic agents; Individual means of protection; Collective protection from weapons of mass destruction; Principles of chemical agent casualty treatment; and Deactivation, decontamination and disinfection.

O. V. Vladimirov N. V. Sergeev V. K. Semenov Y. V. Dorokhov I. G. Petrov

1969-01-01

162

49 CFR 850.15 - Marine casualty investigation by the Board.  

Code of Federal Regulations, 2011 CFR

...2011-10-01 false Marine casualty investigation by the Board. 850.15 Section 850...TRANSPORTATION SAFETY BOARD MARINE CASUALTY INVESTIGATIONS § 850.15 Marine casualty investigation by the Board. (a) The Board...

2011-10-01

163

46 CFR 4.40-25 - Coast Guard marine casualty investigation for the Board.  

Code of Federal Regulations, 2012 CFR

...Coast Guard marine casualty investigation for the Board. 4.40-25...PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Coast Guard-National Transportation...Safety Board Marine Casualty Investigations § 4.40-25 Coast...

2012-10-01

164

46 CFR 4.40-25 - Coast Guard marine casualty investigation for the Board.  

Code of Federal Regulations, 2011 CFR

...Coast Guard marine casualty investigation for the Board. 4.40-25...PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Coast Guard-National Transportation...Safety Board Marine Casualty Investigations § 4.40-25 Coast...

2011-10-01

165

46 CFR 4.40-15 - Marine casualty investigation by the Board.  

Code of Federal Regulations, 2012 CFR

...2012-10-01 false Marine casualty investigation by the Board. 4.40-15...PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Coast Guard-National Transportation...Safety Board Marine Casualty Investigations § 4.40-15 Marine...

2012-10-01

166

49 CFR 850.25 - Coast Guard marine casualty investigation for the Board.  

Code of Federal Regulations, 2011 CFR

...false Coast Guard marine casualty investigation for the Board. 850.25 Section...TRANSPORTATION SAFETY BOARD MARINE CASUALTY INVESTIGATIONS § 850.25 Coast Guard marine casualty investigation for the Board. (a) If the...

2011-10-01

167

49 CFR 850.15 - Marine casualty investigation by the Board.  

Code of Federal Regulations, 2012 CFR

...2012-10-01 false Marine casualty investigation by the Board. 850.15 Section 850...TRANSPORTATION SAFETY BOARD MARINE CASUALTY INVESTIGATIONS § 850.15 Marine casualty investigation by the Board. (a) The Board...

2012-10-01

168

49 CFR 850.25 - Coast Guard marine casualty investigation for the Board.  

Code of Federal Regulations, 2012 CFR

...false Coast Guard marine casualty investigation for the Board. 850.25 Section...TRANSPORTATION SAFETY BOARD MARINE CASUALTY INVESTIGATIONS § 850.25 Coast Guard marine casualty investigation for the Board. (a) If the...

2012-10-01

169

46 CFR 4.40-15 - Marine casualty investigation by the Board.  

Code of Federal Regulations, 2011 CFR

...2011-10-01 false Marine casualty investigation by the Board. 4.40-15...PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Coast Guard-National Transportation...Safety Board Marine Casualty Investigations § 4.40-15 Marine...

2011-10-01

170

17 CFR 210.12-18 - Supplemental information (for property-casualty insurance underwriters).  

Code of Federal Regulations, 2013 CFR

...Supplemental information (for property-casualty insurance underwriters...1940, AND ENERGY POLICY AND CONSERVATION ACT OF 1975 Form and Content...Supplemental information (for property-casualty insurance underwriters...Column K (a) Consolidated property-casualty entities 2...

2013-04-01

171

Social Distribution, Ghettoization, and Educational Triage: A Marxist Analysis.  

ERIC Educational Resources Information Center

|Discusses how many urban students are written off as unworthy of scant educational resources, using Weber and Marx to discuss how educational triage is best understood theoretically, exploring how broader processes of social distribution and triage link up with daily practices and policies in urban classrooms, and highlighting the need for a…

Cameron, Jeanne

2000-01-01

172

Technology Staff Development: Triage Using Three Mastery Levels.  

ERIC Educational Resources Information Center

The technology triage is a workable paradigm for straightforward school-site/school-district implementation of technology resources. Development of a triage system of participant involvement and in-service staff development can help address the tendency to ineffectively allocate funds within the total picture of the school commitment to…

Guffey, J. Stephen; Rampp, Lary C.; Bradley, Mary Jane

173

Does the Manchester triage system detect the critically ill?  

Microsoft Academic Search

BACKGROUND: The Manchester triage system (MTS) is now widely used in UK accident and emergency (A&E) departments. No clinical outcome studies have yet been published to validate the system. Safety of triage systems is related to the ability to detect the critically ill, which has to be balanced with resource implications of overtriage. OBJECTIVES: To determine whether the MTS can

M W Cooke; S Jinks

1999-01-01

174

The Effect of Civilian Casualties in Afghanistan and Iraq  

Microsoft Academic Search

A central question in intrastate conflicts is how insurgents are able to mobilize supporters to participate in violent and risky activities. A common explanation is that violence committed by counterinsurgent forces mobilizes certain segments of the population through a range of mechanisms. We study the effects of civilian casualties in Iraq and Afghanistan to quantify the effect of such casualties

Luke N. Condra; Joseph H. Felter; Radha K. Iyengar; Jacob N. Shapiro

2010-01-01

175

Effects of War Casualties on U.S. Public Opinion.  

National Technical Information Service (NTIS)

The experience of the wars in Korea and Vietnam has led many U.S. policymakers and military leaders to believe that the American public cannot tolerate high casualty rates in regional conflicts. Conventional wisdom holds that as casualties mount, public o...

1994-01-01

176

Multilocation teleradiology system for emergency triage consultation  

NASA Astrophysics Data System (ADS)

A remote consultation system is available at the University of Pittsburgh Medical Center (UPMC) which links four outlying hospitals in Western Pennsylvania and Eastern Ohio. This system has the potential to improve short and long term clinical outcomes and to reduce overall medical care cost by establishing improved emergency triage capability. An EMED, Inc. teleradiology system permits rapid, high-quality transfer of digitized film and CT images from the remote sites to the tertiary care center (UPMC). The images are sent over dial-on- demand ISDN and SW56 lines from the remote hospitals to a central server where they are transmitted to a dual 2K monitor workstation in the Emergency Department, thirteen Eastman Kodak PDS workstations within UPMC, and to three physician homes. Transmission to a workstation at each of the physician homes over ISDN lines enables `after hours' consultation. The radiographic images along with voice and fax communications provide a technique where physicians in outlying hospitals will be able to consult with specialists at any time. A study is in progress to evaluate the effectiveness of this system in terms of perception of utility and its potential to improve emergency triage capability, as well as selection of the appropriate transportation mode (helicopter versus ambulance).

Herron, John M.; Yonas, Howard

1996-05-01

177

Predictors of admission to hospital of patients triaged as nonurgent using the Canadian Triage and Acuity Scale.  

PubMed

ABSTRACTObjectives:To identify factors known prior to triage that might have predicted hospital admission for patients triaged by the Canadian Triage Acuity Scale (CTAS) as level 5 (CTAS 5, nonurgent) and to determine whether inappropriate triage occurred in the admitted CTAS 5 patients.Methods:We reviewed the triage records of patients triaged as CTAS 5 at the emergency departments (EDs) of three tertiary care hospitals between April 2002 and September 2009. Two triage nurses unaware of the study objective independently assigned the CTAS level in 20% of randomly selected CTAS 5 patients who were admitted. We used the kappa statistic (?) to measure the agreement among the raters in CTAS level between the assessment of the research nurses and the original triage assessment and regression analysis to identify independent predictors of admission to hospital.Results:Of the 37,416 CTAS 5 patients included in this study, 587 (1.6%) were admitted. Agreement on CTAS assignment in CTAS 5 patients who were admitted was ? -0.9, (95% confidence interval [CI] -0.96 to -0.84). Age over 65 (odds ratio [OR] 5.46, 95% CI 4.57 to 6.53) and arrival by ambulance (OR 7.42, 95% CI 6.15 to 8.96) predicted hospital admission in CTAS 5 patients.Conclusions:Most of the CTAS 5 patients who were subsequently admitted to hospital may have qualified for a higher triage category. Two potential modifiers, age over 65 and arrival by ambulance, may have improved the prediction of admission in CTAS 5 patients. However, the consistent application of existing CTAS criteria may also be important to prevent incorrect triage. PMID:23721872

Lin, Daren; Worster, Andrew

2013-01-01

178

Intraosseous Vascular Access in the Treatment of Chemical Warfare Casualties Assessed by Advanced Simulation: Proposed Alteration of Treatment Protocol  

Microsoft Academic Search

Current treatment protocols for chemical warfare casu- alties assume no IV access during the early treatment stages. Time constraints in mass casualty scenarios, im- paired manual dexterity of medical personnel wearing protective gear, and victims' complex clinical presenta- tions render standard IV access techniques impractical. A newly developed spring-driven, trigger-operated in- traosseous infusion device may offer an effective solu- tion.

Amir Vardi; Haim Berkenstadt; Inbal Levin; Ariel Bentencur; Amitai Ziv

2004-01-01

179

Development of a lightweight portable ventilator for far-forward battlefield combat casualty support  

NASA Astrophysics Data System (ADS)

Immediate medical provision substantially reduces the number of fatalities sustained during military operations. However, the shift from large-scale regional conflicts to smaller peacekeeping and humanitarian missions has reduced the military medical support infrastructure. Civilian emergency medical services have long emphasized the 'golden hour' during which a patient must receive definitive medical attention. Without on-scene medical support, injured soldiers must be transported significant distances before receiving advanced medical care, and rapid transport to a medical facility is not always a viable option. Technological solutions enable military medics to deliver advanced medical care on the battlefield. We report here on the development of a small lightweight portable respirator for the treatment of far- forward battlefield casualties. The Far Forward Life Support System (FFLSS) utilizes a combination of COTS (commercial off the shelf) components and custom designed systems to provide ventilatory support to injured combatants. It also incorporates a small IV fluid pump and IV fluids for resuscitation. A microcompressor control system monitors both system performance and patient parameters for system control. Telemetry to a pager-like device worn by the front line medic alerts of any anomalies in ventilator or patient parameters, which will add greatly to triage decisions and resource management. Novel elements of the FLSS design include oxygen generation, low-pressure air generation, available patient suction, and the absence of any high pressure air cylinders. A prototype developed for animal testing will be described in detail as well as further design requirements for the human rated prototype.

Cutchis, Protagoras N.; Smith, Dexter G.; Ko, Harvey W.; Wiesmann, William P.; Pranger, L. A.

1999-07-01

180

Decontamination of multiple casualties who are chemically contaminated: a challenge for acute hospitals.  

PubMed

Patients who have been contaminated by chemical compounds present a number of difficulties to emergency departments, in particular, the risk of secondary contamination of healthcare staff and facilities. The Department of Health in the United Kingdom has provided equipment to decontaminate chemically contaminated casualties who present at emergency departments. The capacity of this equipment is limited, and although both the ambulance and fire services have equipment to cope with mass casualties at the scene of a chemical incident, there is still the possibility that acute hospitals will be overwhelmed by large numbers of self-presenting patients. The risks and potential consequences of this gap in resilience are discussed and a number of possible practical solutions are proposed. PMID:18557298

Clarke, Simon F J; Chilcott, Rob P; Wilson, James C; Kamanyire, Robie; Baker, David J; Hallett, Anthony

181

Holter triage ambulatory ECG analysis. Accuracy and time efficiency.  

PubMed

Triage ambulatory electrocardiographic (ECG) analysis permits relatively unskilled office workers to submit 24-hour ambulatory ECG Holter tapes to an automatic instrument (model 563, Del Mar Avionics, Irvine, CA) for interpretation. The instrument system "triages" what it is capable of automatically interpreting and rejects those tapes (with high ventricular arrhythmia density) requiring thorough analysis. Nevertheless, a trained cardiovascular technician ultimately edits what is accepted for analysis. This study examined the clinical validity of one manufacturer's triage instrumentation with regard to accuracy and time efficiency for interpreting ventricular arrhythmia. A database of 50 Holter tapes stratified for frequency of ventricular ectopic beats (VEBs) was examined by triage, conventional, and full-disclosure hand-count Holter analysis. Half of the tapes were found to be automatically analyzable by the triage method. Comparison of the VEB accuracy of triage versus conventional analysis using the full-disclosure hand count as the standard showed that triage analysis overall appeared as accurate as conventional Holter analysis but had limitations in detecting ventricular tachycardia (VT) runs. Overall sensitivity, positive predictive accuracy, and false positive rate for the triage ambulatory ECG analysis were 96, 99, and 0.9%, respectively, for isolated VEBs, 92, 93, and 7%, respectively, for ventricular couplets, and 48, 93, and 7%, respectively, for VT. Error in VT detection by triage analysis occurred on a single tape. Of the remaining 11 tapes containing VT runs, accuracy was significantly increased, with a sensitivity of 86%, positive predictive accuracy of 90%, and false positive rate of 10%. Stopwatch-recorded time efficiency was carefully logged during both triage and conventional ambulatory ECG analysis and divided into five time phases: secretarial, machine, analysis, editing, and total time. Triage analysis was significantly (P < .05) more time efficient for the machine, analysis, and total time phases and required significantly more time in the editing phases. The triage analysis was limited by the inability of the automatic methodology to detect a specific VT waveform contained on one tape. This result which caused substantial loss of sensitivity for VT, emphasizes the necessity for careful quality control and editing of all automatic Holter analysis methods. PMID:8808523

Cooper, D H; Kennedy, H L; Lyyski, D S; Sprague, M K

1996-01-01

182

Redefining Technical Rescue and Casualty Care for SOF: Part 1.  

PubMed

Trauma care in the tactical environment is complex; it requires a unique blend of situational awareness, foresight, medical skill, multitasking, and physical strength. Rescue is a critical, but often over-looked, component of nearly all tactical trauma casualty management. Successful full spectrum casualty management requires proficiency in four areas: casualty access, assessment, stabilization, and extraction. When complex rescue situations arise (casualty removal from roof tops, mountain terrain, collapsed structures, wells, or a karez), casualty care often becomes further complicated. Special Operations units have historically looked to civilian technical rescue techniques and equipment to fill this ?rescue gap.? Similar to the evolution of pre-hospital military medicine from civilian guidelines (e.g. Advanced Trauma Life Support) (ATLS)) to an evidence-based, tactical-specific guideline (Tactical Combat Casualty Care (TCCC)), an evolution is required within the rescue paradigm. This shift from civilian-based technical rescue guidelines towards an Operational Rescue? capability allows tactical variables such as minimal equipment, low light/night vision goggles (NVG) considerations, enemy threats, and variable evacuation times to permeate through the individual rescue skill set. Just as with TCCC, in which the principles of casualty care remain consistent, the practices must be adapted to end-users environment, so it is with rescue. PMID:23536462

McKay, S D; Johnston, J; Callaway, D W

2012-01-01

183

Reframing the Casualties Hypothesis: (Mis)Perceptions of Troop Loss and Public Opinion about War  

Microsoft Academic Search

The casualties hypothesis predicts that as the casualties suffered by a nation mount during a military intervention, public opinion will turn against the intervention and its people will demand troop withdrawal. We use the U.S. war in Iraq as a context for testing the perceived casualties hypothesis, which predicts that public beliefs about the actual number of casualties account for

Teresa A. Myers; Andrew F. Hayes

2010-01-01

184

The effects of area deprivation on the incidence of child and adult pedestrian casualties in England  

Microsoft Academic Search

This paper analyses child pedestrian casualties in England, focusing on the influence of socio-economic deprivation. It develops an area-based model of pedestrian casualties and presents estimates based on data for the English wards. The results detect an association between increased deprivation and higher numbers of pedestrian casualties across England. The deprivation effect is strong both for all child casualties and

Daniel Graham; Stephen Glaister; Richard Anderson

2005-01-01

185

A prospective evaluation of the Cape triage score in the emergency department of an urban public hospital in South Africa  

Microsoft Academic Search

Background: Until recently South Africa had no triage system for emergency department (ED) use. The Cape triage group developed a triage scale called the Cape triage score (CTS). This system consists of a basic physiology score, mobility score and a short list of important discriminators that cannot be accurately triaged on a physiological score alone. Highest priority is given to

S R Bruijns; L A Wallis; V C Burch

2008-01-01

186

Australian triage nurses' decision-making and scope of practice  

Microsoft Academic Search

A survey of 172 Australian triage nurses was undertaken to describe their scope of practice, educational background and to explore the self-reported influences perceived to impact on their decision-making.The survey results reveal variability in the educational requirements for nurses to triage. Indeed, over half of the nurses who participated in the study worked in emergency departments that provided no specified

Tracey Bucknall

2001-01-01

187

Paramedic Injury Severity Perception Can Aid Trauma Triage  

Microsoft Academic Search

Study objective: To compare information contained in standard out-of-hospital trauma triage criteria and standard criteria plus advanced emergency medical technician (EMT) injury severity perception for determination of patient need for trauma center evaluation. Design: Prospective, observational cohort analysis of trauma triage by advanced EMTs. Participants: Out-of-hospital, geographically stratified statewide sample of patients injured in Oregon. Results: Advanced EMTs provided patient

Erik Simmons; Jerris R Hedges; Lisa Irwin; Wilhelmine Maassberg; Howard A Kirkwood

1995-01-01

188

Manchester triage system in paediatric emergency care: prospective observational study  

Microsoft Academic Search

Objective To validate use of the Manchester triage system in paediatric emergency care.Design Prospective observational study.Setting Emergency departments of a university hospital and a teaching hospital in the Netherlands, 2006-7.Participants 17 600 children (aged <16) visiting an emergency department over 13 months (university hospital) and seven months (teaching hospital).Intervention Nurses triaged 16 735\\/17 600 patients (95%) using a computerised Manchester

M van Veen; Ewout W Steyerberg; Madelon Ruige; Alfred H J van Meurs; Jolt Roukema; Johan van der Lei; Henriette A Moll

2008-01-01

189

Speech to Speech Translation for Medical Triage in Korean  

Microsoft Academic Search

S-MINDS is a speech translation engine, which allows an English speaker to communi- cate with a non-English speaker easily within a question-and-answer, interview-style format. It can handle limited dialogs such as medical triage or hospital admissions. We have built and tested an English-Korean system for do- ing medical triage with a translation accuracy of 79.8% (for English) and 78.3% (for

Farzad Ehsani; Jim Kimzey; Demitrios Master; Karen Sudre

2006-01-01

190

Below the Bubble: “Educational Triage” and the Texas Accountability System  

Microsoft Academic Search

This article uses two dominant traditions in the organizational study of schools—the neoinstitutional and faculty workplace approaches—to explain an urban elementary school’s response to the Texas Accountability System. The findings indicate that teachers, guided by an institutional logic, sought to create the appearance of test score improvement by using a constellation of “educational triage” practices. Educational triage was manifest in

Jennifer Booher-Jennings

2005-01-01

191

Trauma-related Infections in Battlefield Casualties From Iraq.  

National Technical Information Service (NTIS)

Objective: To describe risks for, and microbiology and antimicrobial resistance patterns of, war trauma associated infections from Operation Iraqi Freedom. Background: The invasion of Iraq resulted in casualties from high- velocity gunshot, shrapnel, and ...

D. L. Blazes J. R. Danko K. Petersen M. S. Riddle R. Hayden

2007-01-01

192

Emergency slaughter of casualty cattle increases the prevalence of anthelmintic drug residues in muscle.  

PubMed

The ProSafeBeef project studied the prevalence of residues of anthelmintic drugs used to control parasitic worms and fluke in beef cattle in Ireland. Injured (casualty) cattle may enter the human food chain under certain conditions, verified by an attending veterinarian and the livestock keeper. An analytical survey was conducted to determine if muscle from casualty cattle contained a higher prevalence of anthelmintic drug residues than healthy (full slaughter weight) cattle as a result of possible non-observance of complete drug withdrawal periods. A validated analytical method based on matrix solid-phase dispersive extraction (QuEChERS) and ultra-performance liquid chromatography-tandem mass spectrometry was used to quantify 37 anthelmintic drugs and metabolites in muscle (assay decision limits, CC?, 0.15-10.2?µg?kg?¹). Of 199 control samples of beef purchased in Irish shops, 7% contained detectable anthelmintic drug residues but all were compliant with European Union Maximum Residue Limits (MRL). Of 305 muscle samples from injured cattle submitted to abattoirs in Northern Ireland, 17% contained detectable residues and 2% were non-compliant (containing either residues at concentrations above the MRL or residues of a compound unlicensed for use in cattle). Closantel and ivermectin were the most common residues, but a wider range of drugs was detected in muscle of casualty cattle than in retail beef. These data suggest that specific targeting of casualty cattle for testing for anthelmintic residues may be warranted in a manner similar to the targeted testing for antimicrobial compounds often applied in European National Residues Surveillance Schemes. PMID:22632575

Cooper, K M; Whyte, M; Danaher, M; Kennedy, D G

2012-05-28

193

Medical triage for WMD incidents incidents: an adaptation of daily triage.  

PubMed

It's 2000 HRS on a Friday evening. You're assigned to an ALS engine company, and you're just settling down after a busy day when you're dispatched along with a BLS ambulance to a report of a sick person outside a local club where they're holding a concert. During your response, dispatch advises that they're receiving multiple calls on the incident and are dispatching a second BLS ambulance to the call. * As you turn the corner and approach the scene, you notice a haze in the air coming from an industrial site on the same side of the street and see approximately 200 people exiting the club in haste. Several dozen patrons line the street between the club and the subway station. They're coughing and crying, and several are vomiting. * The driver stops the engine in front of the subway entrance, which is located approximately 500 feet from the club and uphill and upwind from the haze. The scene is overwhelming, even to the captain, who turns to you-as the paramedic on the crew-and asks what you want done first. Your first thought is, Triage. But you know that triaging these patients is more complicated than your everyday two-car collision. PMID:18482652

Donohue, Dave

2008-05-01

194

Psychiatric casualties in the Pacific during World War II: servicemen hospitalised in a Brisbane mental hospital.  

PubMed

World War II created many psychiatric casualties but precise incidences were not accurately established. Battle shock was under-reported as some commanding officers were reluctant to admit that their men experienced battle stress. The objective in triage of any casualties was to retain as many patients in the war zone as possible, if further useful service was feasible. This also applied to soldiers with stress-related symptoms, who were treated in base hospitals as near to an operational zone as possible. The main treating maxims were "immediacy, proximity and expectancy", which involved rapid early treatment in the war zone, hoping for an early return to duty (which often meant active duty). Only those with severe psychiatric illness were sent back to their home country. The medical officer had to be sure that the patient had not responded to treatment before sending him home. During the war, the terminology used for psychological responses to the stress of combat was derived from several classifications in textbooks. Psychiatric nomenclature, barely adequate for civilian psychiatry, was totally inadequate for military psychiatry during that period. The aim of classification was to facilitate data collection rather than to provide definitive diagnoses. Psychiatric therapies during World War II were, at least to some degree, diagnostically non-specific. Diagnosis varied according to the soldier's proximity to the war zone (i.e., less severe diagnoses were given to men closer to the frontline, who would be required in battle). In addition, as psychiatrists were rarely available, medical officers without relevant (or having only limited) specialty training usually diagnosed and treated soldiers with psychiatric problems. At the beginning of the war, traumatic psychiatric reactions were classified into psychoneurosis, anxiety state and anxiety reaction, psychoneurosis mixed, and conversion hysteria. By the end of the war, the United States Surgeon General released a revised nomenclature with two new diagnostic categories: transient personality reactions to acute and special stress; and neurotic-type reactions to routine military stress. It was not until the 1950s that formal criteria for the diagnosis of trauma appeared, in the first diagnostic and statistical manual (DSM-I) of the American Psychiatric Association. PMID:8538560

Mellsop, G W; Duraiappah, V; Priest, J A

195

Emergency Department Triage Scales and Their Components: A Systematic Review of the Scientific Evidence  

Microsoft Academic Search

Emergency department (ED) triage is used to identify patients' level of urgency and treat them based on their triage level.\\u000a The global advancement of triage scales in the past two decades has generated considerable research on the validity and reliability\\u000a of these scales. This systematic review aims to investigate the scientific evidence for published ED triage scales. The following\\u000a questions

Nasim Farrohknia; Maaret Castrén; Anna Ehrenberg; Lars Lind; Sven Oredsson; Håkan Jonsson; Kjell Asplund; Katarina E Göransson

2011-01-01

196

'Wellbeing': a collateral casualty of modernity?  

PubMed

In the now vast empirical and theoretical literature on wellbeing knowledge of the subject is provided mainly by psychology and economics, where understanding of the concept are framed in very different ways. We briefly rehearse these, before turning to some important critical points which can be made about this burgeoning research industry, including the tight connections between the meanings of the concept with the moral value systems of particular 'modern' societies. We then argue that both the 'science' of wellbeing and its critique are, despite their diversity, re-connected by and subsumed within the emerging environmental critique of modern consumer society. This places concerns for individual and social wellbeing within the broader context of global human problems and planetary wellbeing. A growing number of thinkers now suggest that Western society and culture are dominated by materialistic and individualistic values, made manifest at the political and social levels through the unending pursuit of economic growth, and at the individual level by the seemingly endless quest for consumer goods, regardless of global implications such as broader environmental harms. The escalating growth of such values is associated with a growing sense of individual alienation, social fragmentation and civic disengagement and with the decline of more spiritual, moral and ethical aspects of life. Taken together, these multiple discourses suggest that wellbeing can be understood as a collateral casualty of the economic, social and cultural changes associated with late modernity. However, increasing concerns for the environment have the potential to counter some of these trends, and in so doing could also contribute to our wellbeing as individuals and as social beings in a finite world. PMID:19765875

Carlisle, Sandra; Henderson, Gregor; Hanlon, Phil W

2009-09-16

197

Disaster triage systems for large-scale catastrophic events.  

PubMed

Large-scale catastrophic events typically result in a scarcity of essential medical resources and accordingly necessitate the implementation of triage management policies to minimize preventable morbidity and mortality. Accomplishing this goal requires a reconceptualization of triage as a population-based systemic process that integrates care at all points of interaction between patients and the health care system. This system identifies at minimum 4 orders of contact: first order, the community; second order, prehospital; third order, facility; and fourth order, regional level. Adopting this approach will ensure that disaster response activities will occur in a comprehensive fashion that minimizes the patient care burden at each subsequent order of intervention and reduces the overall need to ration care. The seamless integration of all orders of intervention within this systems-based model of disaster-specific triage, coordinated through health emergency operations centers, can ensure that disaster response measures are undertaken in a manner that is effective, just, and equitable. PMID:18769264

Bostick, Nathan A; Subbarao, Italo; Burkle, Frederick M; Hsu, Edbert B; Armstrong, John H; James, James J

2008-09-01

198

An Integrated Computerized Triage System in the Emergency Department  

PubMed Central

Emergency department (ED) triage is a fast-paced process that prioritizes the allocation of limited health care resources to patients in greatest need. This paper describes the experiences with an integrated, computerized triage application. The system exchanges information with other information systems, including the ED patient tracking board, the longitudinal electronic medical record, the computerized provider order entry, and the medication reconciliation application. The application includes decision support capabilities such as assessing the patient’s acuity level, age-dependent alerts for vital signs, and clinical reminders. The browser-based system utilizes the institution’s controlled vocabulary, improves data completeness and quality, such as compliance with capturing required data elements and screening questions, initiates clinical processes, such as pneumococcal vaccination ordering, and reminders to start clinical pathways, issues alerts for clinical trial eligibility, and facilitates various reporting needs. The system has supported the triage documentation of >290,000 pediatric and adult patients.

Aronsky, Dominik; Jones, Ian; Raines, Bill; Hemphill, Robin; Mayberry, Scott R; Luther, Melissa A; Slusser, Ted

2008-01-01

199

Prognostic estimations of casualties caused by strong seismic impacts  

NASA Astrophysics Data System (ADS)

The human losses after strong earthquakes that occurred in the world during the twentieth century have been analyzed and a quantitative model for a preliminary assessment of casualties is proposed. It consists of a correlation between the number of casualties and the earthquake magnitude as a function of population density. We tackle the distribution of the total number of casualties within areas of different macroseismic intensity by means of updated seismic intensity attenuation laws and using an application developed in a geographic information system (GIS) environment, tacking advantage of the possibilities of such a system for the treatment of space-distributed data. Prognostic estimations of the expected number of killed or injured people caused by a hypothesized strong earthquake in Andalucia (Spain) using the model based on worldwide data are suggested. Prognostic estimations based on specific data about the Kanto-Tokai (Japan) region are likewise given and compared with the number of casualties due to the 1995 Kobe (Japan) earthquake. In relation to the expected number of victims in areas affected by strong seismic impacts, we compute the casualty rate as the number of killed people divided into the inhabitants of a region, and shows its variation for different population density groups in the case of two extreme earthquake magnitudes.

Badal, J.; Samardzhieva, E.

2003-04-01

200

ED Triage Instrument to Predict Resource Needs/Outcomes. Abstract and Executive Summary.  

National Technical Information Service (NTIS)

The Emergency Severity Index (ESI) triage algorithm facilitates quick triage of ED patients at presentation into five levels based on resources needed as well as urgency. The authors developed a standard training program in ESI triage with a set of 20 cas...

R. C. Wuerz

2000-01-01

201

Online Victim Tracking and Tracing System (ViTTS) for Major Incident Casualties.  

PubMed

Introduction Dealing with major incidents requires an immediate and coordinated response by multiple organizations. Communicating and coordinating over multiple geographical locations and organizations is a complex process. One of the greatest challenges is patient tracking and tracing. Often, data about the number of victims, their condition, location and transport is lacking. This hinders an effective response and causes public distress. To address this problem, a Victim Tracing and Tracking system (ViTTS) was developed. METHODS: An online ViTTS was developed based on a wireless network with routers on ambulances, and direct online registration of victims and their triage data through barcode injury cards. The system was tested for feasibility and usability during disaster drills. RESULTS: The formation of a local radio network of hotspots with mobile routers and connection over General Packet Radio Service (GPRS) to the central database worked well. ViTTS produced accurately stored data, real-time availability, and a real-time overview of the patients (number, seriousness of injury, and location). CONCLUSION: The ViTTS provides a system for early, unique registration of victims close to the impact site. Online application and connection of the various systems used by the different chains in disaster relief promotes interoperability and enables patient tracking and tracing. It offers a real-time overview of victims to all involved disaster relief partners, which is necessary to generate an adequate disaster response. Marres GMH , Taal L , Bemelman M , Bouman J , Leenen LPH . Online Victim Tracking and Tracing System (ViTTS) for major incident casualties. Prehosp Disaster Med. 2013;28(4):1-9 . PMID:23663377

Marres, Geertruid M H; Taal, Luc; Bemelman, Michael; Bouman, Jos; Leenen, Luke P H

2013-05-13

202

Improvements in the hemodynamic stability of combat casualties during en route care.  

PubMed

Three Forward Aeromedical Evacuation platforms operate in Southern Afghanistan: UK Medical Emergency Response Team (MERT), US Air Force Expeditionary Rescue Squadron (PEDRO), and US Army Medical Evacuation Squadrons (DUSTOFF), each with a different clinical capability. Recent evidence suggests that retrieval by a platform with a greater clinical capability (MERT) is associated with improved mortality in critical patients when compared with platforms with less clinical capability (PEDRO and DUSTOFF). It is unclear whether this is due to en route resuscitation or the dispatch procedure. The aim of this study was to compare prehospital Shock Index (SI = heart rate / systolic blood pressure) with admission values as a measure of resuscitation, across these platforms. Patients were identified from the Department of Defense Trauma Registry, who were evacuated between June 2009 and June 2011 in Southern Afghanistan. Data on platform type, physiology, and injury severity was extracted. Overall, 865 patients were identified: 478 MERT, 291 PEDRO, and 96 DUSTOFF patients and groups were compared across three injury severity scoring (ISS) bins: 1 to 9, 10 to 25, and 26 or greater. An improvement in the admission SI was observed across all platforms in the lowest ISS bin. Within the middle bin, both the MERT and PEDRO groups saw improved SI on admission, but not the DUSTOFF group. This trend was continued only in the MERT group for the highest ISS bin (1.39 ± 0.62 vs. 1.09 ± 0.42; P = 0.001), whereas a deterioration was identified in the PEDRO group (0.88 ± 0.37 vs. 1.02 ± 0.43; P = 0.440). The use of a Forward Aeromedical Evacuation platform with a greater clinical capability is associated with an improved hemodynamic status in critical casualties. The ideal prehospital triage should endeavor to match patient need with clinical capability. PMID:23635851

Apodaca, Amy N; Morrison, Jonathan J; Spott, Mary Ann; Lira, John J; Bailey, Jeffery; Eastridge, Brian J; Mabry, Robert L

2013-07-01

203

Mass Casualty Care Strategy for Biological Terrorism Incidents.  

National Technical Information Service (NTIS)

This pamphlet provides information on the Community Outreach (CO) component of the Modular Emergency Medical System (MEMS). MEMS is an approach to disaster medical response, intended to assist emergency planners and health care providers in planning and c...

2002-01-01

204

Weapons of Mass Destruction Events With Contaminated Casualties  

Microsoft Academic Search

Biological and chemical terrorism is a growing concern for the emergency preparedness community. While health care facilities (HCFs) are an essen- tial component of the emergency response system, at present they are poorly prepared for such incidents. The greatest challenge for HCFs may be the sud- den presentation of large numbers of contaminated individuals. Guidelines for managing contaminated patients have

Anthony G. Macintyre; Joseph A. Barbera

2000-01-01

205

Bioterrorism and Mass Casualty Preparedness in Hospitals: United States, 2003  

Microsoft Academic Search

Objectives—This study examined the content of hospital terrorism preparedness emergency response plans; whether those plans had been updated since September 11, 2001; collaboration of hospitals with outside organizations; clinician training in the management of biological, chemical, explosive, and nuclear exposures; drills on the response plans; and equipment and bed capacity. Methods—The National Hospital Ambulatory Medical Care Survey (NHAMCS) is an

Richard W. Niska; Catharine W. Burt

2005-01-01

206

Incidence of Pulmonary Embolus in Combat Casualties With Extremity Amputations and Fractures.  

National Technical Information Service (NTIS)

The objective of this retrospective study was to determine the incidence of pulmonary embolism (PE) in casualties of wartime extremity wounds and specifically in casualties with a trauma-associated amputation.

F. A. Gage F. R. Sheppard J. C. Grayhill K. N. Evans S. M. Gillern

2011-01-01

207

Joint Theater Trauma System Implementation of Burn Resuscitation Guidelines Improves Outcomes in Severely Burned Military Casualties.  

National Technical Information Service (NTIS)

Between March 2003-June 2007, our burn center received 594 casualties from Iraq and Afghanistan. Ongoing acute burn resuscitation as severely burned casualties are evacuated is very challenging. To help standardize care, burn resuscitation guidelines (BRG...

D. J. Barillo E. M. Renz J. L. Ennis K. K. Chung M. C. Albrecht

2007-01-01

208

American War and Military Operations Casualties: Lists and Statistics, February 26, 2010.  

National Technical Information Service (NTIS)

This report is written in response to numerous requests for war casualty statistics and lists of war dead. It provides tables, compiled by sources at the Department of Defense (DOD), indicating the number of casualties among American military personnel se...

A. Leland M. J. Oboroceanu

2010-01-01

209

American War and Military Operations Casualties: Lists and Statistics. Updated May 14, 2008.  

National Technical Information Service (NTIS)

This report is written in response to numerous requests for war casualty statistics and lists of war dead. It provides tables, compiled by sources at the Department of Defense (DOD), indicating the number of casualties among American military personnel se...

H. Fischer K. Klarman M. Oboroceanu

2008-01-01

210

A concept for major incident triage: full-scaled simulation feasibility study  

PubMed Central

Background Efficient management of major incidents involves triage, treatment and transport. In the absence of a standardised interdisciplinary major incident management approach, the Norwegian Air Ambulance Foundation developed Interdisciplinary Emergency Service Cooperation Course (TAS). The TAS-program was established in 1998 and by 2009, approximately 15 500 emergency service professionals have participated in one of more than 500 no-cost courses. The TAS-triage concept is based on the established triage Sieve and Paediatric Triage Tape models but modified with slap-wrap reflective triage tags and paediatric triage stretchers. We evaluated the feasibility and accuracy of the TAS-triage concept in full-scale simulated major incidents. Methods The learners participated in two standardised bus crash simulations: without and with competence of TAS-triage and access to TAS-triage equipment. The instructors calculated triage accuracy and measured time consumption while the learners participated in a self-reported before-after study. Each question was scored on a 7-point Likert scale with points labelled "Did not work" (1) through "Worked excellent" (7). Results Among the 93 (85%) participating emergency service professionals, 48% confirmed the existence of a major incident triage system in their service, whereas 27% had access to triage tags. The simulations without TAS-triage resulted in a mean over- and undertriage of 12%. When TAS-Triage was used, no mistriage was found. The average time from "scene secured to all patients triaged" was 22 minutes (range 15-32) without TAS-triage vs. 10 minutes (range 5-21) with TAS-triage. The participants replied to "How did interdisciplinary cooperation of triage work?" with mean 4,9 (95% CI 4,7-5,2) before the course vs. mean 5,8 (95% CI 5,6-6,0) after the course, p < 0,001. Conclusions Our modified triage Sieve tool is feasible, time-efficient and accurate in allocating priority during simulated bus accidents and may serve as a candidate for a future national standard for major incident triage.

2010-01-01

211

Triage systems: a review of the literature with reference to Saudi Arabia.  

PubMed

This review evaluates some of the international literature on triage in order to provide evidence-based data for the medical community in Saudi Arabia specifically and the Eastern Mediterranean Region in general. The aim is to encourage national health planners and decision-makers to apply formal triage systems in the emergency departments of general and specialist hospitals and other relevant health settings, including primary and psychiatric care. Research and training on triage is extremely limited in Saudi Arabia and the Region and this review highlights the need for more research on triage systems and for the inclusion of training on triage in medical education programmes. PMID:20799600

Qureshi, N A

2010-06-01

212

Testing the “Proximate Casualties Hypothesis”: Local Troop Loss, Attention to News, and Support for Military Intervention  

Microsoft Academic Search

In academic and policy circles, it is believed that the American public is casualties-averse when sending its troops into war and that as casualties mount the public will increasingly call for withdrawal of troops from foreign military interventions. This study tests a variant of this “casualties hypothesis” by examining whether the public conceptualizes the human costs of war in local

Andrew F. Hayes; Teresa A. Myers

2009-01-01

213

Emergency Department Triage: Algorithm and Protocols for Shortness of Breath  

Microsoft Academic Search

Using protocols in triage can facilitate a patient's movement through the emergency department (ED), thus decreasing length of stay (LOS) (Yoon, Steiner, & Reinhardt, 2003). The purpose of the evidence-based practice (EBP) project was to develop an algorithm with associated protocols that specifically focused on a respiratory nature of shortness of breath. The clinical question examined was: In adult patients

Dana J. Robinson

2010-01-01

214

Screening for Cognitive Impairment: A Triage for Outpatient Care  

Microsoft Academic Search

The current increase in aged individuals in number and proportionof the general population warrants dependable strategies to improve early detection of cognitive impairment. It was the goal of the present study to develop a triage for bedside testing and outpatient ser vices. In a prospective clinical cohort study at the outpatient Memory Clinic, University of Ulm, Germany, 232 subjects were

Ulrike Beinhoff; Verena Hilbert; Daniel Bittner; Georg Grön; Matthias W. Riepe

2005-01-01

215

The effects of technology on triage in A & E.  

PubMed

Within the specialty of Accident and Emergency (A & E) nursing, triage is a term meaning to classify or sort patients according to their need for care (Blythin 1988). Burgess (1992) views this process as a means of prioritizing patients in order, so that the more seriously ill or injured are seen first (Table 1). Triage performance is measured in the author's department by computer. This technological source is used to record the patient's arrival time and the time at which the patient is triaged. Technology is defined by the Oxford Dictionary (1996) as 'the study of mechanical arts and science, their application in industry'. This paper explores the impact of this technology and the related issues on the A & E triage nurse, and will focus on issues related to the Patients' Charter (1991), resource implications, safety and staff training. In conclusion, the quality of a patient's total care, in which the author participated, is discussed with reference to the related issues and implications for future practice. PMID:9677876

Roberts, J

1998-04-01

216

MDCT in Early Triage of Patients with Acute Chest Pain  

Microsoft Academic Search

OBJECTIVE. Current risk stratification of patients with acute chest pain but normal initial cardiac enzymes and nondiagnostic ECG is inefficient. We sought to determine whether con- trast-enhanced MDCT-based detection of stenosis is feasible and improves early and accurate triage of patients with acute chest pain. SUBJECTS AND METHODS. We studied 40 patients (53% men; mean age, 57 ± 13 years)

Udo Hoffmann; Antonio J. Pena; Fabian Moselewski; Maros Ferencik; Suhny Abbara; Ricardo C. Cury; Claudia U. Chae; John T. Nagurney

217

Factors Influencing Digital Reference Triage: A Think-Aloud Study  

ERIC Educational Resources Information Center

|This article describes a think-aloud study conducted to identify factors that influence the decisions made by digital reference "triagers" when performing triage on questions received by digital reference services. This study follows and expands on a Delphi study that identified factors that triagers agreed on after the fact of their performance…

Pomerantz, Jeffrey

2004-01-01

218

High-accuracy Decision of Call-triage by Using Bayesian Network  

NASA Astrophysics Data System (ADS)

A new call-triage system, a key part of emergency support system with stochastic network model is examined. The call-triage is an operation allowing the efficient decision of service grade and dispatching of suitable rescue team service from phone call information. Nowadays, the call-triage is being trialed on a few cities and is achieving an effect. However, there is the issue that if under-triage in which the condition of sick person is estimated more lightly is eliminated, the efficiency is degraded (over-triage). In this report, in order to overcome the issue, the Bayesian network scheme is examined to the call-triage system. The experiments with real call-triage data set results show the Bayesian network achieves precision enhancement.

Yunoki, Shota; Hamagami, Tomoki; Oshige, Kenji; Kawakami, Chihiro; Suzuki, Noriyuki

219

Deployment and operation of a transportable burn intensive care unit in response to a burn multiple casualty incident.  

PubMed

In many hospitals, intensive care units (ICUs) operate at or above capacity on a daily basis. Multiple casualty incidents will create a sudden need for additional ICU beds and hospital planning for disaster response must anticipate the need for rapid ICU expansion. In this article, the authors describe the management of 6 patients who were burned in Guam and successfully transported a distance of 7,268 miles to San Antonio, TX, for tertiary burn center care. The mission required creation of a temporary burn ICU at Tripler Army Medical Center in Hawaii, approximately midway between the referring hospital and the receiving burn center. A method of creating a temporary burn center is described. Lessons learned, including the need to standardize equipment, and to cross-train and cross-credential medical personnel, are applicable to both military and civilian mass casualty management. PMID:20349698

Barillo, David J; Cancio, Leopoldo C; Stack, Richard S; Carr, Shamus R; Broger, Kristine P; Crews, David M; Renz, Evan M; Blackbourne, Lorne H

220

Casualties in dry bulk shipping (1963–1996)  

Microsoft Academic Search

In recent years, bulk carriers have been identified with high risks of catastrophic structural failure and foundering, and with heavy loss of human life. This study, based upon Lloyd's of London casualty records, identified four risk factors that had significant, independent effect upon the likelihood of a bulk carrier foundering. The risk of foundering increased with the age of the

Stephen E. Roberts; Peter B. Marlow

2002-01-01

221

Outcome of sports injuries treated in a casualty department  

Microsoft Academic Search

The present investigation analyses 2493 patients with a sports injury treated in a casualty department during a one-year period. Of the patients 73% were men, the age of the patients averaging 26 years and the mean follow-up time was 24 months. Soccer and indoor ball games caused 24% and 23% of the injuries respectively, these being followed by injuries in

J Sandelin; O Kiviluoto; S Santavirta; R Honkanen

1985-01-01

222

Attendances at a casualty department for sport related injuries  

Microsoft Academic Search

In a prospective study over a period of 5 months (July-November, 1982), 506 patients were treated at a District General Hospital for a sports related injury. All the patients were seen initially in the Casualty Department and the majority of attendances (58%) were due to injuries caused by the two principal contact sports--Association and Rugby football. There were 294 patients

P. J. Bedford; D. C. Macauley

1984-01-01

223

Medical Management of Radiological Casualties. Online Third Edition.  

National Technical Information Service (NTIS)

This handbook addresses medical management of casualties in the first 72 hours of a radiation event. The most important consideration in the medical evaluation of a radiation event is the relative magnitude of the situation and the resources needed to add...

R. E. Goans

2010-01-01

224

Iraq: U.S. Casualties, October 2, 2008.  

National Technical Information Service (NTIS)

The following casualty data was compiled by the Department of Defense (DOD), as tallied from the agency's press releases Table 1 provides statistics on fatalities during Operation Iraqi Freedom, which began on March 19, 2003, and is ongoing, as well as on...

S. G. Chesser

2008-01-01

225

Iraq: U.S. Casualties (Updated August 28, 2008).  

National Technical Information Service (NTIS)

The following casualty data was compiled by the Department of Defense (DOD), as tallied from the agencys press releases. Table 1 provides statistics on fatalities during Operation Iraqi Freedom, which began on March 19, 2003, and is ongoing, as well as on...

S. G. Chesser

2008-01-01

226

Iraq: U.S. Casualties (Updated May 29, 2008).  

National Technical Information Service (NTIS)

The following casualty data was compiled by the Department of Defense (DOD), as tallied from the agencys press releases. Table 1 provides statistics on fatalities during Operation Iraqi Freedom, which began on March 19, 2003, and is ongoing, as well as on...

J. O'Bryant

2008-01-01

227

Iraq: U.S. Casualties, October 31, 2008.  

National Technical Information Service (NTIS)

The following casualty data was compiled by the Department of Defense (DOD), as tallied from the agency's press releases. Table 1 provides statistics on fatalities during Operation Iraqi Freedom, which began on March 19, 2003, and is ongoing, as well as o...

S. G. Chesser

2008-01-01

228

Civilian casualties of Iraqi ballistic missile attack to Tehran, capital of Iran.  

PubMed

Objective: To determine the pattern of causalities of Iraqi ballistic missile attacks on Tehran, the capital of Iran, during Iraq-Iran war. Methods: Data were extracted from the Army Staff Headquarters based on daily reports of Iranian army units during the war. Results: During 52 days, Tehran was stroked by 118 Al-Hussein missiles (a modified version of Scud missile). Eighty-six missiles landed in populated areas. During Iraqi missile attacks, 422 civilians died and 1 579 injured (4.9 deaths and 18.3 injuries per missile). During 52 days, 8.1 of the civilians died and 30.4 injured daily. Of the cases that died, 101 persons (24%) were excluded due to the lack of information. Among the remainders, 179 (55.8%) were male and 142 (44.2%) were female. The mean age of the victims was 25.3 years+/-19.9 years. Our results show that the high accuracy of modified Scud missiles landed in crowded areas is the major cause of high mortality in Tehran. The presence of suitable warning system and shelters could reduce civilian casualties. Conclusion: The awareness and readiness of civilian defense forces, rescue services and all medical facilities for dealing with mass casualties caused by ballistic missile attacks are necessary. PMID:22663911

Khaji, Ali; Fallahdoost, Shoaodin; Soroush, Mohammad-Reza; Rahimi-Movaghar, Vafa

2012-06-01

229

Triage decisions for emergency department patients with chest pain  

Microsoft Academic Search

OBJECTIVE: To determine whether physicians’ risk attitudes correlate with their triage decisions for emergency department patients with\\u000a acute chest pain.\\u000a \\u000a \\u000a DESIGN: Cohort.\\u000a \\u000a \\u000a \\u000a \\u000a SETTING: The emergency department of a university teaching hospital.\\u000a \\u000a \\u000a \\u000a \\u000a PATIENTS: Patients presenting to the emergency department with a chief complaint of acute chest pain.\\u000a \\u000a \\u000a \\u000a \\u000a PHYSICIANS: All physicians who were primarily responsible for the emergency department triage of at

Steven D. Pearson; Lee Goldman; E. John Orav; Edward Guadagnoli; Tomas B. Garcia; Paula A. Johnson; Thomas H. Lee

1995-01-01

230

The effectiveness of various health personnel as triage agents  

Microsoft Academic Search

The effectiveness of pediatricians, pediatric nurse practitioners, registered nurses, and receptionists in the performance of triage in the pediatric acute care clinic of a large, urban hospital was assessed. Approximately 888 nonscheduled patients were seen during the course of 24 clinic sessions. Of these, 1.5% presented emergency problems, 9.6% had urgent needs, and 88.9% had problems of a non-urgent nature.

Catherine De Angelis; Margaret McHugh

1977-01-01

231

Invariance of cognitive triage in the development of recall in adulthood.  

PubMed

Past research has demonstrated that cognitive triage (weak-strong-weak recall pattern) is a robust effect that optimises children's recall. The aim of the current research was to determine whether adults' free recall also exhibits triage and whether cognitive triage is less marked with older than younger adults' recall. Younger and older adults memorized 16 unrelated words until all items were recalled perfectly. The triage pattern existed for both the younger and older adults' recall and there was evidence for age differences in triage. Our results are consistent with claims of greater verbatim forgetting and increased susceptibility to output interference with age in adulthood. Further research is needed to determine whether fuzzy-trace theory adequately explains the ageing of triage and what factors play a role in the development of this pattern of recall in adulthood. PMID:19468958

Marche, Tammy A; Howe, Mark L; Lane, David G; Owre, Keith P; Briere, Jennifer L

2009-05-26

232

Calibrating urgency: triage decision-making in a pediatric emergency department  

Microsoft Academic Search

Triage, the first step in the assessment of emergency department patients, occurs in a highly dynamic environment that functions\\u000a under constraints of time, physical space, and patient needs that may exceed available resources. Through triage, patients\\u000a are placed into one of a limited number of categories using a subset of diagnostic information. To facilitate this task and\\u000a standardize the triage

Vimla L. Patel; Lily A. Gutnik; Daniel R. Karlin; Martin Pusic

2008-01-01

233

Reliability and validity of an Italian four-level emergency triage system  

Microsoft Academic Search

ObjectivesTo measure the reliability and predictive validity of a four-level triage system (I-4L).MethodsThis observational study was conducted in an urban hospital. Five nurses were randomly selected to assign a triage level to 246 paper scenarios, using the I-4L model. The I-4L model is a four-level triage system: urgency category (UC) 1 requires immediate response; UCs 2, 3 and 4 require

Nicola Parenti; Roberta Manfredi; Maria Letizia Bacchi Reggiani; Diego Sangiorgi; Tiziano Lenzi

2010-01-01

234

The Soterion Rapid Triage System: Evaluation of inter-rater reliability and validity  

Microsoft Academic Search

The Soterion Rapid Triage System is a new, computerized, five-level triage acuity system. The purpose of this study was to evaluate the system’s inter-rater reliability and validity for stratifying patient acuity. The study was comprised of two components. A prospective evaluation of inter-rater reliability was conducted by the blinded, paired simultaneous triage of 423 patients. A retrospective evaluation of validity

Peter A. Maningas; Derek A. Hime; Donald E. Parker; Ted A. McMurry

2006-01-01

235

Consumer insurance fraud in the US property-casualty industry  

Microsoft Academic Search

Purpose – The purpose of this paper is to review the management of consumer insurance fraud in the US property-casualty market, attending to definition, prevalence, insurer and regulatory responses, and outcomes. A social marketing campaign is offered as a partial, long-term solution. Design\\/methodology\\/approach – This paper explicates the difficulties associated with defining and measuring consumer insurance fraud, then models the

William C. Lesch; Bruce Byars

2008-01-01

236

Sport associated eye injury: a casualty department survey  

Microsoft Academic Search

A survey was performed of all patients attending the combined Glasgow Eye Infirmary and Western Infirmary Eye Casualty Department with sports injuries. During an 18-month period a total of 246 patients presented with such injuries. Football was responsible for 110 (44.7%), rugby for 24 (9.8%), squash for 19 (7.7%), badminton for 16 (6.5%), and skiing for 9 (3.7%), and 68

C. J. MacEwen

1987-01-01

237

Exercise London: a disaster exercise involving numerous casualties  

PubMed Central

A large-scale disaster exercise was conducted to assess how one large community would handle such a situation — particularly, how it would deal with 150 casualties. The planning, undertaken by a subcommittee composed of representatives of all resource groups in the city, took more than a year. The deficiencies of the disaster plan detected during the exercise, which included a lack of trained personnel and various problems of communication, are now being corrected.

Theoret, J.J.

1976-01-01

238

Selecting samples for Mars sample return: Triage by pyrolysis-FTIR  

NASA Astrophysics Data System (ADS)

A future Mars Sample Return mission will deliver samples of the red planet to Earth laboratories for detailed analysis. A successful mission will require selection of the best samples that can be used to address the highest priority science objectives including assessment of past habitability and evidence of life. Pyrolysis is a commonly used method for extracting organic information from rocks but is most often coupled with complex analytical steps such as gas chromatography and mass spectrometry. Pyrolysis-Fourier transform infrared spectroscopy is a less resource demanding method that still allows sample characterisation. Here we demonstrate how pyrolysis-Fourier transform infrared spectroscopy could be used to triage samples destined to return to Earth, thereby maximising the scientific return from future sample return missions.

Sephton, Mark A.; Court, Richard W.; Lewis, James M.; Wright, Miriam C.; Gordon, Peter R.

2013-04-01

239

CBRNE TC3: A Hybrid Approach to Casualty Care in the CBRNE Environment.  

PubMed

The implementation of Tactical Combat Casualty Care (TCCC) guidelines for the Operation Enduring Freedom and Operation Iraqi Freedom contingency operations has dramatically reduced preventable combat deaths. A study of these principles and their application to medical treatment in the chemical, biological, radiological, nuclear, and high-yield explosives (CBRNE), weapons of mass destruction (WMD) environment is presented as a potential readiness and force multiplier for units engaged in this area of operations. Preparing medical operators for support of WMD sampling and mitigation missions requires extensive preventive medicine and post-exposure and downrange trauma threat preparedness. Training and equipping CBRN operators with treatment skills and appropriate interventional material requires pre-implementation planning specific to WMD threats (e.g., anthrax, radiation, organophosphates, and contaminated trauma). A scenario-based study reveals the tactics, techniques, and procedures for training, resourcing, and fielding the CBRN operator of the future. PMID:23817878

Strain, John W

2013-01-01

240

An investigation into the effects of British Summer Time on road traffic accident casualties in Cheshire  

Microsoft Academic Search

OBJECTIVE--To assess the effect of British Summer Time (BST) on road traffic accident casualties and to analyse whether the introduction of year round BST would result in reductions in casualty numbers. DESIGN--A comparative study of road traffic accident data from before and after the onset of BST. SETTING--The county of Cheshire. SUBJECT--Data from a total of 4185 casualties from the

J D Whittaker

1996-01-01

241

Physician-led team triage based on lean principles may be superior for efficiency and quality? A comparison of three emergency departments with different triage models  

PubMed Central

Background The management of emergency departments (EDs) principally involves maintaining effective patient flow and care. Different triage models are used today to achieve these two goals. The aim of this study was to compare the performance of different triage models used in three Swedish EDs. Using efficiency and quality indicators, we compared the following triage models: physician-led team triage, nurse first/emergency physician second, and nurse first/junior physician second. Methods All data of patients arriving at the three EDs between 08:00- and 21:00 throughout 2008 were collected and merged into a database. The following efficiency indicators were measured: length of stay (LOS) including time to physician, time from physician to discharge, and 4-hour turnover rate. The following quality indicators were measured: rate of patients left before treatment was completed, unscheduled return within 24 and 72?hours, and mortality rate within 7 and 30?days. Results Data from 147,579 patients were analysed. The median length of stay was 158?minutes for physician-led team triage, compared with 243 and 197?minutes for nurse/emergency physician and nurse/junior physician triage, respectively (p?triage, 5.3% for nurse/emergency physician, and 9.6% for nurse/junior physician triage (p?triage, 1.0%, compared with 2.1%, and 2.5% for nurse/emergency physician, and nurse/junior physician, respectively (p?triage and 1.0% for the two other triage models (p?triage seemed advantageous, both expressed as efficiency and quality indicators, compared with the two other models.

2012-01-01

242

Emergency Severity Index (ESI): A Triage Tool for Emergency Department Care. Version 4. Implementation Handbook, 2012 Edition.  

National Technical Information Service (NTIS)

The Emergency Severity Index (ESI) is a tool for use in emergency department (ED) triage. The ESI triage algorithm yields rapid, reproducible, and clinically relevant stratification of patients into five groups, from level 1 (most urgent) to level 5 (leas...

A. M. Rosenau D. Travers N. Gilboy P. Tanabe

2011-01-01

243

Applying Lean: Implementation of a Rapid Triage and Treatment System  

PubMed Central

Objective: Emergency department (ED) crowding creates issues with patient satisfaction, long wait times and leaving the ED without being seen by a doctor (LWBS). Our objective was to evaluate how applying Lean principles to develop a Rapid Triage and Treatment (RTT) system affected ED metrics in our community hospital. Methods: Using Lean principles, we made ED process improvements that led to the RTT system. Using this system, patients undergo a rapid triage with low-acuity patients seen and treated by a physician in the triage area. No changes in staffing, physical space or hospital resources occurred during the study period. We then performed a retrospective, observational study comparing hospital electronic medical record data six months before and six months after implementation of the RTT system. Results: ED census was 30,981 in the six months prior to RTT and 33,926 after. Ambulance arrivals, ED patient acuity and hospital admission rates were unchanged throughout the study periods. Mean ED length of stay was longer in the period before RTT (4.2 hours, 95% confidence interval [CI] = 4.2–4.3; standard deviation [SD] = 3.9) than after (3.6 hours, 95% CI = 3.6–3.7; SD = 3.7). Mean ED arrival to physician start time was 62.2 minutes (95% CI = 61.5–63.0; SD = 58.9) prior to RTT and 41.9 minutes (95% CI = 41.5–42.4; SD = 30.9) after. The LWBS rate for the six months prior to RTT was 4.5% (95% CI = 3.1–5.5) and 1.5% (95% CI = 0.6–1.8) after RTT initiation. Conclusion: Our experience shows that changes in ED processes using Lean thinking and available resources can improve efficiency. In this community hospital ED, use of an RTT system decreased patient wait times and LWBS rates.

Murrell, Karen L.; Offerman, Steven R.; Kauffman, Mark B.

2011-01-01

244

Meeting the Demand for College Student Concerns in College Counseling Centers: Evaluating a Clinical Triage System  

Microsoft Academic Search

University counseling centers, experiencing an imbalance between student demand and available resources, respond in various ways. The current mixed-method study evaluated one university counseling center transitioning from a wait-list system to a triage method of managing demand. Significant reductions in wait time and increase in attendance were found. Clients also reported significantly less distress after triage implementation. No reduction in

Jennifer A. Hardy; Ryan D. Weatherford; Benjamin D. Locke; Natalie Hernandez DePalma; Nadia T. DIuso

2011-01-01

245

The Social Network and Relationship Finder: Social Sorting for Email Triage  

Microsoft Academic Search

Email triage is the process of going through unhandled email and deciding what to do with it. This process can quickly become a serious problem for users with large volumes of email. Studies have found that people use a variety of approaches to triage their email, many of which have a social component. We believe that email clients can better

Carman Neustaedter; A. J. Bernheim Brush; Marc A. Smith; Danyel Fisher

2005-01-01

246

Signify® ER Drug Screen Test evaluation: comparison to Triage® Drug of Abuse Panel plus tricyclic antidepressants  

Microsoft Academic Search

Signify® ER Drug Screen Test (Signify ER) and Triage® Drug of Abuse Panel plus TCA (Triage DOA Panel) rapid drug screening devices were compared at four laboratories. Both assay systems are point of care immunoassays, measuring phencyclidine, barbiturates, amphetamine, cocaine metabolite, methamphetamine, tricyclic antidepressants, opiates, marijuana metabolite, and benzodiazepines in human urine. The performance of these two assay systems, including

Jane Ellen Phillips; Stuart Bogema; Paul Fu; Wieslaw Furmaga; Alan H. B Wu; Vlasta Zic; Catherine Hammett-Stabler

2003-01-01

247

Health Care Categories have Politics too: Unpacking the Managerial Agendas of Electronic Triage Systems  

Microsoft Academic Search

While investigating the resistance to the electronic triage system, ETRIAGE, at the emergency department of British Columbia Children's Hospital, we revisit the well- known CSCW-debate about THE COORDINATOR concerning the politics of standardized categories. Examining the history as well as the design of ETRIAGE, we reveal four basic assumptions about triage work in emergency departments, which are reflected in the

Pernille Bjørn; Ellen Balka

2007-01-01

248

Triage: Limitations in Predicting Need for Emergent Care and Hospital Admission  

Microsoft Academic Search

See related editorial, p 506Study objective: Little is known about the accuracy and reliability of current triage methods. We examined agreement among observers with regard to the need for ED care and the ability to predict at triage the need for admission to the hospital and compared these findings with admission rates after medical evaluation and management. Methods: We used

Judith C Brillman; David Doezema; Dan Tandberg; David P Sklar; Kathleen D Davis; Shelby Simms; Betty J Skipper

1996-01-01

249

Evaluation of the Paediatric Canadian Triage and Acuity Scale in a pediatric ED  

Microsoft Academic Search

The aim of this study was to compare the performance of the Paediatric Canadian Triage and Acuity Scale (Paed CTAS) to a previous triage tool with respect to the percentage of admissions, the diagnostic and therapeutic interventions, and the mean pediatric risk of admission (PRISA) score in a pediatric tertiary center emergency department. Data were prospectively collected for 4 months

Serge Gouin; Jocelyn Gravel; Devendra K. Amre; Sylvie Bergeron

2005-01-01

250

Identifying high-risk patients for triage and resource allocation in the ED  

Microsoft Academic Search

Five-point triage assessment scales currently used in many emergency departments (EDs) across the country have been shown to be accurate and reliable. We have found the system to be highly predictive of outcome (hospital admission, intensive care unit\\/operating room admission, or death) at either extreme of the scale but much less predictive in the middle triage group. This is problematic

Jennifer Prah Ruger; Lawrence M. Lewis; Christopher J. Richter

2007-01-01

251

A retrospective cohort pilot study to evaluate a triage tool for use in a pandemic  

Microsoft Academic Search

INTRODUCTION: The objective of this pilot study was to assess the usability of the draft Ontario triage protocol, to estimate its potential impact on patient outcomes, and ability to increase resource availability based on a retrospective cohort of critically ill patients cared for during a non-pandemic period. METHODS: Triage officers applied the protocol prospectively to 2 retrospective cohorts of patients

Michael D Christian; Cindy Hamielec; Neil M Lazar; Randy S Wax; Lauren Griffith; Margaret S Herridge; David Lee; Deborah J Cook

2009-01-01

252

Improving Trauma Triage Using Basic Crash Scene Data  

PubMed Central

Objective: to analyze the occurrence of severe injuries and deaths among crash victims transported to hospitals in relation to occupant and scene characteristics, including on-scene patient mobility, and their potential use in triaging patients to the appropriate level of care. Methods: the occurrence of death and ISS>15 were studied in relation to occupant, crash and mobility data readily available to EMS at the scene, using weighted NASS-CDS data. Data set was randomly split in two for model development and evaluation. Characteristics were combined to develop new triage schemes. Overtriage and undertriage rates were calculated for the NASS-CDS case trauma center allocation and for the newly developed triage schemes. Results: Compared to the NASS-CDS distribution, a scheme using patient mobility alone showed lower overtriage of those with ISS?15 (38.8% vs. 55.5%) and lower undertriage of victims who died from their crash-related injuries (2.34% vs. 21.47%). Undertriage of injuries with ISS> 15 was similar (16.0 vs. 16.9). A scheme based on the presence of one of many scene risk factors (age>55, GCS<14, intrusion ?18”, near lateral impact, far lateral impact with intrusion ?12”, rollover or lack of restraint use) resulted in an undertriage of 0.86% (death) and 10.5% (ISS>15) and an overtriage of 63.4%. The combination of at least one of the scene risk factors and mobility status greatly decreased overtriage of those with ISS<15 (24.4%) with an increase in death undertriage (3.19%). Further combination of mobility and scene factors allowed for maintenance of a low undertriage (0.86%) as well as an acceptable overtriage (48%). Conclusion: Patient mobility data easily obtained at the scene of a crash allows triaging of injured patients to the appropriate facility with a high sensitivity and specificity. The addition of crash scene data to scene mobility allows further reductions on undertriaging or overtriaging.

Ryb, Gabriel E.; Dischinger, Patricia C.

2011-01-01

253

The utility of venous lactate to triage injured patients in the trauma center 1 1 No competing interests declared  

Microsoft Academic Search

Background: Field triage criteria for trauma patients results in over-triage rates of 30% to 50% to achieve under-triage rates of 10%. This large number of patients may stress trauma center resources. Elevated arterial lactate (ALAC) levels have been shown to be a marker of serious injury but the need for arterial sampling limits the utility of the determination. The goal

Robert F. Lavery; David H. Livingston; Bartholomew J. Tortella; Justin T. Sambol; Brian M. Slomovitz; John H. Siegel

2000-01-01

254

Field triage to primary angioplasty combined with emergency department bypass reduces treatment delays and is associated with improved outcome  

Microsoft Academic Search

Aims We investigated the net benefit in the outcome of reducing treatment delay through field triage and emergency department (ED) bypass in patients with ST-elevation myocardial infarction (STEMI) treated with primary angioplasty. Methods and results In a prospective registry study, consecutive patients with suspected STEMI were assigned to: (i) pre-hospital ECG and triage or (ii) ECG and triage at the

Steen Carstensen; Greg C. I. Nelson; Peter S. Hansen; Lewis Macken; Stephen Irons; Michael Flynn; Pramesh Kovoor; Soon Y. Soo Hoo; Michael R. Ward; Helge H. Rasmussen

255

Application of novel hyperspectral imaging technologies in combat casualty care  

NASA Astrophysics Data System (ADS)

Novel hyperspectral imaging (HSI) methods may play several important roles in Combat Casualty Care: (1) HSI of the skin may provide spatial data on hemoglobin saturation of oxygen, as a "window" into perfusion during shock. (2) HSI or similar technology could be incorporated into closed-loop, feedback-controlled resuscitation systems. (3) HSI may provide information about tissue viability and/or wound infection. (4) HSI in the near-infrared range may provide information on the tissue water content--greatly affected, e.g., by fluid resuscitation. Thus, further refinements in the speed and size of HSI systems are sought to make these capabilities available on the battlefield.

Cancio, Leopoldo C.

2010-02-01

256

49 CFR 1242.65 - Other and casualties and insurance (accounts XX-51-99 and 50-51-00).  

Code of Federal Regulations, 2012 CFR

... Other and casualties and insurance (accounts XX-51-99 and 50-51-00). 1242...DEPARTMENT OF TRANSPORTATION (CONTINUED) ACCOUNTS, RECORDS AND REPORTS SEPARATION... Other and casualties and insurance (accounts XX-51-99 and 50-51-00)....

2012-10-01

257

49 CFR 1242.54 - Other and casualties and insurance (accounts XX-27-99 and 50-27-00).  

Code of Federal Regulations, 2012 CFR

... Other and casualties and insurance (accounts XX-27-99 and 50-27-00). 1242...DEPARTMENT OF TRANSPORTATION (CONTINUED) ACCOUNTS, RECORDS AND REPORTS SEPARATION... Other and casualties and insurance (accounts XX-27-99 and 50-27-00)....

2012-10-01

258

49 CFR 1242.72 - Other and casualties and insurance (accounts XX-52-99 and 50-52-00).  

Code of Federal Regulations, 2012 CFR

... Other and casualties and insurance (accounts XX-52-99 and 50-52-00). 1242...DEPARTMENT OF TRANSPORTATION (CONTINUED) ACCOUNTS, RECORDS AND REPORTS SEPARATION... Other and casualties and insurance (accounts XX-52-99 and 50-52-00)....

2012-10-01

259

49 CFR 1242.82 - Other and casualties and insurance (accounts XX-55-99 and 50-55-00).  

Code of Federal Regulations, 2012 CFR

... Other and casualties and insurance (accounts XX-55-99 and 50-55-00). 1242...DEPARTMENT OF TRANSPORTATION (CONTINUED) ACCOUNTS, RECORDS AND REPORTS SEPARATION... Other and casualties and insurance (accounts XX-55-99 and 50-55-00)....

2012-10-01

260

49 CFR 1242.41 - Other and casualties and insurance (accounts XX-26-99 and 50-26-00).  

Code of Federal Regulations, 2012 CFR

... Other and casualties and insurance (accounts XX-26-99 and 50-26-00). 1242...DEPARTMENT OF TRANSPORTATION (CONTINUED) ACCOUNTS, RECORDS AND REPORTS SEPARATION... Other and casualties and insurance (accounts XX-26-99 and 50-26-00)....

2012-10-01

261

27 CFR 25.282 - Beer lost by fire, theft, casualty, or act of God.  

Code of Federal Regulations, 2010 CFR

...2010-04-01 2010-04-01 false Beer lost by fire, theft, casualty, or act...DEPARTMENT OF THE TREASURY LIQUORS BEER Refund or Adjustment of Tax or Relief From Liability § 25.282 Beer lost by fire, theft, casualty, or...

2010-04-01

262

27 CFR 25.282 - Beer lost by fire, theft, casualty, or act of God.  

Code of Federal Regulations, 2010 CFR

...2009-04-01 2009-04-01 false Beer lost by fire, theft, casualty, or act...DEPARTMENT OF THE TREASURY LIQUORS BEER Refund or Adjustment of Tax or Relief From Liability § 25.282 Beer lost by fire, theft, casualty, or...

2009-04-01

263

Lessons learned from casualty statistics in health care system development: Afghanistan 2008-2009.  

PubMed

A retrospective study of Afghanistan National Army casualty rates for a 1-year period was completed to assist in health care system assessment and further development during a period of rapid force expansion. Battle and disease nonbattle injuries by Corps area were determined from data on soldier visits from all military health care facilities. The number of fielded forces in each Corps was used to calculate the populations at risk. Total manpower losses from all casualties were tabulated. The 15,336 casualties (175 per thousand fielded soldiers) resulted in the loss of 146,986 duty days (average 9.5 days per casualty). Battle casualties were 739 (8.4 per 1,000) and nonbattle casualties were 14,597(166 per 1,000) with 72% secondary to infectious diseases. Casualty rates from both battle and disease nonbattle injuries were high, but casualty rates were particularly high from infectious diseases. Rapid force expansion in developing countries requires early consideration for resourcing and implementation of preventive medicine programs. PMID:21305967

Zahoor, Sayed H; Ubiera, Juan I; Davis, Gary D; Anderson, Joseph B; Welch, Richard R; Lowe, Daniel K

2011-01-01

264

Analysis of the Correlation Between Casualties and Human Perception, Cognition & Decision-Making at Sea  

Microsoft Academic Search

Analysis of maritime casualties conducted over the last 30 years showed no improvement in any aspect, and proved that the human factor is still dominant in most casualties. To improve this situation, technology has been introduced to marine navigation an integrated navigation systems, however, this situation remains the same. The collisions and groundings of ocean-going vessels continue to concern those

Ahmed HANAFI

265

Echoes of Vietnam?Casualty Framing and Public Perceptions of Success and Failure in Iraq  

Microsoft Academic Search

In the early stages of the counterinsurgency campaign in Iraq, military leaders resisted the release of body count and “casualty ratio” data. However, in the spring of 2004, the U.S. military (and American media) began to focus on the “limited” American casualties in specific operations versus the “significant” number of insurgents killed. This article examines the extent to which body

William A. Boettcher; Michael D. Cobb

2006-01-01

266

Ophthalmic emergencies in a district general hospital casualty department.  

PubMed Central

A survey of ophthalmic emergencies attending the casualty department of a district general hospital over a 12-month period is presented. The total number of new casualty attendances was 30,649 of which 1870 (6.1%) presented with an ophthalmic problem. There was a 3 to 1 male to female preponderance and a peak age of presentation between 20 and 30 years. The main aetiological factors were trauma 65.6% and inflammation 21.7%. Of the trauma patients 80% had sustained minor trauma (abrasions or foreign material to the cornea or conjunctiva) and of the patients with inflammation 71% had either conjunctivitis or blepharitis. There was a trend towards increased numbers in the summer months. The percentage of patients with inflammatory disease was higher in the early summer and the winter months. Nine of the 11 patients with acute angle closure glaucoma presented between November and February. All patients were initially seen by the accident and emergency medical staff, who were able to treat 69% without further consultation. No serious pathology was overlooked. It is suggested that, in the district general hospital setting, co-operation between the eye and the accident and emergency departments can be to their mutual benefit.

Edwards, R S

1987-01-01

267

Mixed-methods approach for measuring the impact of video telehealth on outpatient clinic triage nurse workflow.  

PubMed

Nurse-delivered telephone triage is a common component of outpatient clinic settings. Adding new communication technology to clinic triage has the potential to not only transform the triage process but also alter triage workflow. Evaluating the impact of new technology on an existing workflow is paramount to maximizing the efficiency of the delivery system. This study investigated triage nurse workflow before and after the implementation of video telehealth using a sequential mixed-methods protocol that combined ethnography and time-motion study to provide a robust analysis of the implementation environment. Outpatient clinic triage using video telehealth required significantly more time than telephone triage did, indicating a reduction in nurse efficiency. Despite the increased time needed to conduct video telehealth, nurses consistently rated it useful in providing triage. Interpretive analysis of the qualitative and quantitative data suggests that the increased depth and breadth of data available during video triage alter the assessment that triage nurses provide physicians. This in turn could affect the time physicians spend formulating a diagnosis and treatment plan. While the immediate impact of video telehealth is a reduction in triage nurse efficiency, what is unknown is the impact of video telehealth on physician and overall clinic efficiency. Future studies should address this area. PMID:24080753

Cady, Rhonda G; Finkelstein, Stanley M

2013-09-01

268

A redundant resource: a pre-planned casualty clearing station for a FIFA 2010 Stadium in Durban.  

PubMed

This report details the background, planning, and establishment of a mass-casualty management area for the Durban Moses Mabhida Stadium at the Natal Mounted Rifles base, by the Department of Health and the eThekwini Fire and Rescue Service, for the Fédération Internationale de Football Association (FIFA) 2010 Soccer World Cup. The report discusses the use of the site during the seven matches played at that stadium, and details the aspects of mass-gathering major incident site planning for football (soccer). The area also was used as a treatment area for other single patient incidents outside of the stadium, but within the exclusion perimeter, and the 22 patients treated by the Casualty Clearing Station (CCS) team are described and briefly discussed. A site-specific patient presentation rate of 0.48 per 10,000 and transport-to-hospital rate (TTHR) of 0.09/10,000 are reported. Lessons learned and implications for future event planning are discussed in the light of the existing literature. PMID:22591650

Hardcastle, Timothy C; Samlal, Sanjay; Naidoo, Rajen; Hendrikse, Steven; Gloster, Alex; Ramlal, Melvin; Ngema, Sibongiseni; Rowe, Michael

2012-05-17

269

The Scenescore for Improved Pre-Hospital Triage of Motor-Vehicle Crash Victims  

PubMed Central

The SceneScore is a simple mechanism of injury scoring system designed to facilitate the appropriate triage of crash victims. It comprises 7 variables including age, collision type, impact location, airbag deployment, steering wheel deformity, intrusion, and restraint use. A cutoff value of 7 or 8 provides the maximum balance between sensitivity and specificity, with sensitivities of 75% to 83% and specificities of 29% to 46%. For cases triaged to the trauma center based only on high suspicion of injury, the SceneScore reduces the overtriage rate by almost half. Proper application of the SceneScore may lead to improved triage and enhanced communication of mechanism of injury criteria.

Schulman, C.I.; Wilbur, V.; Leibowitz, B.; Labiste, L.; Perdeck, E.; PhD, G Bahouth; Digges, K.; Augenstein, J.S.

2007-01-01

270

DEVELOPMENT OF IT TRIAGE SYSTEM (TRACY) TO SHARE REGIONAL DISASTER MEDICAL INFORMATION  

NASA Astrophysics Data System (ADS)

We developed an IT triage system for collecting disaster medical information in real time. FeliCa cards and card readers are used to obtain the number and cond ition of patients. The system is composed of two elements. First, the number of patie nts for each triage level and the accepted number of patients in each diagnosis and treatment department are obtained in real time, including response for changing triage level. Second, this information can be shared among hospitals, the administration, and residents in real time who are searching for their family. A disaster drill utiliz ing this system was held at the University of Yamanashi Hospital with 450 participants.

Numada, Muneyoshi; Hada, Yasunori; Ohara, Miho; Meguro, Kimiro

271

Triaging for adult critical care in the event of overwhelming need  

Microsoft Academic Search

Introduction  Predictions of the need for critical care within the H1N1 influenza pandemic suggested overwhelming need beyond potential\\u000a resources, necessitating rationing of care via triaging.\\u000a \\u000a \\u000a \\u000a \\u000a Method  The triage model described was derived from informed discourse within a conjoined NHS and University Clinical Ethics Committee,\\u000a supplemented by specialists in intensive care and infectious diseases.\\u000a \\u000a \\u000a \\u000a \\u000a The Model  The triage methodology described is justified ethically primarily

Nigel Eastman; Barbara Philips; Andrew Rhodes

2010-01-01

272

A Casualty in the Class War: Canada's Medicare.  

PubMed

"There's class warfare, all right, but it's my class, the rich class, that's making war, and we're winning." (Warren Buffett, five years ago.) Last year's Occupy Wall Street movement suggested that people are finally catching on. Note, making war: Buffett meant that there was deliberate intent and agency behind the huge transfer of wealth, since 1980, from the 99% to the 1%. Nor is the war metaphorical. There are real casualties, even if no body bags. Sadly, much Canadian commentary on inequality is pitiably naïve or deliberately obfuscatory. The 1% have captured national governments. The astronomical cost of American elections excludes the 99%. In Canada, parliamentary government permits one man to rule as a de facto dictator. The 1% don't like medicare. PMID:23372577

Evans, Robert G

2012-02-01

273

Trauma-related Infections in Battlefield Casualties From Iraq  

PubMed Central

Objective: To describe risks for, and microbiology and antimicrobial resistance patterns of, war trauma associated infections from Operation Iraqi Freedom. Background: The invasion of Iraq resulted in casualties from high-velocity gunshot, shrapnel, and blunt trauma injuries as well as burns. Infectious complications of these unique war trauma injuries have not been described since the 1970s. Methods: Retrospective record review of all trauma casualties 5 to 65 years of age evacuated from the Iraqi theatre to U.S. Navy hospital ship, USNS Comfort March to May 2003.War trauma-associated infection was defined by positive culture from a wound or sterile body fluid (ie, blood, cerebrospinal fluid) and at least two of the following infection-associated signs/symptoms: fever, dehiscence, foul smell, peri-wound erythema, hypotension, and leukocytosis. A comparison of mechanisms of injury, demographics, and clinical variables was done using multivariate analysis. Results: Of 211 patients, 56 met criteria for infection. Infections were more common in blast injuries, soft tissue injuries, >3 wound sites, loss of limb, abdominal trauma, and higher Injury Severity Score (ISS). Wound infections accounted for 84% of cases, followed by bloodstream infections (38%). Infected were more likely to have had fever prior to arrival, and had higher probability of ICU admission and more surgical procedures. Acinetobacter species (36%) were the predominant organisms followed by Escherichia coli and Pseudomonas species (14% each). Conclusions: Similar to the Vietnam War experience, gram-negative rods, particularly Acinetobacter species, accounted for the majority of wound infections cared for on USNS Comfort during Operation Iraqi Freedom. Multidrug resistance was common, with the exception of the carbapenem class, limiting antibiotic therapy options.

Petersen, Kyle; Riddle, Mark S.; Danko, Janine R.; Blazes, David L.; Hayden, Richard; Tasker, Sybil A.; Dunne, James R.

2007-01-01

274

State-level Lists of Casualties from the Vietnam Conflict (1957-)  

NSDL National Science Digital Library

The Center for Electronic Records of the US National Archives and Records Administration has recently added this database to its already existing casualty list for the Korean Conflict (discussed in the March 6, 1998 Scout Report). The database, which is only browseable, includes name of casualty, rank, branch of military service, "home of record," date of birth and death, "category of casualty," and an indicator as to whether the remains have been recovered. Records may be sorted alphabetically or by "home of record," within state. The database covers 1957-1995 and contains records for 58,187 individuals.

275

Simulated evaluation of two triage scales in an emergency department in Israel.  

PubMed

At the time of this study, the Sheba Medical Center Emergency Department (ED) in Israel had no formal triage system in place. To evaluate the interobserver reliability of two triage scales among nurses in our ED, the time-based Australasian Triage Scale (ATS) and the resource-based Emergency Severity Index (ESI), 10 nurses participated in a workshop on ATS and ESI. They then independently assessed 100 simulated triage scenarios taken from actual ED patients, and completed a survey. Intraclass correlation coefficients were calculated. The intraclass correlation coefficient for ATS was 0.64 (95% confidence interval: 0.57, 0.71), whereas for ESI, it was 0.52 (95% confidence interval: 0.45, 0.61). The nurses felt that ESI was slightly easier to use. Using conventional interpretations, the agreement for ATS is considered substantial, whereas that for ESI is considered moderate. Conversely, the nurses found the ESI somewhat easier to use. PMID:24165355

Alpert, Evan A; Lipsky, Ari M; Hertz, Dvora; Rieck, Jonathon; Or, Jacob

2013-12-01

276

Emergency department triaging of admitted stroke patients--a Bayesian Network analysis.  

PubMed

This study uses hospital administrative data to ascertain the differences in the patient characteristics, process and outcomes of care between the Emergency Department (ED) triage categories of patients admitted from an ED presentation into a large metropolitan teaching hospital with a Stroke Care Unit. Bayesian Networks (BNs) derived from the administrative data were used to provide the descriptive models. Nearly half the patients in each stroke subtype were triaged as 'Urgent' (to be seen within 30 minutes). With a decrease in the urgency of triage categories, the proportion admitted within 8 hours decreased dramatically and the proportion of formal discharge increased. Notably, 45% of transient ischaemic attacks (TIAs) were categorized as 'Semi-urgent' (to be attended within 60 minutes), indicating an opportunity to improve emergency assessment of TIAs. The results illustrate the utility of hospital administrative data and the applicability of BNs for review of the current triage practices and subsequent impact. PMID:22193829

Nadathur, Shyamala G; Warren, James R

2011-12-01

277

The cognitive processes underpinning clinical decision in triage assessment: A theoretical conundrum?  

PubMed

High quality clinical decision-making (CDM) has been highlighted as a priority across the nursing profession. Triage nurses, in the Accident and Emergency (A&E) department, work in considerable levels of uncertainty and require essential skills including: critical thinking, evaluation and decision-making. The content of this paper aims to promote awareness of how triage nurses make judgements and decisions in emergency situations. By exploring relevant literature on clinical judgement and decision-making theory, this paper demonstrates the importance of high quality decision-making skills underpinning the triage nurse's role. Having an awareness of how judgements and decisions are made is argued as essential, in a time where traditional nurse boundaries and responsibilities are never more challenged. It is hoped that the paper not only raises this awareness in general but also, in particular, engages the triage nurse to look more critically at how they make their own decisions in their everyday practice. PMID:23685041

Noon, Amy J

2013-05-16

278

Developing an Intelligent Phone-based Emergency Triage Communication and Support System  

PubMed Central

In this study, the emergency triage support system was taken as an example. We develop new call flow style and combine traditional passive call flow. The system is designed by voice menu and users can command services actively. The telephone connect computer server to enter call flow module with ASR and TTS. Then the recognition term come from voice term database. Voice management center is an ER triage decision system.

Hsiao, Fang-Ying; Kuo, Yu-Yin; Chang, Polun

2006-01-01

279

Triage nurse X-ray protocols for hand and wrist injuries.  

PubMed

Enabling triage nurses to request X-rays has a number of benefits for patients and staff. This article describes the development of a protocol and in-house training programme that allows triage nurses to assess patients with hand and wrist injuries, make a differential diagnosis of potential fracture and request X-rays. The protocol not only improves patients' journeys, but also empowers members of the emergency department's nursing team to develop new skills. PMID:20209751

Hunter, David

2010-02-01

280

Validation of triage criteria for deciding which apparently inebriated persons require emergency department care  

Microsoft Academic Search

ObjectivesThe sensitivity and specificity of consensus triage criteria for identifying which apparently inebriated patients could be triaged to care in a sobering centre were determined. Sensitivity and specificity for modifications to these criteria were also investigated.MethodsParamedics prospectively collected data on apparently inebriated persons en route to the emergency department (ED). 99 of these patients' ED charts were retrospectively reviewed to

Keith Flower; Anneke Post; Jeremy Sussman; Niels Tangherlini; John Mendelson; Mark J Pletcher

2010-01-01

281

Evaluation of nurse triage in a British accident and emergency department  

Microsoft Academic Search

OBJECTIVE--To compare formal nurse triage with an informal prioritisation process for waiting times and patient satisfaction. SETTING--Accident and emergency department of a district general hospital in the midlands in 1990. DESIGN--Patients attending between 8:00 am and 9:00 pm over six weeks were grouped for analysis according to whether triage was operating at time of presentation and by their degree of

S. George; S. Read; L. Westlake; B. Williams; A. Fraser-Moodie; P. Pritty

1992-01-01

282

Undertriage in the Manchester triage system: an assessment of severity and options for improvement  

Microsoft Academic Search

BackgroundThe Manchester Triage System (MTS) determines an inappropriately low level of urgency (undertriage) to a minority of children. The aim of the study was to assess the clinical severity of undertriaged patients in the MTS and to define the determinants of undertriage.MethodsPatients who had attended the emergency department (ED) were triaged according to the MTS. Undertriage was defined as a

N Seiger; M van Veen; E W Steyerberg; M Ruige; A H J van Meurs; H A Moll

2011-01-01

283

The importance of interdepartmental collaboration and safe triage for pregnant women in the emergency department.  

PubMed

Pregnant women who present to the emergency department can present challenges that range from the diagnoses of unsuspected pregnancies to the determination of where evaluations should occur. In this review we identify literature associated with the triage of pregnant women in the emergency department and propose a model for triage and evaluation of pregnant women in the emergency department. Strategies are described to facilitate interdepartmental communication to optimize safe maternal/fetal care. PMID:24004212

Chagolla, Brenda A; Keats, John P; Fulton, Janet M

2013-09-04

284

Prediction of Emergent Heart Failure Death by Semi-Quantitative Triage Risk Stratification  

Microsoft Academic Search

ObjectivesGeneric triage risk assessments are widely used in the emergency department (ED), but have not been validated for prediction of short-term risk among patients with acute heart failure (HF). Our objective was to evaluate the Canadian Triage Acuity Scale (CTAS) for prediction of early death among HF patients.MethodsWe included patients presenting with HF to an ED in Ontario from Apr

Harriette G. C. Van Spall; Clare Atzema; Michael J. Schull; Gary E. Newton; Susanna Mak; Alice Chong; Jack V. Tu; Thérèse A. Stukel; Douglas S. Lee

2011-01-01

285

Effect of Visual Cues, Vital Signs, and Protocols on Triage: A Prospective Randomized Crossover Trial  

Microsoft Academic Search

Study objectives: We sought to compare triage designations derived from in-person and telephone interviews and systematically examine the effect of visual cues, vital signs, and complaint-based protocols on the triage process. Methods: We conducted a 2-phase, prospective, observational study employing a randomized, crossover design in a university teaching hospital emergency department. In both phases, every eligible patient underwent sequential in-person

Eric D Salk; David L Schriger; Kelly A Hubbell; Brad L Schwartz

1998-01-01

286

'Mass allergy': acute scombroid poisoning in a deployed Australian Defence Force health facility.  

PubMed

On the last night of disaster relief operations in Sumatra, Indonesia, a mass casualty event occurred that involved deployed Australian Defence Force personnel. Symptoms of acute urticaria, angioedema, wheeze and gastrointestinal upset were experienced to varying degrees by 16% of the deployed element. The present report describes a presumed scombroid poisoning cluster and demonstrates the difficulties of operating in a deployed environment, the confusion that might be associated with evolving non-kinetic mass casualties, and provides a learning opportunity for an unusual mass casualty incident. PMID:21284820

Ward, David Ian

2011-02-01

287

Mathematical Models for Prediction of Neuropsychiatric and Other Non-Battle Casualties in High Intensity Combat.  

National Technical Information Service (NTIS)

Historical data on combat-produced neuropsychiatric (NP) casualties, from several sources, are mathematically fit to functions which depend upon time in combat, wounded in action rate, type of unit, and others. Data from World II are contrasted with data ...

S. G. Levin J. T. Klopcic

1986-01-01

288

Advancing critical care: joint combat casualty research team and joint theater trauma system.  

PubMed

Despite the severity and complexity of injuries, survival rates among combat casualties are equal to or better than those from civilian trauma. This article summarizes the evidence regarding innovations from the battlefield that contribute to these extraordinary survival rates, including preventing hemorrhage with the use of tourniquets and hemostatic dressings, damage control resuscitation, and the rapid evacuation of casualties via MEDEVAC and the US Air Force Critical Care Air Transport Teams. Care in the air for critically injured casualties with pulmonary injuries and traumatic brain injury is discussed to demonstrate the unique considerations required to ensure safe en route care. Innovations being studied to decrease sequelae associated with complex orthopedic and extremity trauma are also presented. The role and contributions of the Joint Combat Casualty Research Team and the Joint Theater Trauma System are also discussed. PMID:20683227

Bridges, Elizabeth; Biever, Kimberlie

289

State Solvency Regulation of Property-Casualty and Life Insurance Companies. A Commission Report.  

National Technical Information Service (NTIS)

The report is to inform policymakers of the options available for improving state solvency regulation of the property-casualty and life insurance industries. The report examines the entire range of issues in state solvency regulation, including regulatory...

S. B. McCray

1992-01-01

290

Marine casualty and pollution database (raw data only) (on CD-ROM). Data file  

SciTech Connect

The Marine Casualty and Pollution Database provides details about marine casualty and pollution incidents investigated by the US Coast Guard Marine Safety Officer. The database is an invaluable source of information to understand particulars and circumstances of marine accidents and pollution incidents. The CD-ROM contains forty data tables derived from marine casualty and pollution investigations conducted by investigators at US Coast Guard Marine Safety Offices throughout the United States. The data collection period began in 1973 and is ongoing. Also included on the CD-ROM are vessel and facility tables with specific information on vessel and facility constitution and operating details. The Coast Guard maintains a comprehensive database on approximately 460,000 US and foreign vessels and 32,000 facilities. Entity and attribute descriptions and suggested solutions to general marine pollution, vessel casualty, and personnel injury and death questions are outlined in the documentation.

NONE

1998-06-01

291

Continuous Renal Replacement Therapy Improves Survival in Severely Burned Military Casualties With Acute Kidney Injury.  

National Technical Information Service (NTIS)

Background: Acute kidney injury in severely burned patients is associated with high mortality. We wondered whether early use of continuous renal replacement therapy (CRRT) changes outcomes in severely burned military casualties with predetermined criteria...

E. E. Mann E. M. Renz K. K. Chung L. Juncos S. E. Wolf

2007-01-01

292

Failed States and Casualty Phobia: Implications for Force Structure and Technology Choices.  

National Technical Information Service (NTIS)

The emergence of failed states as the principal source of international political instability and the appearance of mounting casualty phobia among U.S. political and military elites have significant force structure and technology implications. Overseas, i...

J. Record

2000-01-01

293

The Effects of Tax-Law Changes on Property-Casualty Insurance Prices  

Microsoft Academic Search

During the 1980s, the federal income tax treatment of property-casualty insurers and their policyholders underwent several important changes, the most significant of which came in 1986. This paper develops theoretical predictions for how these changes should have affected the equilibrium prices of property-casualty insurance policies, and explores the extent to which the theoretical predictions are reflected in data on industry

David F. Bradford; Kyle Logue

1996-01-01

294

Causes of casualties and the regulation of occupational health and safety in the shipping industry  

Microsoft Academic Search

The aim of this paper is to investigate maritime safety from an occupational hazards perspective as opposed to a maritime\\u000a casualty perspective. It is recognised that safety in shipping should encompass casualties arising from accidents occurring\\u000a in the course of performing normal seafaring duties, not just those arising from technical defects or maritime disasters.\\u000a The paper discusses an investigation involving

Detlef Nielsen; Photis M. Panayides

2005-01-01

295

Excelsior Surgical Society Edward D Churchill Lecture. Changes in combat casualty care.  

PubMed

There have been many positive changes in combat casualty care since Desert Storm. The Air Force has made a major change and significant improvement in combat casualty care, which is aided by the United States Army and Navy. The current care is second to none, including rehabilitation. This improvement in care and outcomes is due to the dedication of the doctors, nurses, corpsmen, pilots, and the incredible support services that make it happen. PMID:22626545

Trunkey, Donald

2012-06-01

296

Triaging referrals as part of hematology/oncology fellowship training.  

PubMed

We developed an integrative component of the consult rotation for fellows training in hematology/oncology. This component consisted of triaging all consults to the hematology/oncology service of the CAVHS during a 1-year period of time. The goals of the rotation were to improve timeliness of response to consultation requests, to gain experience in differential diagnosis of patients with potential hematologic/oncologic disorders through of such patients, review of decisions with attending physicians, and communication of such with the referring physician. The major benefits were that fellows integrated didactic learning into real-life clinical cases, selected patients for their continuity clinic to assure sufficient variety and complexity of cases, honed their communication skills, learned about referring and attending physicians' styles, and gained practice in clinical vignettes representative of cases they would be expected to see in clinical practice. Disadvantages were time involvement (approximately 2 h/day) and risks of over- or under-referrals. Administratively, there was a significant decline in the wait time for patients to be seen in the hematology/oncology service. In all, this elective is a valuable integrative experience of senior fellows, but may have less value for first year fellows. PMID:20339965

Kyei, Mark; Lavelle, Ellen; Kyasa, Jameel; Safar, Mazin; Makhoul, Issam; Mehta, Paulette

2010-09-01

297

Mass  

SciTech Connect

In the classical physics we inherited from Isaac Newton, mass does not arise, it simply is. The mass of a classical object is the sum of the masses of its parts. Albert Einstein showed that the mass of a body is a measure of its energy content, inviting us to consider the origins of mass. The protons we accelerate at Fermilab are prime examples of Einsteinian matter: nearly all of their mass arises from stored energy. Missing mass led to the discovery of the noble gases, and a new form of missing mass leads us to the notion of dark matter. Starting with a brief guided tour of the meanings of mass, the colloquium will explore the multiple origins of mass. We will see how far we have come toward understanding mass, and survey the issues that guide our research today.

Quigg, Chris (Fermilab)

2007-12-05

298

Ultrasonography in the evaluation of hemoperitoneum in war casualties.  

PubMed

The aim of this study was to evaluate the sensitivity, specificity, accuracy, and positive and negative predictive values of emergent ultrasound examination in the detection of hemoperitoneum among war casualties, and to compare the results of this method in a specific war situation and civil conditions. Ninety-four wounded individuals with suspected blunt or penetrating abdominal trauma were treated at a level I war hospital (group W), and 242 civilians with multiple injuries with suspected blunt abdominal trauma were evaluated at the emergency center of a university hospital (group C). All examinations were performed in less than 5 minutes with a portable ultrasonographic scanner, and typical points were scanned (Morison's pouch, Douglas and perisplenic spaces, paracolic gutter). In group W, hemoperitoneum was identified correctly in 19 patients, with three false-negative and no false-positive findings, whereas group C presented 98 true-positive results, 13 false-negative results, and again no false-positive results. We observed that ultrasonography in specific war conditions showed sensitivity of 86%, specificity of 100%, accuracy as high as 97%, positive predictive value of 100%, and negative predictive value of 96%, whereas in civil conditions the corresponding values were 88%, 100%, 95%, 100%, and 91%, respectively. The sensitivity, specificity, accuracy, and positive and negative predictive values of emergent ultrasound examination in the diagnosis of hemoperitoneum are approximately equal in war and civil conditions. PMID:10459274

Mileti?, D; Fuckar, Z; Mraovi?, B; Dimec, D; Mozetic, V

1999-08-01

299

Bicycle crash casualties in a highly motorized city.  

PubMed

The characteristics of bicycle crashes in cities where bicycles are a minor transport mode have received little attention in road safety research. However, the characteristics of these injury-inflicting bicycle crashes are expected to be very different from those happening in cities where cycling is generally considered as one of the major transport modes. Specifically, this study has the following three objectives: (1) to conduct the first scientific spatial analysis of bicycle crashes in Hong Kong; (2) to analyze the circumstances leading to bicycle crashes; and (3) to conduct an epidemiological study on injury patterns of cyclist casualties. Various spatial and statistical tools, including buffer analysis, chi-square tests, analysis-of-variance and binary logistic regression, are used to analyze the bicycle crashes in Hong Kong from 2005-2007. An important finding of this paper is that the bicycle safety problem has a clear spatial dimension. The crash circumstances in different parts of the city differed systematically. Furthermore, the findings suggest that initiatives to develop new cycle tracks and to encourage bicycles as a transport mode must be planned carefully with new infrastructure and policies to ensure the safety of cyclists. PMID:20728641

Loo, Becky P Y; Tsui, K L

2010-06-09

300

Treating the war casualty: case reports of polytrauma.  

PubMed

The new generation of wounded Warriors is vastly different from those seen in the past, and military occupational therapists (OTs) must adapt to the challenges to meet the needs of these young men and women. Three case reports will be presented demonstrating the adaptability and flexibility of military OTs serving the combat wounded Warrior. The first case report reviews the rehabilitation process of a Sailor who was hit by an improvised explosive device (IED) and sustained an open shrapnel wound to his left upper extremity. The second case report presents the complex rehabilitation process of a Soldier who sustained an open distal radius and carpal fractures with soft tissue loss to his left hand from a gunshot wound after his helicopter was shot down. The final case report represents a Soldier who was injured using a table saw while in Iraq and sustained lacerations to his left hand thumb, index, and ring fingers. These case reports represent some of the demands and challenges that military OTs face when treating the war casualty. PMID:18436139

Smurr, Lisa M; Robinson, Michael; Smith-Forbes, Enrique

301

Triage rapid initial assessment by doctor (TRIAD) improves waiting time and processing time of the emergency department  

Microsoft Academic Search

Aim: To evaluate the effect of triage rapid initial assessment by doctor (TRIAD) on waiting time and processing time of an emergency department (ED) without extra staff.Method: A senior emergency doctor was put into triage instead of a consultation cubicle for seven shifts of 9 hours each. All the patients were assessed and necessary interventions started at the time of

Y F Choi; T W Wong; C C Lau

2006-01-01

302

Triage and Injury Severity Scores as predictors of mortality and hospital admission for injuries: A validation study  

Microsoft Academic Search

BackgroundMany emergency departments use a rating system to establish priority based on urgency: “triage”. The aim of this study was to evaluate the validity of triage in predicting hospitalization and mortality compared to that of the ICD-9-CM based Injury Severity Score (ISS).

Laura Camilloni; Paolo Giorgi Rossi; Sara Farchi; Francesco Chini; Piero Borgia; Gabriella Guasticchi

2010-01-01

303

Evolution and challenges in the design of computational systems for triage assistance  

PubMed Central

Compared with expert systems for specific disease diagnosis, knowledge-based systems to assist decision making in triage usually try to cover a much wider domain but can use a smaller set of variables due to time restrictions, many of them subjective so that accurate models are difficult to build. In this paper we first study criteria that most affect the performance of systems for triage assistance. Such criteria include whether principled approaches from Machine Learning can be used to increase accuracy and robustness and to represent uncertainty, whether data and model integration can be performed or whether temporal evolution can be modeled to implement retriage or represent medication responses. Following the most important criteria we explore current systems and identify some missing features that, if added, may yield to more accurate triage systems.

Abad-Grau, Maria M.; Ierache, Jorge; Cervino, Claudio; Sebastiani, Paola

2008-01-01

304

Is Manchester (MTS) more than a triage system? A study of its association with mortality and admission to a large Portuguese hospital  

Microsoft Academic Search

Background:The Manchester Triage System (MTS) is a 5-point triage scale used to triage patients presenting to the emergency department. It was introduced in the UK in 1996 and is now widespread, especially in Europe, and has been in use in our hospital since 2000 via a computerised protocol. A study was undertaken to determine whether the subgroups created by the

H M G Martins; L M De Castro Dominguez Cuña; P Freitas

2009-01-01

305

Resident-Initiated Advanced Triage Effect on Emergency Department Patient Flow.  

PubMed

BACKGROUND: Emergency Department (ED) overcrowding is a national problem. Initiating orders in triage has been shown to decrease length of stay (LOS), however, nurse, physician assistant, and attending physician advanced triage have all been criticized. STUDY OBJECTIVES: Our primary objective was to show that Emergency Medicine resident-initiated advanced triage shortens patient LOS. Our secondary objective was to evaluate whether or not resident triage decreases the number of patients who left prior to medical screening (LPTMS). METHODS: This prospective interventional study was performed in a 42-bed, Level III trauma center, academic ED in the United States, with an annual census of approximately 41,000 patients. A junior or senior Emergency Medicine resident initiated orders on 16 weekdays for 6 h daily on patients presenting to triage. Patients evaluated during the 6-h period on other weekdays served as the control. The study was powered to detect a reduction in LOS of 45 min. Multivariable median regression was used to compare length of stay and Fisher's exact test to compare proportions. RESULTS: There were 1346 patients evaluated in the ED during the intervention time. Regression analysis showed a 37-min decrease in median LOS for patients on intervention days as compared to control days (p = 0.02). The proportion of patients who LPTMS was not statistically different (p = 0.7) for intervention days (96/1346, 7.13%) compared to control days (136/1810, 7.51%). CONCLUSIONS: Resident-initiated advanced triage is an effective method to decrease patient LOS, however, our effect size is smaller than predicted and did not significantly affect the percent of patients leaving before medical screening. PMID:23777776

Svirsky, Irina; Stoneking, Lisa R; Grall, Kristi; Berkman, Matthew; Stolz, Uwe; Shirazi, Farshad

2013-06-15

306

Benefits of multidisciplinary collaboration for earthquake casualty estimation models: recent case studies  

NASA Astrophysics Data System (ADS)

Earthquake casualty loss estimation, which depends primarily on building-specific casualty rates, has long suffered from a lack of cross-disciplinary collaboration in post-earthquake data gathering. An increase in our understanding of what contributes to casualties in earthquakes involve coordinated data-gathering efforts amongst disciplines; these are essential for improved global casualty estimation models. It is evident from examining past casualty loss models and reviewing field data collected from recent events, that generalized casualty rates cannot be applied globally for different building types, even within individual countries. For a particular structure type, regional and topographic building design effects, combined with variable material and workmanship quality all contribute to this multi-variant outcome. In addition, social factors affect building-specific casualty rates, including social status and education levels, and human behaviors in general, in that they modify egress and survivability rates. Without considering complex physical pathways, loss models purely based on historic casualty data, or even worse, rates derived from other countries, will be of very limited value. What’s more, as the world’s population, housing stock, and living and cultural environments change, methods of loss modeling must accommodate these variables, especially when considering casualties. To truly take advantage of observed earthquake losses, not only do damage surveys need better coordination of international and national reconnaissance teams, but these teams must integrate difference areas of expertise including engineering, public health and medicine. Research is needed to find methods to achieve consistent and practical ways of collecting and modeling casualties in earthquakes. International collaboration will also be necessary to transfer such expertise and resources to the communities in the cities which most need it. Coupling the theories and findings from the field surveys with experiments would also be advantageous as it is not always be possible to validate theories and models with actual earthquake data. In addition, colleagues in other disciplines will benefit from being introduced to the loss algorithms, methodologies and advances familiar to the engineering community, to help dissemination in earthquake mitigation and preparedness programs. It follows that new approaches to loss estimation must include a progressive assessment of what contributes to the final casualty value. In analyzing recent earthquakes, testing common hypotheses, talking to local and international researchers in the field, interviewing search and rescue and medical personnel, and comparing notes with colleagues who have visited other events, the author has developed a list of contributory factors to formulate fatality rates for use in earthquake loss estimation models. In this presentation, we will first look at the current state of data collection and assessment in casualty loss estimation. Then, the analyses of recent earthquake field data, which provide important insights to the contributory factors of fatalities in earthquakes, will be explored. The benefits of a multi-disciplinary approach in deriving fatality rates for masonry buildings will then be examined in detail.

So, E.

2010-12-01

307

How Norwegian casualty clinics handle contacts related to mental illness: A prospective observational study  

PubMed Central

Background Low-threshold and out-of-hours services play an important role in the emergency care for people with mental illness. In Norway casualty clinic doctors are responsible for a substantial share of acute referrals to psychiatric wards. This study’s aim was to identify patients contacting the casualty clinic for mental illness related problems and study interventions and diagnoses. Methods At four Norwegian casualty clinics information on treatment, diagnoses and referral were retrieved from the medical records of patients judged by doctors to present problems related to mental illness including substance misuse. Also, routine information and relation to mental illness were gathered for all consecutive contacts to the casualty clinics. Results In the initial contacts to the casualty clinics (n?=?28527) a relation to mental illness was reported in 2.5% of contacts, whereas the corresponding proportion in the doctor registered consultations, home-visits and emergency call-outs (n?=?9487) was 9.3%. Compared to other contacts, mental illness contacts were relatively more urgent and more frequent during night time. Common interventions were advice from a nurse, laboratory testing, prescriptions and minor surgical treatment. A third of patients in contact with doctors were referred to in-patient treatment, mostly non-psychiatric wards. Many patients were not given diagnoses signalling mental problems. When police was involved, they often presented the patient for examination. Conclusions Most mental illness related contacts are managed in Norwegian casualty clinics without referral to in-patient care. The patients benefit from a wide range of interventions, of which psychiatric admission is only one.

2012-01-01

308

46 CFR 35.15-1 - Notice and reporting of casualty and voyage records-TB/ALL.  

Code of Federal Regulations, 2012 CFR

... false Notice and reporting of casualty and voyage records-TB/ALL. 35.15-1 Section 35.15-1 Shipping COAST...15-1 Notice and reporting of casualty and voyage recordsâTB/ALL. The requirements for providing notice and...

2012-10-01

309

14 CFR Appendix D to Part 420 - Impact Dispersion Areas and Casualty Expectancy Estimate for an Unguided Suborbital Launch Vehicle  

Code of Federal Regulations, 2010 CFR

...2009-01-01 2009-01-01 false Impact Dispersion Areas and Casualty Expectancy Estimate...D Appendix D to Part 420âImpact Dispersion Areas and Casualty Expectancy Estimate...overflight exclusion zone and impact dispersion areas, and how to evaluate...

2009-01-01

310

14 CFR Appendix D to Part 420 - Impact Dispersion Areas and Casualty Expectancy Estimate for an Unguided Suborbital Launch Vehicle  

Code of Federal Regulations, 2010 CFR

...2010-01-01 2010-01-01 false Impact Dispersion Areas and Casualty Expectancy Estimate...D Appendix D to Part 420âImpact Dispersion Areas and Casualty Expectancy Estimate...overflight exclusion zone and impact dispersion areas, and how to evaluate...

2010-01-01

311

Casualties, Public Opinion and U.S. Military Intervention. Implications for U.S. Regional Deterrence Strategies.  

National Technical Information Service (NTIS)

A view commonly held by America's military and political leaders as well as by America's potential adversaries is that the U.S. public is particularly sensitive to casualties and that, if met with a great number of casualties in a regional military interv...

B. C. Schwarz

1994-01-01

312

Quantitative Estimates of the Numbers of Casualties to be Expected due to Major Earthquakes Near Megacities  

NASA Astrophysics Data System (ADS)

Defining casualties as the sum of the fatalities plus injured, we use their mean number, as calculated by QUAKELOSS (developed by Extreme Situations Research Center, Moscow) as a measure of the extent of possible disasters due to earthquakes. Examples of cities we examined include Algiers, Cairo, Istanbul, Mumbai and Teheran, with populations ranging from about 3 to 20 million. With the assumption that the properties of the building stock has not changed with time since 1950, we find that the number of expected casualties will have increased about 5 to 10 fold by the year 2015. This increase is directly proportional to the increase of the population. For the assumed magnitude, we used M7 and M6.5 because shallow earthquakes in this range can occur in the seismogenic layer, without rupturing the surface. This means, they could occur anywhere in a seismically active area, not only along known faults. As a function of epicentral distance the fraction of casualties of the population decrease from about 6% at 20 km, to 3% at 30 km and 0.5% at 50 km, for an earthquake of M7. At 30 km distance, the assumed variation of the properties of the building stock from country to country give rise to variations of 1% to 5% for the estimate of the percent of the population that become casualties. As a function of earthquake size, the expected number of casualties drop by approximately an order of magnitude for an M6.5, compared to an M7, at 30 km distance. Because the computer code and database in QUAKELOSS are calibrated based on about 1000 earthquakes with fatalities, and verified by real-time loss estimates for about 60 cases, these results are probably of the correct order of magnitude. However, the results should not be taken as overly reliable, because (1) the probability calculations of the losses result in uncertainties of about a factor of two, (2) the method has been tested for medium size cities, not for megacities, and (3) many assumptions were made. Nevertheless, it is clear that there are no hospital facilities anywhere that could take care of the injured (3/4 of the total casualties) in any of the scenarios, even if we assume that only 1/4 are heavily injured. Given the enormous numbers of casualties that must be expected, even mitigation measure that could only save a fraction of the casualties would help large numbers of people.

Wyss, M.; Wenzel, F.

2004-12-01

313

Triage for conserving populations of threatened species: The case of woodland caribou in Alberta  

Microsoft Academic Search

Prioritization of conservation efforts for threatened and endangered species has tended to focus on factors measuring the risk of extirpation rather than the probability of success and cost. Approaches such as triage are advisable when three main conditions are present: insufficient capacity exists to adequately treat all patients, patients are in a critical state and cannot wait until additional capacity

Richard R. Schneider; Grant Hauer; Stan Boutin

2010-01-01

314

Software-assisted spine registered nurse care coordination and patient triage--one organization's approach.  

PubMed

Back disorders encompass a spectrum of conditions, from those of acute onset and short duration to lifelong disorders. The use of a traditional spine center model of patient flow, in which the patient is scheduled the first available appointment without an initial assessment of spine-related symptoms at West Virginia University Spine Center, Morgantown, West Virginia, resulted in frustration and delays for the spine patient and referring physician dissatisfaction. Today, the use of a software-assisted spine patient triage and registered nurse care coordinator patient navigation system in this multidiscipline, multimodality comprehensive spine program provides quick and efficient patient triage to the appropriate level of spine care (surgeon vs. nonsurgeon). The model consists of five major steps, which are explored in this article: medical history intake; films or studies retrieval; rapid review of the patient's medical condition and diagnostics by a spine specialist preappointment and subsequent triage to the appropriate level of spine care; registered nurse care coordinator patient education and guided navigation through the patient's preferred treatment plan; and last, diagnostic study, pain injection, and provider scheduling. Patient satisfaction scores, referring physician satisfaction scores, and resultant impact on referral volumes, ancillary utilization, workload productivity, and surgical yield demonstrate that this new approach to patient triage has made significant improvements in efficiency, productivity, and service. PMID:19678508

Crossley, Leslie; Mueller, Lori; Horstman, Patricia

2009-08-01

315

???Disaster management, triage-based wound care, and patient safety: reflections on practice following an earthquake.  

PubMed

??Triage is the process of prioritizing patient care based on need and available resources. Clinicians in wound clinics triage daily because time and resources never seem to be sufficient. The triage concept is taken to an extreme when a disaster strikes--the clinical goal of patient care transforms from the individual patient to providing the greatest good for the greatest number of patients. Situational awareness of system resources is of paramount importance in a disaster. Planning for surge capacity while simultaneously attending to patients who require immediate attention is a must. The recent earthquake in Haiti provided an opportunity to test those skill sets. Scores of clinicians volunteered their time and expertise, elevating wound care to the status of a clinical division. The experience of providing quality wound care despite a myriad of situational limitations suggests that busy wound clinics can learn valuable lessons from the realm of disaster management. The rate of under- and over-triage in wound clinics can be reduced by utilizing commonly collected outcomes and operational data. Patient safety improves when the hierarchy is flattened, communication is open, checklists are used, debriefings are held, and teamwork is encouraged. Reflecting on the working conditions in Haiti, it is clear that patients and clinicians benefit when success is measured by patient outcomes instead of individual accomplishments. PMID:21131698

Ennis, William J

2010-11-01

316

Telephone triage reduces out-of-hours work for country doctors  

Microsoft Academic Search

Objective To report call centre-based telephone triage of after hours calls to a rural medical centre. Method Healthline's automated call logging systems were used to examine calls diverted from Dargaville Medical Cen- tre, and to compare those data with data derived from other rural and urban callers. Results Callers' age, sex and range of symptoms were similar for all groups.

Matthew Cullen; MBBS FRANZCP; McKesson Asia-Pacific; Michelle Branney; Michael Hogan; Lisa Duncan

2003-01-01

317

Making an IMPACT on emergency department flow: improving patient processing assisted by consultant at triage  

Microsoft Academic Search

Objectives: To assess whether initial patient consult by senior clinicians reduces numbers of patients waiting to be seen as an indirect measure of waiting time throughout the emergency department (ED).Methods: An emergency medicine consultant and a senior ED nurse (G or F grade), known as the IMPACT team, staffed the triage area for four periods of four hours per week,

J Terris; P Leman; N O’Connor; R Wood

2004-01-01

318

Triage decisions and outcome among the critically ill at the University Hospital of the West Indies  

Microsoft Academic Search

The worldwide scarcity of intensive care therapy leads to the rationing of this expensive resource. This prospective study investigates the rationing of intensive therapy at the University Hospital of the West Indies (UHWI) by recording triage decisions for intensive care unit (ICU) admission and the impact of these decisions on patient outcome. Between June 2001 and May 2002, all patients

R Augier; IR Hambleton; H Harding

2005-01-01

319

Development of a triage protocol for patients presenting with gastrointestinal hemorrhage: a prospective cohort study  

Microsoft Academic Search

INTRODUCTION: Many patients presenting with acute gastrointestinal hemorrhage (GIH) are admitted to the intensive care unit (ICU) for monitoring. A simple triage protocol based upon validated risk factors could decrease ICU utilization. METHODS: Records of 188 patients admitted with GIH from the emergency department (ED) were reviewed for BLEED criteria (visualized red blood, systolic blood pressure below 100 mm Hg,

Aneesa M Das; Namita Sood; Katherine Hodgin; Lydia Chang; Shannon S Carson

2008-01-01

320

Comprehensive Strategy for the Evaluation and Triage of the Chest Pain Patient  

Microsoft Academic Search

See related editorial, p 168.Study objective: To evaluate the safety and efficacy of a systematic evaluation and triage strategy including immediate resting myocardial perfusion imaging in patients presenting to the emergency department with chest pain of possible ischemic origin. Methods: We conducted an observational study of 1,187 consecutive patients seen in the ED of an urban tertiary care hospital with

James L Tatum; Robert L Jesse; Michael C Kontos; Christopher S Nicholson; Kristin L Schmidt; Charlotte S Roberts; Joseph P Ornato

1997-01-01

321

Reduction in mortality after inappropriate early discharge from intensive care unit: logistic regression triage  

Microsoft Academic Search

Objective To develop a predictive model to triage patients for discharge from intensive care units to reduce mortality after discharge. Design Logistic regression analyses and modelling of data from patients who were discharged from intensive care units. Setting Guy's hospital intensive care unit and 19 other UK intensive care units from 1989 to 1998. Participants 5475 patients for the development

Kathleen Daly; R Beale; R W S Chang

2001-01-01

322

Application of a New Resource-Constrained Triage Method to Military-Age Victims.  

National Technical Information Service (NTIS)

Objective: Evaluate the resource-constrained, evidence-based, and outcome-driven Sacco Triage method (STM) for military-age victims of blunt, penetrating, and blast overpressure-like trauma. Methods: STM is based on a mathematical model of resource-constr...

D. M. Navin G. McGill W. J. Sacco

2009-01-01

323

Triage and treatment tools for use in a scarce resources-crisis standards of care setting after a nuclear detonation.  

PubMed

Based on background information in this special issue of the journal, possible triage recommendations for the first 4 days following a nuclear detonation, when response resources will be limited, are provided. The series includes: modeling for physical infrastructure damage; severity and number of injuries; expected outcome of triage to immediate, delayed, or expectant management; resources required for treating injuries of varying severity; and how resource scarcity (particularly medical personnel) worsens outcome. Four key underlying considerations are: 1.) resource adequacy will vary greatly across the response areas by time and location; 2.) to achieve fairness in resource allocation, a common triage approach is important; 3.) at some times and locations, it will be necessary to change from "conventional" to "contingency" or "crisis" standards of medical care (with a resulting change in triage approach from treating the "sickest first" to treating those "most likely to survive" first); and 4.) clinical reassessment and repeat triage are critical, as resource scarcity worsens or improves. Changing triage order and conserving and allocating resources for both lifesaving and palliative care can maintain fairness, support symptomatic care, and save more lives. Included in this article are printable triage cards that reflect our recommendations. These are not formal guidelines. With new research, data, and discussion, these recommendations will undoubtedly evolve. PMID:21402803

Coleman, C Norman; Weinstock, David M; Casagrande, Rocco; Hick, John L; Bader, Judith L; Chang, Florence; Nemhauser, Jeffrey B; Knebel, Ann R

2011-03-01

324

Implementing an obstetric triage acuity scale: interrater reliability and patient flow analysis.  

PubMed

A 5-category Obstetric Triage Acuity Scale (OTAS) was developed with a comprehensive set of obstetrical determinants. The objectives of this study were as follows: (1) to test the interrater reliability of OTAS and (2) to determine the distribution of patient acuity and flow by OTAS level. To test the interrater reliability, 110 triage charts were used to generate vignettes and the consistency of the OTAS level assigned by 8 triage nurses was measured. OTAS performed with substantial (Kappa, 0.61 - 0.77, OTAS 1-4) and near perfect correlation (0.87, OTAS 5). To assess patient flow, the times to primary and secondary health care provider assessments and lengths of stay stratified by acuity were abstracted from the patient management system. Two-thirds of triage visits were low acuity (OTAS 4, 5). There was a decrease in length of stay (median [interquartile range], minutes) as acuity decreased from OTAS 1 (120.0 [156.0] minutes) to OTAS 3 (75.0 [120.8]). The major contributor to length of stay was time to secondary health care provider assessment and this did not change with acuity. The percentage of patients admitted to the antenatal or birthing unit decreased from 80% (OTAS 1) to 12% (OTAS 5). OTAS provides a reliable assessment of acuity and its implementation has allowed for triaging of obstetric patients based on acuity, and a more in-depth assessment of the patient flow. By standardizing assessment, OTAS allows for opportunities to improve performance and make comparisons of patient care and flow across organizations. PMID:23535239

Smithson, David S; Twohey, Rachel; Rice, Tim; Watts, Nancy; Fernandes, Christopher M; Gratton, Robert J

2013-03-25

325

Deregulating Property-Casualty Insurance Pricing: The Case of Workers' Compensation  

Microsoft Academic Search

Property and casualty lines of insurance have traditionally been subject to more regulatory price control than most goods in the U.S. economy. However, beginning in the 1970s, some states began to deregulate these lines of insurance, either dropping mandatory pricing in concert by means of rating bureaus or, additionally, dropping regulatory prior approval of premiums. This paper assesses the impact

2001-01-01

326

46 CFR 185.210 - Alcohol or drug use by individuals directly involved in casualties.  

Code of Federal Regulations, 2011 CFR

...2011-10-01 2011-10-01 false Alcohol or drug use by individuals directly involved...Casualties and Voyage Records § 185.210 Alcohol or drug use by individuals directly involved...determine whether there is any evidence of alcohol or drug use by individuals directly...

2011-10-01

327

46 CFR 4.05-12 - Alcohol or drug use by individuals directly involved in casualties.  

Code of Federal Regulations, 2012 CFR

...2012-10-01 2012-10-01 false Alcohol or drug use by individuals directly involved...Casualty and Voyage Records § 4.05-12 Alcohol or drug use by individuals directly involved...determine whether there is any evidence of alcohol or drug use by individuals directly...

2012-10-01

328

46 CFR 4.05-12 - Alcohol or drug use by individuals directly involved in casualties.  

Code of Federal Regulations, 2011 CFR

...2011-10-01 2011-10-01 false Alcohol or drug use by individuals directly involved...Casualty and Voyage Records § 4.05-12 Alcohol or drug use by individuals directly involved...determine whether there is any evidence of alcohol or drug use by individuals directly...

2011-10-01

329

46 CFR 122.210 - Alcohol or drug use by individuals directly involved in casualties.  

Code of Federal Regulations, 2012 CFR

...2012-10-01 2012-10-01 false Alcohol or drug use by individuals directly involved...Casualties and Voyage Records § 122.210 Alcohol or drug use by individuals directly involved...determine whether there is any evidence of alcohol or drug use by individuals directly...

2012-10-01

330

46 CFR 185.210 - Alcohol or drug use by individuals directly involved in casualties.  

Code of Federal Regulations, 2012 CFR

...2012-10-01 2012-10-01 false Alcohol or drug use by individuals directly involved...Casualties and Voyage Records § 185.210 Alcohol or drug use by individuals directly involved...determine whether there is any evidence of alcohol or drug use by individuals directly...

2012-10-01

331

OPTIMAL CASUALTY INSURANCE, REPAIR, AND REGULATION IN THE PRESENCE OF A SECURITIES MARKET  

Microsoft Academic Search

Insurance regulation is often based on keeping probabilities of failure small and not on any explicit analysis of economic trade-os. We build a simple economic model of optimal casualty insurance based on a story about insuring a house. This is done in the presence of a securities market that is complete over states distinguished by security payos. We show that

PHILIP H. DYBVIG

332

Gender patterns in minor head and neck injuries: An analysis of casualty register data  

Microsoft Academic Search

This study was designed to determine the age- and gender-specific incidences of moderate and minor head and neck injuries from emergency room casualty registers in two cities in northern Sweden. By contrast with findings in most studies on injuries, the incidence of minor and moderate head and neck injuries was higher among women than men in the 15–17- and the

Gunilla Bring; Ulf Björnstig; Göran Westman

1996-01-01

333

Age, period and cohort effects on the incidence of motorcyclist casualties in traffic crashes  

PubMed Central

Objectives (1) Estimate age, period and cohort effects for motorcyclist traffic casualties 1979–2008 in New Zealand and (2) forecast the incidence of New Zealand motorcycle traffic casualties for the period 2019–2023 assuming future age, cohort and period effects, and compare these with an estimate based on simple linear extrapolation. Methods Age-period-cohort (APC) modelling was used to estimate the individual effects of age, period and cohort after adjusting for the other two factors. Forecasting was produced for three period-effect scenarios. Results After adjusting for cohort and period effects, 15–19-year-olds have substantially elevated risk. The period effect reduced in significance over time until the last period, 2004–2008, where the risk was higher than the preceding period. The 10-year cohorts born 1949–1958, 1954–1963, 1959–1968 and 1964–1973, had elevated risk. The forecasting, based on APC modelling, resulted in the lowest estimates of the future incidence being approximately one-third that of the highest estimate (6641). Conclusion Trends in motorcycle casualties have been influenced by significant independent age, period and cohort effects. These need to be considered in forecasting future casualties. The selection of the period effect has a significant impact on the estimates. Which period-effect scenario readers choose to accept depends on their views about a wide range of factors which might influence motorcycle use and crash risk over time.

Samaranayaka, Ari; Begg, Dorothy J

2013-01-01

334

Civilian Casualties in the Colombian Conflict: A New Approach to Human Security1  

Microsoft Academic Search

We develop a new, quantitative approach to the analysis of human security during armed conflict and apply this methodology to the Colombian conflict, 1988-2003. We consider 21 different attack types (unopposed events) plus clashes between pairs of armed groups. For each event type we determine the number of civilian killings and injuries (casualties), the armed group(s) involved and the population

Jorge Restrepo; Michael Spagat

2004-01-01

335

Eating Order: A 13-Week Trust Model Class for Dieting Casualties  

ERIC Educational Resources Information Center

|Chronic dieting distorts eating behaviors and causes weight escalation. Desperation about losing weight results in pursuit of extreme weight loss measures. Instead of offering yet another diet, nutrition educators can teach chronic dieters (dieting casualties) to develop eating competence. Eating Order, a 13-week class for chronic dieters based…

Jackson, Elizabeth G.

2008-01-01

336

Development of damage and casualty functions for basement shelters. Final report on phase 2  

Microsoft Academic Search

This report describes progress during the second year's work on a Civil Defense program to provide FEMA with a range of damage functions and casualty functions to determine the survivability fo people in various basement shelters. The characteristics of flat and two-way slab systems and the effects of code specified design procedures, engineering practice, and construction procedures were discussed. Non-upgraded

C. Wilton; T. C. Zsutty; A. B. Willoughby

1983-01-01

337

The feasibility of linking hospital and police road crash casualty records without names  

Microsoft Academic Search

Government and other agencies routinely collect complementary information on road crash casualties and there may be opportunities to widen the scope of data available for research and policy evaluation if mechanisms can be established to combine these data sources. Where unit record data are available, direct links within and between individual records can often be achieved using record linkage techniques.

Diana L. Rosman

1996-01-01

338

46 CFR 185.210 - Alcohol or drug use by individuals directly involved in casualties.  

Code of Federal Regulations, 2010 CFR

(a) For each marine casualty required to be reported by § 185.202, the owner, agent, master, or person in charge of the vessel shall determine whether there is any evidence of alcohol or drug use by individuals directly involved in the...

2010-10-01

339

The Battle of Bentonville: Caring for Casualties of the Civil War. Teaching with Historic Places.  

ERIC Educational Resources Information Center

|At the First Battle of Manassas (Virginia) in 1861 many Union doctors fled the battlefield in fear. Those who remained found themselves without adequate medical supplies or ambulances for their patients. As the U.S. Civil War progressed and casualties mounted, military surgeons became more adept at caring for the wounded. By the Battle of…

Goode, John C.; Beck, Elaine

340

Casualties of the War on Crime: Fairness, Reliability and the Credibility of Criminal Justice Systems  

Microsoft Academic Search

Due process of law has become a casualty of the war on crime. As representatives of both parties compete to show which is the toughest on crime, the criminal justice systems in the United States have become so result-oriented that little attention is paid to the fairness and reliability of the process which leads to those results. In the quest

Stephen B. Bright

1997-01-01

341

Comparison of the 1999 and 2006 Trauma Triage Guidelines: Where do Patients Go?  

PubMed Central

In 2006, the CDC released a revised Field Triage Decision Scheme. It is unknown how this modified scheme will affect the number of patients identified by EMS for transport to a trauma center. Objective To determine the change in the number of patients transported by EMS who meet the 2006 scheme, compared to the 1999 scheme, and to determine how the scheme change would affect under- and over-triage rates. Methods EMS providers in charge of care for injured adult patients transported to a regional trauma center in three mid-sized cities were interviewed immediately after completing transport. All injured patients were included, regardless of severity. The interview included patient demographics, vital signs, apparent anatomic injury, and the mechanism of injury. Included patients were then followed through hospital discharge. The 1999 and 2006 scheme criteria were each retrospectively applied to the collected data. The number of patients identified by the two schemes was determined. Patients were considered to have needed a trauma center if they had non-orthopedic surgery within 24 hours, ICU admission, or died. Data were analyzed using descriptive statistics including 95% confidence intervals. Results EMS interviews were conducted for 11,892 patients and outcome data was unavailable for one patient. Average patient age was 48 years; 51% were men. Providers reported bringing 54% of the enrolled patients to the trauma center based on their local trauma protocol. 12% of enrolled patients were identified as needing a trauma center based on medical record review. Use of the 2006 scheme would have resulted in 1,423 fewer patients (12%; 95% CI:11-13%) being identified as needing a trauma center by EMS providers (40%; 95%CI:39-41% versus 28%; 95%CI:27-29%). 1,344 of those patients did not actually need the resources of a trauma center (94%). 78 (6%) of those patients actually needed the resources of a trauma center and would have been under-triaged. Conclusion Use of the 2006 Field Triage Decision Scheme would have resulted in a significant decrease in the number of patients identified as needing the resources of a trauma center. These changes reduced over-triage while causing a small increase in the number of patients who would have been under-triaged.

Lerner, E. Brooke; Shah, Manish N.; Swor, Robert; Cushman, Jeremy T.; Guse, Clare E.; Brasel, Karen; Blatt, Alan; Jurkovich, Gregory J.

2010-01-01

342

Influence mechanism of mass fog on Highway traffic safety  

Microsoft Academic Search

According to statistical analysis of historical data from the meteorological observations of Shanghai-Nanjing Highway, we found a series of features of mass fog. It always happens suddenly after sunrise and changes the visibility by leaps and bounds in a uncertain area. Because of these features, mass fogs often lead to a chain rear-end accidents resulting in many casualties on the

Hu Sitao; Wang Xuemei; Dai Chuchu; Zhu Jing

2011-01-01

343

Effectiveness of a five-level Paediatric Triage System: an analysis of resource utilisation in the emergency department in Taiwan  

PubMed Central

Objectives To examine the effectiveness of a five-level Paediatric Triage and Acuity System (Ped-TTAS) by comparing the reliability of patient prioritisation and resource utilisation with the four-level Paediatric Taiwan Triage System (Ped-TTS) among non-trauma paediatric patients in the emergency department (ED). Methods The study design used was a retrospective longitudinal analysis based on medical chart review and a computer database. Except for a shorter list of complaints and some abnormal vital sign criteria modifications, the structure and triage process for applying Ped-TTAS was similar to that of the Paediatric Canadian Emergency Triage and Acuity Scale. Non-trauma paediatric patients presenting to the ED were triaged by well-trained triage nurses using the four-level Ped-TTS in 2008 and five-level Ped-TTAS in 2010. Hospitalisation rates and medical resource utilisation were analysed by acuity levels between the contrasting study groups. Results There was a significant difference in patient prioritisation between the four-level Ped-TTS and five-level Ped-TTAS. Improved differentiation was observed with the five-level Ped-TTAS in predicting hospitalisation rates and medical costs. Conclusions The five-level Ped-TTAS is better able to discriminate paediatric patients by triage acuity in the ED and is also more precise in predicting resource utilisation. The introduction of a more accurate acuity and triage system for use in paediatric emergency care should provide greater patient safety and more timely utilisation of appropriate ED resources.

Chang, Yu-Che; Ng, Chip-Jin; Wu, Chang-Teng; Chen, Li-Chin; Chen, Jih-Chang; Hsu, Kuang-Hung

2013-01-01

344

Application of a Triage Approach to Peripheral Bone Densitometry Reduces the Requirement for Central DXA but is not Cost Effective  

Microsoft Academic Search

A method proffered for the interpretation of measurements from peripheral dual energy X-ray absorptiometry (pDXA) is a triage\\u000a approach to stratify patients into one of three risk categories; (i) high-treat, (ii) medium-refer for central DXA and (iii)\\u000a low-reassure. The aim of this study was to apply the triage approach to measures from peripheral scanners and risk indices\\u000a and stratify patients

Elizabeth J. Harrison; Judith E. Adams

2006-01-01

345

Predicting admission and mortality with the Emergency Severity Index and the Manchester Triage System: a retrospective observational study  

Microsoft Academic Search

Objective:To compare the degree to which the Emergency Severity Index (ESI) and the Manchester Triage System (MTS) predict admission and mortality.Methods:A retrospective observational study of four emergency department (ED) databases was conducted. Patients who presented to the ED between 1 January and 18 July 2006 and were triaged with the ESI or MTS were included in the study.Results:37 974 patients

I van der Wulp; A J P Schrijvers; H F van Stel

2009-01-01

346

The association between deprivation levels, attendance rate and triage category of children attending a children's accident and emergency department  

Microsoft Academic Search

Objective—To determine the relation between deprivation category, triage score and accident and emergency (A&E) attendance for children under the age of 13.Design—Retrospective study of all children attending an A&E department over one year.Setting—A paediatric teaching hospital in Edinburgh.Subjects—All children attending the A&E department who had a postcode and a triage score documented on attendance. The postcode was used to determine

T F Beattie; D R Gorman; J J Walker

2001-01-01

347

Using the OntoGene pipeline for the triage task of BioCreative 2012  

PubMed Central

In this article, we describe the architecture of the OntoGene Relation mining pipeline and its application in the triage task of BioCreative 2012. The aim of the task is to support the triage of abstracts relevant to the process of curation of the Comparative Toxicogenomics Database. We use a conventional information retrieval system (Lucene) to provide a baseline ranking, which we then combine with information provided by our relation mining system, in order to achieve an optimized ranking. Our approach additionally delivers domain entities mentioned in each input document as well as candidate relationships, both ranked according to a confidence score computed by the system. This information is presented to the user through an advanced interface aimed at supporting the process of interactive curation. Thanks, in particular, to the high-quality entity recognition, the OntoGene system achieved the best overall results in the task.

Rinaldi, Fabio; Clematide, Simon; Hafner, Simon; Schneider, Gerold; Grigonyte, Gintare; Romacker, Martin; Vachon, Therese

2013-01-01

348

Combat Casualties in Afghanistan Cared for by a Single Forward Surgical Team during the Initial Phases of Operation Enduring Freedom.  

National Technical Information Service (NTIS)

Background: The 274th Forward Surgical Team (FST) was the first FST deployed to Bagram, Afghanistan, to provide surgical care for combat casualties during the initial phases of Operation Enduring Freedom. This is an analysis of the distribution, cause, an...

B. Burlingame G. E. Peoples R. Craig T. Gerlinger

2005-01-01

349

Survey and Analysis of the Heat Casualty Prevention Experiment for Resphiblex 1-81, Operation 'Lancer Eagle', 43D, MAU.  

National Technical Information Service (NTIS)

This report describes the results of a heat casualty prevention experiment conducted in cooperation with reserve elements of the 43D Marine Amphibious Unit, during a training exercise, Operation Lancer Eagle, which took place at Little Creek, VA and Camp ...

R. W. Hubbard W. Matthew D. Wright

1982-01-01

350

Physiologic Waveform Analysis for Early Detection of Hemorrhage during Transport and Higher Echelon Medical Care of Combat Casualties.  

National Technical Information Service (NTIS)

Early detection of hemorrhage is crucial for managing combat casualties. However, mean arterial blood pressure (ABP) and other vital signs are late indicators of a bleed. By contrast, cardiac output (CO), stroke volume (SV), ventricular end-diastolic volu...

R. Mukkamala

2012-01-01

351

Physiologic Waveform Analysis for Early Detection of Hemorrhage during Transport and Higher Echelon Medical Care of Combat Casualties.  

National Technical Information Service (NTIS)

Early detection of hemorrhage is crucial for managing combat casualties. However, mean arterial blood pressure (ABP) and other vital signs are late indicators of a bleed. By contrast, cardiac stroke volume (SV), cardiac end-diastolic volume (EDV), and aut...

R. Mukkamala

2011-01-01

352

Effect of Recombinant Activated Factor VII on Mortality in Combat- Related Casualties With Severe Trauma and Massive Transfusion.  

National Technical Information Service (NTIS)

Background: The majority of patients with potentially survivable combat-related injuries die from hemorrhage. Our objective was to determine whether the use of recombinant activated factor VII (rFVIIa) decreased mortality in combat casualties with severe ...

D. F. McLaughlin J. G. Perkins K. W. Grathwohl P. C. Spinella S. E. Niles

2008-01-01

353

Triage of medical or social issues through preoperative and postoperative telephone calls by primary nurses  

Microsoft Academic Search

A preoperative telephone call from a primary nurse decreases patient's anxiety and allows a medium for triaging medical and\\/or social issues which could adversely affect patients and\\/or cause costly delays in operating room start times. This telephone call also establishes a bond with the patient, which continues throughout the patient's hospitalization.The postoperative telephone call by a primary nurse enables the

Christine Evans Wachter

1995-01-01

354

Computerized telephone nurse triage. An evaluation of service quality and cost.  

PubMed

The current reimbursement structure of health care in the United States motivates the providers of health care services to deliver these services with a cost-conscious mentality without compromising quality. This has led to the development of alternative methods of delivering health care services, one of which is computerized telephone nurse triage. This study investigates service quality from the perception of callers who used this system on behalf of a pediatric client. Cost was evaluated by comparing what the caller would have done if they did not speak with nurse triage with what they actually did after their interaction. A modified version of the SERVQUAL tool was administered via telephone survey to members of a managed health care plan who recently used nurse triage services for a pediatric patient. Findings were that the majority of callers--employed female parents--rated the level of service quality very highly. Education, employment status, age of the caller, child gender, birth order among siblings, and age of child did not affect the rating of service quality. Relationship to the child had an effect on the rating of service quality as men/fathers rated the level of service quality slightly lower than their female/mother counterparts. The evaluation of cost revealed that the action taken by the caller after they spoke with the nurse resulted in significant cost savings. Computerized telephone nurse triage is a well-accepted cost-saving alternative method of health care delivery that can effectively serve a variety of callers and pediatric patients. PMID:12698927

Cariello, Francesca P

355

Telephone Triage Service Data for Detection of Influenza-Like Illness  

Microsoft Academic Search

BackgroundSurveillance for influenza and influenza-like illness (ILI) is important for guiding public health prevention programs to mitigate the morbidity and mortality caused by influenza, including pandemic influenza. Nontraditional sources of data for influenza and ILI surveillance are of interest to public health authorities if their validity can be established.Methods\\/Principal FindingsNational telephone triage call data were collected through automated means for

W. Katherine Yih; Kathryn S. Teates; Allyson Abrams; Ken Kleinman; Martin Kulldorff; Robert Pinner; Robert Harmon; Stanley Wang; Richard Platt; Joel Mark Montgomery

2009-01-01

356

3q26 Amplification Is an Effective Negative Triage Test for LSIL: A Historical Prospective Study  

PubMed Central

Background Women with low grade squamous intraepithelial lesions (LSIL) at cervical cancer screening are currently referred for further diagnostic work up despite 80% having no precancerous lesion. The primary purpose of this study is to measure the test characteristics of 3q26 chromosome gain (3q26 gain) as a host marker of carcinogenesis in women with LSIL. A negative triage test may allow these women to be followed by cytology alone without immediate referral to colposcopy. Methods and Findings A historical prospective study was designed to measure 3q26 gain from the archived liquid cytology specimens diagnosed as LSIL among women attending colposcopy between 2007 and 2009. 3q26 gain was assessed on the index liquid sample; and sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were measured at immediate triage and at 6–16 months after colposcopic biopsy. The sensitivity of 3q26 gain measured at immediate triage from automated and manually reviewed tests in 65 non-pregnant unique women was 70% (95% CI: 35, 93) with a NPV of 89% (95% CI: 78, 96). The sensitivity and NPV increased to 80% (95% CI: 28, 99) and 98% (95% CI: 87, 100), respectively, when only the automated method of detecting 3q26 gain was used. Conclusions 3q26 gain demonstrates high sensitivity and NPV as a negative triage test for women with LSIL, allowing possible guideline changes to routine surveillance instead of immediate colposcopy. Prospective studies are ongoing to establish the sensitivity, specificity, PPV and NPV of 3q26 gain for LSIL over time.

Heitmann, Erica R.; Lankachandra, Kamani M.; Wall, Jeff; Harris, George D.; McKinney, Hollie J.; Jalali, G. Reza; Verma, Yogita; Kershnar, Eric; Kilpatrick, Michael W.; Tsipouras, Petros; Harper, Diane M.

2012-01-01

357

Prospective evaluation of the MET-AP system providing triage plans for acute pediatric abdominal pain  

Microsoft Academic Search

BackgroundChildren with acute abdominal pain (AP) are frequently assessed in the Emergency Department (ED). Though the majority of patients have benign causes, uncertainty during the physician's initial assessment may result in unnecessary tests and prolonged observation before a definitive disposition decision can be made. A rule-based mobile clinical decision support system, Mobile Emergency Triage-Abdominal Pain (MET-AP), has been developed to

Ken J. Farion; Wojtek Michalowski; Steven Rubin; Szymon Wilk; Rhonda Correll; Isabelle Gaboury

2008-01-01

358

Predictive Value of Initial Triage Vital Signs for Critically Ill Older Adults  

PubMed Central

Introduction: Triage of patients is critical to patient safety, yet no clear information exists as to the utility of initial vital signs in identifying critically ill older emergency department (ED) patients. The objective of this study is to evaluate a set of initial vital sign thresholds as predictors of severe illness and injury among older adults presenting to the ED. Methods: We reviewed all visits by patients aged 75 and older seen during 2007 at an academic ED serving a large community of older adults. Patients’ charts were abstracted for demographic and clinical information including vital signs, via automated electronic methods. We used bivariate analysis to investigate the relationship between vital sign abnormalities and severe illness or injury, defined as intensive care unit (ICU) admission or ED death. In addition, we calculated likelihood ratios for normal and abnormal vital signs in predicting severe illness or injury. Results: 4,873 visits by patients aged 75 and above were made to the ED during 2007, and of these 3,848 had a complete set of triage vital signs. For these elderly patients, the sensitivity and specificity of an abnormal vital sign taken at triage for predicting death or admission to an ICU were 73% (66,81) and 50% (48,52) respectively (positive likelihood ratio 1.47 (1.30,1.60); negative likelihood ratio 0.54 (0.30,0.60). Conclusion: Emergency provider assessment and triage scores that rely primarily on initial vital signs are likely to miss a substantial portion of critically ill older adults.

LaMantia, Michael A.; Stewart, Paul W.; Platts-Mills, Timothy F.; Biese, Kevin J.; Forbach, Cory; Zamora, Ezequiel; McCall, Brenda K.; Shofer, Frances S.; Cairns, Charles B.; Busby-Whitehead, Jan; Kizer, John S.

2013-01-01

359

After-hours paediatric telephone triage and advice: the Neuchâtel experience  

Microsoft Academic Search

Delivery of paediatric primary care by call centres has emerged as a satisfactory system. It has been reported in the literature in the United States and Australia. European public-funded paediatric emergency departments (ED) have little epidemiological data to rely on to match the demand in care. Since 1996, we have run a free nurse-led after-hours paediatric telephone triage and advice

Sybil Bolli; Guy Van Melle; Bernard Laubscher

2005-01-01

360

Identifying workload and types of admissions in an obstetric triage department  

Microsoft Academic Search

IntroductionRoyal College of Obstetricians and Gynaecologists recommendations are that every pregnant woman attending A&E for other than minor injuries should be seen by a midwife or obstetrician. In the UK, obstetric departments are frequently isolated from A&E. Consequently, in the last decade obstetric triage departments (OTDs) have developed. The only published literature on OTDs comes from the US where roles

RA Samangaya; MK Whitworth; J Mason; A Brockbank; J Gillham

2010-01-01

361

Manchester triage system version II and resource utilisation in emergency department.  

PubMed

Emergency department (ED) triage systems aim to direct the best clinical assistance to those who are in the greatest urgency and guarantee that resources are efficiently applied.The study's purpose was to determine whether the Manchester Triage System (MTS) second version is a useful instrument for determining the risk of hospital admission, intrahospital death and resource utilisation in ED and to compare it with the MTS first version.This was a prospective study of patients that attended the ED at a large hospital. It comprised a total of 25 218 cases that were triaged between 11 July and 13 October 2011. The MTS codes were grouped into two clusters: red and orange into a 'high acuity/priority' (HP) cluster, and yellow, green and blue into a 'low acuity/priority' cluster.The risk of hospital admission in the HP cluster was 4.86 times that of the LP cluster for both admission route and ages. The percentage of patient hospital admission between medical and surgical specialties, in high and low priority clusters, was similar. We found the risk of death in the HP cluster to be 5.58 times that of the risk of the low acuity/priority cluster. The MTS had an inconsistent association relative to the utilisation of x-ray, while it seemed to portray a consistent association between ECG and laboratory utilisation and MTS cluster.There were no differences between medical and surgical specialities risk of admission. This suggests that improvements were made in the second version of MTS, particularly in the discriminators of patients triaged to surgical specialties, because this was not true for the first version of MTS. PMID:23345313

Santos, André Peralta; Freitas, Paulo; Martins, Henrique Manuel Gil

2013-01-23

362

Sources of non-compliance with clinical practice guidelines in trauma triage: a decision science study  

PubMed Central

Background United States trauma system guidelines specify when to triage patients to specialty centers. Nonetheless, many eligible patients are not transferred as per guidelines. One possible reason is emergency physician decision-making. The objective of the study was to characterize sensory and decisional determinants of emergency physician trauma triage decision-making. Methods We conducted a decision science study using a signal detection theory-informed approach to analyze physician responses to a web-based survey of 30 clinical vignettes of trauma cases. We recruited a national convenience sample of emergency medicine physicians who worked at hospitals without level I/II trauma center certification. Using trauma triage guidelines as our reference standard, we estimated physicians’ perceptual sensitivity (ability to discriminate between patients who did and did not meet guidelines for transfer) and decisional threshold (tolerance for false positive or false negative decisions). Results We recruited 280 physicians: 210 logged in to the website (response rate 74%) and 168 (80%) completed the survey. The regression coefficient on American College of Surgeons – Committee on Trauma (ACS-COT) guidelines for transfer (perceptual sensitivity) was 0.77 (p<0.01, 95% CI 0.68 – 0.87) indicating that the probability of transfer weakly increased as the ACS-COT guidelines would recommend transfer. The intercept (decision threshold) was 1.45 (p<0.01, 95% CI 1.27 – 1.63), indicating that participants had a conservative threshold for transfer, erring on the side of not transferring patients. There was significant between-physician variability in perceptual sensitivity and decisional thresholds. No physician demographic characteristics correlated with perceptual sensitivity, but men and physicians working at non-trauma centers without a trauma-center affiliation had higher decisional thresholds. Conclusions On a case vignette-based questionnaire, both sensory and decisional elements in emergency physicians’ cognitive processes contributed to the under-triage of trauma patients.

2012-01-01

363

“Canada’s Roll of Honour”: Controversy over Casualty Notification and Publication During the Second World War  

Microsoft Academic Search

During the Second World War, the Canadian Army’s announcement of casualties to next–of–kin and the press often caused controversy. Even though the army tried to notify the family and public as quickly as possible, it could not always do so. Unofficial communications with the family, procedural failures, and more frequently press and censorship errors, cause occasional mistakes in casualty reporting.

Timothy Balzer

2012-01-01

364

Clinical management of casualties exposed to lung damaging agents: a critical review  

PubMed Central

There is no specific antidote for the treatment of casualties exposed to chlorine, phosgene, or mustards; therefore, management is largely supportive. Corticosteroid treatment has been given to casualties accidentally exposed to chlorine. Clinical data on efficacy are inconclusive as the numbers given steroids have been small and the indications for administration unclear. There have been no clinical controlled studies. There is a stronger evidence base from animal studies, particularly from porcine and rodent models. Lung injury induced by phosgene and mustard appears to be mediated by glutathione depletion, lipid peroxidation, free radical generation, and subsequent cellular toxicity. There is limited evidence to suggest that repletion of glutathione reduces and/or prevents lung damage by these agents. This may provide an opportunity for therapeutic intervention.

Russell, D; Blaine, P G; Rice, P

2006-01-01

365

Web based tool for resource allocation in multiple mass casualty incidents.  

PubMed

In this paper we introduce a web based real time resource allocation tool that can assist the incident commanders and resource managers in the complex task of resource allocation and transportation for multiple simultaneous incidents that occur in close geographical proximity. The tool takes real time inputs like the location of emergency sites and damaged routes from Google Maps, generates an optimal transportation plan so that emergency sites with highest priorities for a resource are assigned the resources in the least amount of time. The optimal solution is presented graphically using Google Maps. Our solution can be used for emergency resource allocation at both the initial response stage and later stages. PMID:19964011

Inampudi, Venkata S; Ganz, Aura

2009-01-01

366

The debate on the potential for mass?casualty terrorism: The challenge to us security  

Microsoft Academic Search

The United States of America, the world's only superpower, is increasingly endangered by terrorism because of the rise of fanatical groups dedicated to the total annihilation of those they see as their enemies. Their opportunity arises from the growing availability, for example, of biological weapons, or of nuclear materials from the former Soviet Union. This work explores several hypothetical threat?vignette

Joseph W. Foxell Jr

1999-01-01

367

77 FR 52746 - Medical Countermeasures for a Burn Mass Casualty Incident  

Federal Register 2010, 2011, 2012, 2013

...poster session. FDA has identified general topics in this document. FDA will do its best...on all aspects of the public workshop topics. The deadline for submitting comments...addition, when responding to specific topics as outlined in section II of this...

2012-08-30

368

EARLY BIODOSIMETRY RESPONSE: RECOMMENDATIONS FOR MASS-CASUALTY RADIATION ACCIDENTS AND TERRORISM  

Microsoft Academic Search

The accepted generic multiparameter and early-response approach includes measuring radioactivity and monitoring the exposed individual; observing and recording prodromal signs\\/symptoms and erythema; obtaining complete blood counts with white-blood-cell differential; sampling blood for the chromosome-aberration cytogenetic bioassay using the \\

W. F. Blakely

369

Radiation Injury Treatment Network (RITN): Healthcare professionals preparing for a mass casualty radiological or nuclear incident  

PubMed Central

Purpose To describe the history, composition, and activities of the Radiation Injury Treatment Network (RITN). The Radiation Injury Treatment Network® is a cooperative effort of the National Marrow Donor Program and the American Society for Blood and Marrow Transplantation. The goals of RITN are to educate hematologists, oncologists, and stem cell transplant practitioners about their potential involvement in the response to a radiation incident and provide treatment expertise. Injuries to the marrow system readily occur when a victim is exposed to ionising radiation. This focus therefore leverages the expertise of these specialists who are accustomed to providing the intensive supportive care required by patients with a suppressed marrow function. Following a radiological incident, RITN centres may be asked to: Accept patient transfers to their institutions; provide treatment expertise to practitioners caring for victims at other centres; travel to other centres to provide medical expertise; or provide data on victims treated at their centres. Moving forward, it is crucial that we develop a coordinated interdisciplinary approach in planning for and responding to radiological and nuclear incidents. The ongoing efforts of radiation biologists, radiation oncologists, and health physicists can and should complement the efforts of RITN and government agencies. Conclusion RITN serves as a vital partner in preparedness and response efforts for potential radiological and nuclear incidents.

ROSS, JOEL R.; CASE, CULLEN; CONFER, DENNIS; WEISDORF, DANIEL J.; WEINSTOCK, DAVID; KRAWISZ, ROBERT; CHUTE, JOHN; WILHAUK, JULIE; NAVARRO, WILLIS; HARTZMAN, ROBERT; COLEMAN, C. NORMAN; HATCHETT, RICHARD; CHAO, NELSON

2011-01-01

370

Online screening for distress, the 6th vital sign, in newly diagnosed oncology outpatients: randomised controlled trial of computerised vs personalised triage  

PubMed Central

Background: This randomised controlled trial examined the impact of screening for distress followed by two different triage methods on clinically relevant outcomes over a 12-month period. Methods: Newly diagnosed patients attending a large tertiary cancer centre were randomised to one of the two conditions: (1) screening with computerised triage or (2) screening with personalised triage, both following standardised clinical triage algorithms. Patients completed the Distress Thermometer, Pain and Fatigue Thermometers, the Psychological Screen for Cancer (PSSCAN) Part C and questions on resource utilisation at baseline, 3, 6 and 12 months. Results: In all, 3133 patients provided baseline data (67% of new patients); with 1709 (54.5%) retained at 12 months (15.4% deceased). Mixed effects models revealed that both groups experienced significant decreases in distress, anxiety, depression, pain and fatigue over time. People receiving personalised triage and people reporting higher symptom burden were more likely to access services, which was subsequently related to greater decreases in distress, anxiety and depression. Women may benefit more from personalised triage, whereas men may benefit more from a computerised triage model. Conclusion: Screening for distress is a viable intervention that has the potential to decrease symptom burden up to 12?months post diagnosis. The best model of screening may be to incorporate personalised triage for patients indicating high levels of depression and anxiety while providing computerised triage for others.

Carlson, L E; Waller, A; Groff, S L; Zhong, L; Bultz, B D

2012-01-01

371

Fluctuations of Lightning Casualties in the United States: 1959-1990.  

NASA Astrophysics Data System (ADS)

Long-term fluctuations in the number of lightning deaths and injuries from 1959 to 1990 have been examined for the contiguous United States. After taking into account the population increase, there was an overall trend amounting to a 30% reduction in casualties during the period. It is possible that this trend resulted from improved forecasts and warnings, increased education efforts of the public, and socioeconomic changes.In addition, there was a 40% reduction in the number of deaths but not of nonfatal injuries. This additional reduction in deaths was probably due to improved medical attention given to lightning victims and a wider knowledge of cardiopulmonary resuscitation techniques among the public. Improved medical care would increase the chances of a person surviving a lightning strike but would not affect the total number of casualties.Superimposed on the overall downward trend there were fluctuations of one or two decades in duration. From 1959 until 1968 there was a sharp reduction in the number of casualties, but starting in 1969 and continuing until the present, there was an overall increase. These oscillations appear to be climatologically related. The patterns of these fluctuations were parallel to nationwide changes in thunder-day frequencies, cyclone frequencies, and surface temperature values, representing thunderstorm, synoptic, and continental scales.

López, Raúl E.; Holle, Ronald L.

1996-03-01

372

The Casualty Assistance Readiness Enhancement System: A Case Study in Rapid Prototyping and Design for Flexibility  

NASA Astrophysics Data System (ADS)

Numerous government benefits are available to the surviving family of fallen U.S. military service members. Unfortunately, most of these entitlements require a considerable amount of paperwork to process correctly, necessitating a great deal of patience, attention to detail, and composure from families at a time when their grief is raw. Even though the U.S. Army appoints a Casualty Assistance Officer (CAO) to help surviving family members through this process, the soldiers serving as CAOs tend to be inexperienced and oftentimes find themselves challenged to provide accurate and thorough assistance. Consequently, some families do not receive all benefits in a timely manner, and some entitlements may be overlooked entirely. To help with the military's Casualty Program, we have developed the Casualty Assistance Readiness Enhancement System (CARES), an information system that improves how the Department of the Army cares for military families in arguably their greatest time of need. The tool and associated process reduced the time required to complete forms, reduced the potential for errors on repetitive information, assisted CAOs through the process, and provided electronic copies of completed forms.

Goerger, Simon R.; Wong, Ernest Y.; Henderson, Dale L.; Sperling, Brian K.; Bland, William

373

Casualty Risk Assessment Controlled Re-Entry of EPS - Ariane 5ES - ATV Mission  

NASA Astrophysics Data System (ADS)

To fulfil its mission of compliance check to the French Space Operations Act, CNES has developed ELECTRA© tool in order to estimate casualty risk induced by a space activity (like rocket launch, controlled or un-controlled re-entry on Earth of a space object). This article describes the application of such a tool for the EPS controlled re-entry during the second Ariane 5E/S flight (Johannes Kepler mission has been launched in February 2011). EPS is the Ariane 5E/S upper composite which is de-orbited from a 260 km circular orbit after its main mission (release of the Automated Transfer Vehicle - ATV). After a brief description of the launcher, the ATV-mission and a description of all the failure cases taken into account in the mission design (which leads to "back-up scenarios" into the flight software program), the article will describe the steps which lead to the casualty risk assessment (in case of failure) with ELECTRA©. In particular, the presence on board of two propulsive means of de-orbiting (main engine of EPS, and 4 ACS longitudinal nozzles in case of main engine failure or exhaustion) leads to a low remaining casualty risk.

Arnal, M.-H.; Laine, N.; Aussilhou, C.

2012-01-01

374

Cause of casualty and drinking patterns: an emergency room study of unintentional injuries.  

PubMed

A probability sample of 1494 adult casualty patients sampled in four hospitals in a single Californian county were breathalyzed and interviewed regarding the cause of injury, drinking prior to the injury, quantity and frequency of usual drinking, frequency of drunkenness and prior alcohol-related accidents. In the total sample, 9% were positive on the breathalyzer (4% were at or above 0.10), 17% reported drinking within 6 h prior to the injury, and 29% reported heavy drinking during the last year. Overall, 15% reported a prior alcohol-related accident and this was significantly greater among heavy drinkers than other drinkers. Cause of casualty (fall, cutting/piercing, motor vehicle accident, other collision, fire, other cause) in relation to alcohol consumption variables was analyzed separately in gender- and age-specific categories. Few significant associations were found between drinking variables and individual causes of injury. While these findings may be due to the relatively small number of cases for some causes, as well as to other variables not examined here including severity and type of injury, such baseline exploratory data are important in furthering our understanding of alcohol's involvement in casualty occurrence and point to the need for additional research on alcohol and causes of injury. PMID:8082557

Cherpitel, C J

1994-03-01

375

A Method for Reviewing the Accuracy and Reliability of a Five-Level Triage Process (Canadian Triage and Acuity Scale) in a Community Emergency Department Setting: Building the Crowding Measurement Infrastructure  

PubMed Central

Objectives. Triage data are widely used to evaluate patient flow, disease severity, and emergency department (ED) workload, factors used in ED crowding evaluation and management. We defined an indicator-based methodology that can be easily used to review the accuracy of Canadian Triage and Acuity Scale (CTAS) performance. Methods. A trained nurse reviewer (NR) retrospectively triaged two separate month's ED charts relative to a set of clinical indicators based on CTAS Chief Complaints. Interobserver reliability and accuracy were compared using Kappa and comparative statistics. Results. There were 2838 patients in Trial 1 and 3091 in Trial 2. The rate of inconsistent triage was 14% and 16% (Kappa 0.596 and 0.604). Clinical Indicators “pain scale, chest pain, musculoskeletal injury, respiratory illness, and headache” captured 68% and 62% of visits. Conclusions. We have demonstrated a system to measure the levels of process accuracy and reliability for triage over time. We identified five key clinical indicators which captured over 60% of visits. A simple method for quality review uses a small set of indicators, capturing a majority of cases. Performance consistency and data collection using indicators may be important areas to direct training efforts.

Howlett, Michael K.; Atkinson, Paul R. T.

2012-01-01

376

A systematic review of triage-related interventions to improve patient flow in emergency departments  

PubMed Central

Background Overcrowding in emergency departments is a worldwide problem. A systematic literature review was undertaken to scientifically explore which interventions improve patient flow in emergency departments. Methods A systematic literature search for flow processes in emergency departments was followed by assessment of relevance and methodological quality of each individual study fulfilling the inclusion criteria. Studies were excluded if they did not present data on waiting time, length of stay, patients leaving the emergency department without being seen or other flow parameters based on a nonselected material of patients. Only studies with a control group, either in a randomized controlled trial or in an observational study with historical controls, were included. For each intervention, the level of scientific evidence was rated according to the GRADE system, launched by a WHO-supported working group. Results The interventions were grouped into streaming, fast track, team triage, point-of-care testing (performing laboratory analysis in the emergency department), and nurse-requested x-ray. Thirty-three studies, including over 800,000 patients in total, were included. Scientific evidence on the effect of fast track on waiting time, length of stay, and left without being seen was moderately strong. The effect of team triage on left without being seen was relatively strong, but the evidence for all other interventions was limited or insufficient. Conclusions Introducing fast track for patients with less severe symptoms results in shorter waiting time, shorter length of stay, and fewer patients leaving without being seen. Team triage, with a physician in the team, will probably result in shorter waiting time and shorter length of stay and most likely in fewer patients leaving without being seen. There is only limited scientific evidence that streaming of patients into different tracks, performing laboratory analysis in the emergency department or having nurses to request certain x-rays results in shorter waiting time and length of stay.

2011-01-01

377

The Simple Triage Scoring System (STSS) successfully predicts mortality and critical care resource utilization in H1N1 pandemic flu: a retrospective analysis  

Microsoft Academic Search

INTRODUCTION: Triage protocols are only initiated when it is apparent that resource deficits will occur across a broad geographical area despite efforts to expand or acquire additional capacity. Prior to the pandemic the UK Department of Health (DOH) recommended the use of a staged triage plan incorporating Sepsis-related Organ Failure Assessment (SOFA) developed by the Ontario Ministry of Health to

Kayode A Adeniji; Rebecca Cusack

2011-01-01

378

Triage, not just for the emergency department: a discussion of the appropriate level of care for the transitioning infant.  

PubMed

Determining the appropriate placement for infants experiencing a delay in transition or who require more intensive assessment, monitoring, and nursing care can be a challenge. Not all of these infants need to be admitted to the NICU. Since 1994, we have had a triage program to care for these infants. We define triage as a temporary (12 hours or fewer) level of care for monitoring, assessment, and intervention. This level of care is more intensive than in the newborn nursery, but the infant does not require an immediate NICU admission. Caring for these infants presents challenges in staffing, family-centered care, and reimbursement. This article shares information on the evolution of our triage program, its benefits to infants and their families, and how it is integrated into our NICU practices. PMID:21520683

Allison, Beth Ann; Burcin, Elizabeth

379

Cost-effectiveness evaluation of a home visiting triage program for family planning in Turkey.  

PubMed

Graduate Turkish midwives were trained in triage rules for determining family planning home visit frequency based on risk of couples. In a sample of 542 couples followed for six months, modern contraceptive use increased 22 per cent among high-risk and about 15 per cent among moderate- and low-risk couples. After making assumptions about the fecundity, contraceptive success, and pregnancy complications, the estimated average cost per complication averted was $61 for high-risk, $177 for moderate-risk and $526 for low-risk couples. PMID:112875

Bertera, R L; Green, L W

1979-09-01

380

Improving triage and management of patients with skin cancer: challenges and considerations for the future.  

PubMed

Skin cancer is the most common malignancy in humans, thus representing a major health concern. Because of the increasing attention to skin cancer prevention, there has been a growing workload for dermatology clinics, with patients referred from primary care requiring assessment of suspicious skin tumors. This places a strain on limited specialist resources and can create a paradoxical situation wherein an early diagnosis becomes increasingly difficult for those patients who actually do suffer from skin cancer. The aim of these recommendations is to propose an updated, rational system of triage, involving improved accuracy of diagnosis and more timely management of skin cancer by both general practitioners and dermatologists. PMID:22594896

Argenziano, Giuseppe; Giacomel, Jason; Abramavicus, Alexandre; Pellacani, Giovanni; Longo, Caterina; De Pace, Barbara; Albertini, Giuseppe; Cristofolini, Mario; Zalaudek, Iris

2012-05-01

381

Prediction of Emergent Heart Failure Death by Semi-Quantitative Triage Risk Stratification  

PubMed Central

Objectives Generic triage risk assessments are widely used in the emergency department (ED), but have not been validated for prediction of short-term risk among patients with acute heart failure (HF). Our objective was to evaluate the Canadian Triage Acuity Scale (CTAS) for prediction of early death among HF patients. Methods We included patients presenting with HF to an ED in Ontario from Apr 2003 to Mar 2007. We used the National Ambulatory Care Reporting System and vital statistics databases to examine care and outcomes. Results Among 68,380 patients (76±12 years, 49.4% men), early mortality was stratified with death rates of 9.9%, 1.9%, 0.9%, and 0.5% at 1-day, and 17.2%, 5.9%, 3.8%, and 2.5% at 7-days, for CTAS 1, 2, 3, and 4–5, respectively. Compared to lower acuity (CTAS 4–5) patients, adjusted odds ratios (aOR) for 1-day death were 1.32 (95%CI; 0.93–1.88; p?=?0.12) for CTAS 3, 2.41 (95%CI; 1.71–3.40; p<0.001) for CTAS 2, and highest for CTAS 1: 9.06 (95%CI; 6.28–13.06; p<0.001). Predictors of triage-critical (CTAS 1) status included oxygen saturation <90% (aOR 5.92, 95%CI; 3.09–11.81; p<0.001), respiratory rate >24 breaths/minute (aOR 1.96, 95%CI; 1.05–3.67; p?=?0.034), and arrival by paramedic (aOR 3.52, 95%CI; 1.70–8.02; p?=?0.001). While age/sex-adjusted CTAS score provided good discrimination for ED (c-statistic?=?0.817) and 1-day (c-statistic?=?0.724) death, mortality prediction was improved further after accounting for cardiac and non-cardiac co-morbidities (c-statistics 0.882 and 0.810, respectively; both p<0.001). Conclusions A semi-quantitative triage acuity scale assigned at ED presentation and based largely on respiratory factors predicted emergent death among HF patients.

Van Spall, Harriette G. C.; Atzema, Clare; Schull, Michael J.; Newton, Gary E.; Mak, Susanna; Chong, Alice; Tu, Jack V.; Stukel, Therese A.; Lee, Douglas S.

2011-01-01

382

Physician electrocardiogram reading in the emergency department—Accuracy and effect on triage decisions  

Microsoft Academic Search

Objective:To determine how well physicians in emergency departments read electrocardiographic (ECG) ST-segment and T-wave changes and\\u000a how this affects triage decisions.\\u000a \\u000a Methods:In the emergency departments of six teaching and nonteaching hospitals, the authors prospectively collected physicians’ ECG\\u000a readings and clinical data for 2,320 patients presenting with possible acute cardiac ischemia from 1979 to 1981.\\u000a \\u000a \\u000a \\u000a Results:Compared with electrocardiographers, the study physicians

Robert L. Jayes; Greg C. Larsen; Joni R. Beshansky; Ralph B. D’Agostino; Harry P. Selker

1992-01-01

383

Precision of field triage in patients brought to a trauma centre after introducing trauma team activation guidelines  

PubMed Central

Background Field triage is important for regional trauma systems providing high sensitivity to avoid that severely injured are deprived access to trauma team resuscitation (undertriage), yet high specificity to avoid resource over-utilization (overtriage). Previous informal trauma team activation (TTA) at Ulleval University Hospital (UUH) caused imprecise triage. We have analyzed triage precision after introduction of TTA guidelines. Methods Retrospective analysis of 7 years (2001–07) of prospectively collected trauma registry data for all patients with TTA or severe injury, defined as at least one of the following: Injury Severity Score (ISS) > 15, proximal penetrating injury, admitted ICU > 2 days, transferred intubated to another hospital within 2 days, dead from trauma within 30 days. Interhospital transfers to UUH and patients admitted by non-healthcare personnel were excluded. Overtriage is the fraction of TTA where patients are not severely injured (1-positive predictive value); undertriage is the fraction of severely injured admitted without TTA (1-sensitivity). Results Of the 4 659 patients included in the study, 2 221 (48%) were severely injured. TTA occurred 4 440 times, only 2 002 of which for severely injured (overtriage 55%). Overall undertriage was 10%. Mechanism of injury was TTA criterion in 1 508 cases (34%), of which only 392 were severely injured (overtriage 74%). Paramedic-manned prehospital services provided 66% overtriage and 17% undertriage, anaesthetist-manned services 35% overtriage and 2% undertriage. Falls, high age and admittance by paramedics were significantly associated with undertriage. A Triage-Revised Trauma Score (RTS) < 12 in the emergency department reduced the risk for undertriage compared to RTS = 12 (normal value). Field RTS was documented by anaesthetists in 64% of the patients compared to 33% among paramedics. Patients subject to undertriage had an ISS-adjusted Odds Ratio for 30-day mortality of 2.34 (95% CI 1.6–3.4, p < 0.001) compared to those correctly triaged to TTA. Conclusion Triage precision had not improved after TTA guideline introduction. Anaesthetists perform precise trauma triage, whereas paramedics have potential for improvement. Skewed mission profiles makes comparison of differences in triage precision difficult, but criteria or the use of them may contribute. Massive undertriage among paramedics is of grave concern as patients exposed to undertriage had increased risk of dying.

Rehn, Marius; Eken, Torsten; Kruger, Andreas Jorstad; Steen, Petter Andreas; Skaga, Nils Oddvar; Lossius, Hans Morten

2009-01-01

384

Acculturation, alcohol consumption, and casualties among United States Hispanics in the emergency room.  

PubMed

The association of alcohol consumption and casualties was analyzed among Hispanic emergency room patients to determine whether level of acculturation and accompanying changes in drinking patterns influence risk of alcohol-related injuries. A sample of patients admitted to a county hospital emergency room during a 1-year period was breathalyzed and interviewed (N = 1,102). Of these, 112 identified themselves as Hispanic. Hispanic males were more likely than non-Hispanics to have positive breathalyzer readings, to report drinking prior to the event, and to attribute a causal association of drinking with the event. These findings were most pronounced among those in the moderate and high acculturation groups. PMID:1399165

Cherpitel, C J

1992-09-01

385

Colonization of Libyan civil war casualties with multidrug-resistant bacteria.  

PubMed

In November 2011 51 Libyan war casualties were admitted to the Major Incident Hospital in Utrecht and from there were transferred to 26 other Dutch hospitals. Cultures and clinical data were collected to establish the prevalence of multidrug-resistant (MDR) bacteria in this patient group and to identify the associated risk factors. The prevalence of MDR bacteria was 59% (30/51 patients); extended spectrum ?-lactamase-producing enterobacteriaceae were most common (26/51 patients: 51%). The major risk factor for carriage of MDR bacteria was the presence of open wounds at admission to the Major Incident Hospital. PMID:23413838

Koole, K; Ellerbroek, P M; Lagendijk, R; Leenen, L P H; Ekkelenkamp, M B

2013-02-15

386

Detector photon response and absorbed dose and their applications to rapid triage techniques  

NASA Astrophysics Data System (ADS)

As radiation specialists, one of our primary objectives in the Navy is protecting people and the environment from the effects of ionizing and non-ionizing radiation. Focusing on radiological dispersal devices (RDD) will provide increased personnel protection as well as optimize emergency response assets for the general public. An attack involving an RDD has been of particular concern because it is intended to spread contamination over a wide area and cause massive panic within the general population. A rapid method of triage will be necessary to segregate the unexposed and slightly exposed from those needing immediate medical treatment. Because of the aerosol dispersal of the radioactive material, inhalation of the radioactive material may be the primary exposure route. The primary radionuclides likely to be used in a RDD attack are Co-60, Cs-137, Ir-192, Sr-90 and Am-241. Through the use of a MAX phantom along with a few Simulink MATLAB programs, a good anthropomorphic phantom was created for use in MCNPX simulations that would provide organ doses from internally deposited radionuclides. Ludlum model 44-9 and 44-2 detectors were used to verify the simulated dose from the MCNPX code. Based on the results, acute dose rate limits were developed for emergency response personnel that would assist in patient triage.

Voss, Shannon Prentice

387

[Presentation of ELISA: a new triage algorithm suitable for emergency department].  

PubMed

Emergency departments are frequently overcrowded due to the imbalance between need and availability of care. It results that influx patients should be regulated by using a triage tool located at the entrance area. This process has been in development for almost 15 years.We propose a new algorithm of triage (ELISA or Liège Scale of severity index at admission) based on a five-score level of emergency from U1 (emergent) to U5 (non urgent). Such a stratification of the state of emergency is associated with a time-delay for the first medical contact (immediate to 120 min) and a corresponding track for providing optimal care (emergency care unit, B sector or bed, A sector or ambulatory and waiting room) which together fit the sorting for the right patient to the right resources in the right place at the right time. Our algorithm has a confident efficiency as evidenced by the comparison between initial score of emergency and patient's follow up (intensive care, hospital recovery and discharge). PMID:23342873

Jobe, J; Ghuysen, A; D'Orio, V

2012-12-01

388

A new handbook on triage, monitoring and treatment of people following malevolent use of radiation.  

PubMed

Through the Euratom 6 Framework Programme, the European Commission is co-sponsoring the specific targeted research project "Triage, Monitoring and Treatment-Handbook for management of the public in the event of malevolent use of radiation" (TMT Handbook). The main aim of the project is to produce a handbook for the effective and timely triage, monitoring, and treatment of people exposed to radiation following a malevolent act. The World Health Organization contributed to this project with development of guidelines on medical and public health response. A training course based on the TMT Handbook was developed. It will help to enhance national capacity for planning and response to acts involving the malevolent use of radiation. The course will also provide a platform to identify common challenges and discuss opportunities for harmonizing response strategies throughout the European Union. Focusing on its medical and public health response aspects, this paper introduces the TMT Handbook and its potential applicability not only as practical guidance for end-users but also as a useful tool for education and training. PMID:20445402

del Rosario Pérez, Maria; Carr, Zhanat; Rojas-Palma, Carlos; van der Meer, Klaus; Smith, Karen; Rahola, Tua; Muikku, Maarit; Liland, Astrid; Jaworska, Alicja; Jerstad, Anne

2010-06-01

389

The casualty chain inventory: a new scale for measuring peritraumatic responses: a cross-sectional study  

PubMed Central

Background Peritraumatic psychological- and sensory impressions in victims of civilian accidents are only partly understood. This study scrutinizes the level and duration of perceived psychological threat at scene of injury as well as in hospital (the casualty chain) measured by the Casualty Chain Inventory (CCI). The purpose of the study was to assess and validate the CCI, and to examine the correlations between the new instrument and stress responses measured by the Impact of Event Scale (IES) and the Post-traumatic Stress Scale-10 (PTSS-10) Methods Three hundred and fifteen injured, conscious, hospitalised patients were assessed with a self-report questionnaire. The CCI consists of eight items including sensory impressions and well-known psychological responses to trauma. Results The internal consistency of the CCI was solid (Cronbach's alpha: .83-.85). A factor analysis revealed two components, "perception" and "dissociation". The instrument correlates significantly with the Impact of Event Scale (r = 0.47 - 0.54) and the Posttraumatic Stress Scale-10 (r = 0.32 - 0.50). The explained variance is high both at the scene of injury (61%) and in the hospital (65%). Dissociation and perception either used as a two-factor solution or as a sum score measured in the hospital, gave the strongest prediction for later psychological distress. Conclusions The CCI appears to be a useful screening instrument for, at an early state, identifying patients hospitalized after a physical incident at risk for subsequent psychological distress.

2011-01-01

390

Management of Open Pneumothorax in Tactical Combat Casualty Care: TCCC Guidelines Change 13-02.  

PubMed

During the recent United States Central Command (USCENTCOM) and Joint Trauma System (JTS) assessment of prehospital trauma care in Afghanistan, the deployed director of the Joint Theater Trauma System (JTTS), CAPT Donald R. Bennett, questioned why TCCC recommends treating a nonlethal injury (open pneumothorax) with an intervention (a nonvented chest seal) that could produce a lethal condition (tension pneumothorax). New research from the U.S. Army Institute of Surgical Research (USAISR) has found that, in a model of open pneumothorax treated with a chest seal in which increments of air were added to the pleural space to simulate an air leak from an injured lung, use of a vented chest seal prevented the subsequent development of a tension pneumothorax, whereas use of a nonvented chest seal did not. The updated TCCC Guideline for the battlefield management of open pneumothorax is: ?All open and/ or sucking chest wounds should be treated by immediately applying a vented chest seal to cover the defect. If a vente chest seal is not available, use a non-vented chest seal. Monitor the casualty for the potential development of a subsequent tension pneumothorax. If the casualty develops increasing hypoxia, respiratory distress, or hypotension and a tension pneumothorax is suspected, treat by burping or removing the dressing or by needle decompression.? This recommendation was approved by the required two-thirds majority of the Committee on TCCC in June 2013. PMID:24048995

Butler, Frank K; Dubose, Joseph J; Otten, Edward J; Bennett, Donald R; Gerhardt, Robert T; Kheirabadi, Bijan S; Gross, Kriby R; Cap, Andrew P; Littlejohn, Lanny F; Edgar, Erin P; Shackelford, Stacy A; Blackbourne, Lorne H; Kotwal, Russ S; Holcomb, John B; Bailey, Jeffrey A

2013-01-01

391

Effectiveness of prehospital trauma triage guidelines for the identification of major trauma in elderly motor vehicle crash victims  

Microsoft Academic Search

Introduction: Undertriage of older trauma victims has been a persistent and serious problem. Because of physiologic changes and pre-existing disease, blunt trauma in older persons is often covert. Prehospital trauma triage guidelines developed for use with a general adult population may not be sensitive enough to detect covert injuries in elderly trauma patients. This study examined the sensitivity and specificity

Linda J. Scheetz

2003-01-01

392

A physiotherapy triage assessment service for people with low back disorders: evaluation of short-term outcomes  

PubMed Central

Purpose: To determine the short-term effects of physiotherapy triage assessments on self-reported pain, functioning, and general well-being and quality of life in people with low back-related disorders. Methods: Participants with low back–related complaints were recruited from those referred to a spinal triage assessment program delivered by physiotherapists (PTs). Before undergoing the triage assessment, the participants completed a battery of questionnaires covering a range of sociodemographic, clinical, and psychosocial features. The study used the Numeric Pain Rating Scale (NPRS), the Oswestry Disability Index (ODI), and the Medical Outcomes Survey 36-item short-form version 2 (SF-36v2) to assess self-reported pain, function, and quality of life. Baseline measures and variables were analyzed using a descriptive analysis method (ie, proportions, means, medians). Paired samples t-tests or Wilcoxon matched-pair signed-rank tests were used to analyze the overall group differences between the pretest and posttest outcome measures where appropriate. Results: A total of 108 out of 115 (93.9%) participants completed the posttest survey. The Physical Component Summary of the SF36v2 was the only measure that demonstrated significant improvement (P < 0.001). Conclusion: A spinal triage assessment program delivered by PTs can be viewed as a complex intervention that may have the potential to affect a wide range of patient-related outcomes. Further research is needed to examine the long-term outcomes and explore potential mechanisms of improvement using a biopsychosocial framework.

Bath, Brenna; Pahwa, Punam

2012-01-01

393

Triaging patients with serious head injury: results of a simulation evaluating strategies to bypass hospitals without neurosurgical facilities  

Microsoft Academic Search

Objectives: to inform the debate on whether seriously head-injured adult patients should be transported directly to the regional neurosurgical unit or indirectly after evaluation and stabilisation at the nearest hospital. Design: a simulation model was constructed to compare triage strategies and to identify those that predicted the maximum survivors. In each strategy, an estimate of the patient's condition in the

Matthew D Stevenson; Peter A Oakley; Stephen M Beard; Alan Brennan; Alexandra L Cook

2001-01-01

394

After-Hours Telephone Coverage: The Application of an Area-Wide Telephone Triage and Advice System for Pediatric Practices.  

ERIC Educational Resources Information Center

Examines data from four years of operation of a program to manage after-hours pediatrics calls using specially trained pediatric nurses with standardized protocols to provide triage and advice. Found that over 100,000 calls had been successfully managed without adverse clinical outcomes. Satisfaction among subscribing pediatricians was 100%, and…

Poole, Steven R.; And Others

1993-01-01

395

Mortality among workers exposed to coal tar pitch volatiles and welding emissions: an exercise in epidemiologic triage  

Microsoft Academic Search

The United Automobile Workers International Union has established a system of epidemiologic triage to evaluate patterns of mortality among groups of union members. In response to worker concerns, the Union examined mortality at a metal stamping plant, using a method which linked pension records with the State of Michigan computerized death registry. The observed proportion of malignant neoplasms was nearly

M. Silverstein; N. Maizlish; F. Mirer

1985-01-01

396

Investigating respiratory variation using a forehead reflectance pulse oximeter to identify airway obstruction for automated remote triage  

Microsoft Academic Search

An automated triage system called ARTEMIS has been developed in an effort to improve combat and multicasualty care within the battlefield or disaster zone. The status of airway, breathing, and circulation is critical in these types of situations. This preliminary study uses sleep apnea patients to determine whether certain features can be extracted from the photoplethysmograph of a Nonin® forehead

Janelle M. Chang; Susan P. McGrath; George T. Blike

2005-01-01

397

Nurse telephone triage in out-of-hours GP practice: determinants of independent advice and return consultation  

Microsoft Academic Search

BACKGROUND: Nowadays, nurses play a central role in telephone triage in Dutch out-of-hours primary care. The percentage of calls that is handled through nurse telephone advice alone (NTAA) appears to vary substantially between GP cooperatives. This study aims to explore which determinants are associated with NTAA and with subsequent return consultations to the GP. METHODS: For the ten most frequently

Eric Peter Moll van Charante; Gerben ter Riet; Sara Drost; Loes van der Linden; Niek S Klazinga; Patrick JE Bindels

2006-01-01

398

Predictive values of triage temperature and pulse for antibiotic administration and hospital admission in elderly patients with potential infection  

Microsoft Academic Search

To determine how well triage temperature and pulse abnormalities in elderly patients with potential infections predict antibiotic administration and hospital admission. Data from the National Hospital Ambulatory Care Survey (2001-2002), a sample of US emergency departments, were used. Patients (?65 years) with a reason for visit suggesting potential infection were included. Of 10586 patients 65 years or older, 32% had

Jesse M. Pines; Jane M. Prosser; Worth W. Everett; Munish Goyal

2006-01-01

399

The effect of limited English proficiency on admission rates from a pediatric ED: Stratification by triage acuity  

Microsoft Academic Search

The objectives of this study were to determine the effect of Limited English Proficiency (LEP) visits and acuity status on admission rates from a pediatric ED. A retrospective cohort study was performed using a fully computerized medical record, which includes information on language spoken, triage acuity, and disposition. Data was collected on all patient visits from July 2002 to November

Alexander J. Rogers; Carlos A. Delgado; Harold K. Simon

2004-01-01

400

Polymorphonuclear neutrophil (PMN) recruitment in a 2-front murine injury model: Triage of PMNs to competing stimuli of recruitment  

Microsoft Academic Search

Background: Intensive care unit patients as a group have the highest rate of nosocomial infections, such as pneumonia, urinary tract infections, and wound infections. The triage of polymorphonuclear neutrophils (PMNs) during an acute inflammatory response was investigated to determine if the severity of injury or infection contributes to PMN delivery. Methods: A murine cecal ligation and puncture-induced peritonitis model with

Daniel E Swartz; Andrew J. E Seely; Felicia Huang; Betty Giannias; Nicolas V Christou

2000-01-01

401

Emergency triage assessment for hypoxaemia in neonates and young children in a Kenyan hospital: an observational study  

Microsoft Academic Search

Objective To describe the prevalence of hypoxaemia in children admitted to a hospital in Kenya for the purpose of identifying clinical signs of hypoxaemia for emergency triage assessment, and to test the hypothesis that such signs lead to correct identification of hypoxaemia in children, irrespective of their diagnosis. Methods From 2002 to 2005 we prospectively collected clinical data and pulse

Michael K Mwaniki; D James Nokes; James Ignas; Patrick Munywoki; Mwanajuma Ngama; Kathryn Maitland; James A Berkley

2009-01-01

402

A Framework for Comparative Evaluation of Dosimetric Methods to Triage a Large Population Following a Radiological Event  

PubMed Central

Background To prepare for a possible major radiation disaster involving large numbers of potentially exposed people, it is important to be able to rapidly and accurately triage people for treatment or not, factoring in the likely conditions and available resources. To date, planners have had to create guidelines for triage based on methods for estimating dose that are clinically available and which use evidence extrapolated from unrelated conditions. Current guidelines consequently focus on measuring clinical symptoms (e.g., time-to-vomiting), which may not be subject to the same verification of standard methods and validation processes required for governmental approval processes of new and modified procedures. Biodosimeters under development have not yet been formally approved for this use. Neither set of methods has been tested in settings involving large-scale populations at risk for exposure. Objective To propose a framework for comparative evaluation of methods for such triage and to evaluate biodosimetric methods that are currently recommended and new methods as they are developed. Methods We adapt the NIH model of scientific evaluations and sciences needed for effective translational research to apply to biodosimetry for triaging very large populations following a radiation event. We detail criteria for translating basic science about dosimetry into effective multi-stage triage of large populations and illustrate it by analyzing 3 current guidelines and 3 advanced methods for biodosimetry. Conclusions This framework for evaluating dosimetry in large populations is a useful technique to compare the strengths and weaknesses of different dosimetry methods. It can help policy-makers and planners not only to compare the methods’ strengths and weaknesses for their intended use but also to develop an integrated approach to maximize their effectiveness. It also reveals weaknesses in methods that would benefit from further research and evaluation.

Flood, Ann Barry; Nicolalde, Roberto J.; Demidenko, Eugene; Williams, Benjamin B.; Shapiro, Alla; Wiley, Albert L.; Swartz, Harold M.

2011-01-01

403

Econometric analysis of the changing effects in wind strength and significant wave height on the probability of casualty in shipping  

Microsoft Academic Search

This study uses econometric models to measure the effect of significant wave height and wind strength on the probability of casualty and tests whether these effects changed. While both effects are in particular relevant for stability and strength calculations of vessels, it is also helpful for the development of ship construction standards in general to counteract increased risk resulting from

Sabine Knapp; Shashi Kumar; Yuri Sakurada; Jiajun Shen

2011-01-01

404

Casualties Hypothesis: The Influence of News Media Coverage of U.S. Military Deaths on Public Support for Military Operations.  

National Technical Information Service (NTIS)

The casualties hypothesis is cited in social science literature as a principle consideration of U.S. foreign policy decision makers and military planners when faced with the option of using military force. Its basic premise is that the U.S. public will no...

T. D. Smith

2005-01-01

405

Daily variation in natural disaster casualties: information flows, safety, and opportunity costs in tornado versus hurricane strikes.  

PubMed

Casualties from natural disasters may depend on the day of the week they strike. With data from the Spatial Hazard Events and Losses Database for the United States (SHELDUS), daily variation in hurricane and tornado casualties from 5,043 tornado and 2,455 hurricane time/place events is analyzed. Hurricane forecasts provide at-risk populations with considerable lead time. Such lead time allows strategic behavior in choosing protective measures under hurricane threat; opportunity costs in terms of lost income are higher during weekdays than during weekends. On the other hand, the lead time provided by tornadoes is near zero; hence tornados generate no opportunity costs. Tornado casualties are related to risk information flows, which are higher during workdays than during leisure periods, and are related to sheltering-in-place opportunities, which are better in permanent buildings like businesses and schools. Consistent with theoretical expectations, random effects negative binomial regression results indicate that tornado events occurring on the workdays of Monday through Thursday are significantly less lethal than tornados that occur on weekends. In direct contrast, and also consistent with theory, the expected count of hurricane casualties increases significantly with weekday occurrences. The policy implications of observed daily variation in tornado and hurricane events are considered. PMID:23126406

Zahran, Sammy; Tavani, Daniele; Weiler, Stephan

2012-11-05

406

Advanced Product Development for Combat Casualty Care at the U.S. Army Institute of Surgical Research.  

National Technical Information Service (NTIS)

The Institute of Surgical Research (USAISR) is the U.S. Army s lead research laboratory for improving the care of combat casualties. The Institute follows a rigorous process for analyzing patterns of injury and the burden of disease to determine where res...

D. G. Baer J. C. Wenke L. L. McGhee M. A. Dubick V. A. Convertino

2010-01-01

407

Market Discipline in Property\\/Casualty Insurance: Evidence from Premium Growth Surrounding Changes in Financial Strength Ratings  

Microsoft Academic Search

Analysis of abnormal premium growth surrounding changes in financial strength ratings for a large panel of property\\/casualty insurers generally indicates significant premium declines in the year of and the year following rating downgrades. Consistent with greater risk sensitivity of demand, premium declines were concentrated among commercial insurance, which has narrower guaranty fund protection than personal insurance. Premium declines were greater

Karen Epermanis; Scott E. Harrington

2006-01-01

408

Development of the triage, monitoring and treatment Handbook for Members of the Public Affected by Radiological Terrorism - A European Response  

Microsoft Academic Search

European national emergency response plans have long been focused on accidents at nuclear power plants. Recently, the possible threats by disaffected groups have shifted the focus to being prepared also for malevolent use of radiation that are aimed at creating disruption and panic in the society. The casualties will most likely be members of the public. According to the scenario,

P. Kruse; C. Rojas-Palma

2007-01-01

409

DESIGN AND PRELIMINARY VALIDATION OF A RAPID AUTOMATED BIODOSIMETRY TOOL FOR HIGH THROUGPUT RADIOLOGICAL TRIAGE.  

PubMed

This paper presents design, hardware, software, and parameter optimization for a novel robotic automation system. RABiT is a Rapid Automated Biodosimetry Tool for high throughput radiological triage. The design considerations guiding the hardware and software architecture are presented with focus on methods of communication, ease of implementation, and need for real-time control versus soft time control cycles. The design and parameter determination for a non-contact PVC capillary laser cutting system is presented. A novel approach for lymphocyte concentration estimation based on computer vision is reported. Experimental evaluations of the system components validate the success of our prototype system in achieving a throughput of 6,000 samples in a period of 18 hours. PMID:21258614

Chen, Youhua; Zhang, Jian; Wang, Hongliang; Garty, Guy; Xu, Yanping; Lyulko, Oleksandra V; Turner, Helen C; Randers-Pehrson, Gerhard; Simaan, Nabil; Yao, Y Lawrence; Brenner, D J

2009-01-01

410

Rapid Analytical Methods for On-Site Triage for Traumatic Brain Injury  

NASA Astrophysics Data System (ADS)

Traumatic brain injury (TBI) results from an event that causes rapid acceleration and deceleration of the brain or penetration of the skull with an object. Responses to stimuli and questions, loss of consciousness, and altered behavior are symptoms currently used to justify brain imaging for diagnosis and therapeutic guidance. Tests based on such symptoms are susceptible to false-positive and false-negative results due to stress, fatigue, and medications. Biochemical markers of neuronal damage and the physiological response to that damage are being identified. Biosensors capable of rapid measurement of such markers in the circulation offer a solution for on-site triage, as long as three criteria are met: (a) Recognition reagents can be identified that are sufficiently sensitive and specific, (b) the biosensor can provide quantitative assessment of multiple markers rapidly and simultaneously, and (c) both the sensor and reagents are designed for use outside the laboratory.

North, Stella H.; Shriver-Lake, Lisa C.; Taitt, Chris R.; Ligler, Frances S.

2012-07-01

411

Triage, monitoring and dose assessment for people exposed to ionising radiation following a malevolent act.  

PubMed

The part played by individual monitoring within the context of the overall response to incidents involving the malevolent use of radiation or radioactive material is discussed. The main objectives of an individual monitoring programme are outlined, and types of malevolent use scenario briefly described. Some major challenges facing those with responsibilities for planning the monitoring response to such an incident are identified and discussed. These include the need for rapid selection and prioritisation of people for individual monitoring by means of an effective triage system; the need for rapid initiation of individual monitoring; problems associated with monitoring large numbers of people; the particular difficulties associated with incidents involving pure-beta and alpha-emitting radionuclides; the need for techniques that can provide retrospective estimates of external radiation exposures rapidly and the need for rapid interpretation of contamination monitoring data. The paper concludes with a brief review of assistance networks and relevant international projects planned or currently underway. PMID:21147786

Etherington, G; Rothkamm, K; Shutt, A L; Youngman, M J

2010-12-08

412

Biomarker-enhanced triage in respiratory infections: a proof-of-concept feasibility trial.  

PubMed

Concerns about inadequate performance and complexity limit routine use of clinical risk scores in lower respiratory tract infections. Our aim was to study feasibility and effects of adding the biomarker proadrenomedullin (proADM) to the confusion, urea >7 mmol·L(-1), respiratory rate ?30 breaths·min(-1), blood pressure <90 mmHg (systolic) or ?60 mmHg (diastolic), age ?65 years (CURB-65) score on triage decisions and length of stay. In a randomised controlled proof-of-concept intervention trial, triage and discharge decisions were made for adults with lower respiratory tract infection according to interprofessional assessment using medical and nursing risk scores either without (control group) or with (proADM group) knowledge of proADM values, measured on admission, and on days 3 and 6. An adjusted generalised linear model was calculated to investigate the effect of our intervention. On initial presentation the algorithms were overruled in 123 (39.3%) of the cases. Mean length of stay tended to be shorter in the proADM (n=154, 6.3 days) compared with the control group (n=159, 6.8 days; adjusted regression coefficient -0.19, 95% CI -0.41-0.04; p=0.1). This trend was robust in subgroup analyses and for overall length of stay within 90 days (7.2 versus 7.9 days; adjusted regression coefficient -0.18, 95% CI -0.40-0.05; p=0.13). There were no differences in adverse outcomes or readmission. Logistic obstacles and overruling are major challenges to implement biomarker-enhanced algorithms in clinical settings and need to be addressed to shorten length of stay. PMID:23349444

Albrich, Werner C; Rüegger, Kristina; Dusemund, Frank; Schuetz, Philipp; Arici, Birsen; Litke, Alexander; Blum, Claudine A; Bossart, Rita; Regez, Katharina; Schild, Ursula; Guglielmetti, Merih; Conca, Antoinette; Schäfer, Petra; Schubert, Maria; de Geest, Sabina; Reutlinger, Barbara; Irani, Sarosh; Bürgi, Ulrich; Huber, Andreas; Müller, Beat

2013-01-24

413

Benefit of a Tiered-Trauma Activation System to Triage Dead-on-Arrival Patients  

PubMed Central

Introduction Although national guidelines have been published for the management of critically injured traumatic cardiopulmonary arrest (TCPA) patients, many hospital systems have not implemented in-hospital triage guidelines. The objective of this study was to determine if hospital resources could be preserved by implementation of an in-hospital tiered triage system for patients in TCPA with prolonged resuscitation who would likely be declared dead on arrival (DOA). Method We conducted a retrospective analysis of 4,618 severely injured patients, admitted to our Level I trauma center from December 2000 to December 2008 for evaluation. All of the identified patients had sustained life-threatening penetrating and blunt injuries with pre-hospital TCPA. Patients who received cardiopulmonary resuscitation (CPR) for 10 minutes were assessed for survival rate, neurologic outcome, and charge-for-activation (COA) for our hospital trauma system. Results We evaluated 4,618 charts, which consisted of patients seen by the MSM trauma service from December 2001 through December 2008. We identified 140 patients with severe, life-threatening traumatic injuries, who sustained pre-hospital TCPA requiring prolonged CPR in the field and were brought to the emergency department (ED). Group I was comprised of 108 patients sustaining TCPA (53 blunt, 55 penetrating), who died after receiving < 45 minutes of ACLS after arrival. Group II, which consisted of 32 patients (25 blunt, 7 penetrating), had resuscitative efforts in the ED lasting > 45 minutes, but all ultimately died prior to discharge. Estimated hospital charge-for-activation for Group I was approximately $540,000, based on standard charges of $5000 per full-scale trauma system activation (TSA). Conclusion Full-scale trauma system activation for patients sustaining greater than 10 minutes of prehospital TCPA in the field is futile and economically depleting.

Danner, Omar K; Wilson, Kenneth L; Heron, Sheryl; Ahmed, Yusuf; Walker, Travelyan M; Houry, Debra; Haley, Leon L; Matthews, Leslie Ray

2012-01-01

414

Biomarker-enhanced triage in respiratory infections: a proof-of-concept feasibility trial  

PubMed Central

Concerns about inadequate performance and complexity limit routine use of clinical risk scores in lower respiratory tract infections. Our aim was to study feasibility and effects of adding the biomarker proadrenomedullin (proADM) to the confusion, urea >7 mmol·L?1, respiratory rate ?30 breaths·min?1, blood pressure <90 mmHg (systolic) or ?60 mmHg (diastolic), age ?65 years (CURB-65) score on triage decisions and length of stay. In a randomised controlled proof-of-concept intervention trial, triage and discharge decisions were made for adults with lower respiratory tract infection according to interprofessional assessment using medical and nursing risk scores either without (control group) or with (proADM group) knowledge of proADM values, measured on admission, and on days 3 and 6. An adjusted generalised linear model was calculated to investigate the effect of our intervention. On initial presentation the algorithms were overruled in 123 (39.3%) of the cases. Mean length of stay tended to be shorter in the proADM (n=154, 6.3 days) compared with the control group (n=159, 6.8 days; adjusted regression coefficient -0.19, 95% CI -0.41–0.04; p=0.1). This trend was robust in subgroup analyses and for overall length of stay within 90 days (7.2 versus 7.9 days; adjusted regression coefficient -0.18, 95% CI -0.40–0.05; p=0.13). There were no differences in adverse outcomes or readmission. Logistic obstacles and overruling are major challenges to implement biomarker-enhanced algorithms in clinical settings and need to be addressed to shorten length of stay.

Albrich, Werner C.; Ruegger, Kristina; Dusemund, Frank; Schuetz, Philipp; Arici, Birsen; Litke, Alexander; Blum, Claudine A.; Bossart, Rita; Regez, Katharina; Schild, Ursula; Guglielmetti, Merih; Conca, Antoinette; Schafer, Petra; Schubert, Maria; de Geest, Sabina; Reutlinger, Barbara; Irani, Sarosh; Burgi, Ulrich; Huber, Andreas; Muller, Beat

2013-01-01

415

Impact of the Department of Health initiative to equip and train acute trusts to manage chemically contaminated casualties  

PubMed Central

Background: Before 1999, there was no national model or standard doctrine for managing casualties from chemical incidents in the UK. A Department of Health (DoH) initiative to prepare the National Health Service (NHS) for chemical incidents was launched in the same year. This led to the distribution of an NHS standard chemical personal protective equipment suit (CPPE) together with a new single half day training package (Structured Approach to Chemical Casualties (SACC)) in 2001. Objectives: To assess the impact of the DoH initiative on acute hospital and ambulance trusts. To identify deficiencies in the design and operational deployment of the new CPPE, training initiative, and decontamination procedures at hospital level. Method: A survey to assess progress in specific areas of chemical incident preparedness and two simulated incidents with "live" chemically contaminated casualties conducted in two acute trusts. Umpires evaluated the operational performance against DoH SACC standards. Results: There has been marked improvement in many aspects of preparedness for chemical incidents since the original National Focus survey. Some deficiencies remain and this study identified areas for further work. In the live casualty exercises, hospital staff complied well with SACC protocols. Some practical difficulties were encountered with the deployment of the CPPE and in some aspects of the operational response, leading to some delays in the delivery of care to the casualties and to the integrity of the uncontaminated (clean) zones within the hospitals. Conclusion: Problems with the design and deployment of the CPPE, together with training difficulties have been fed back into the planning and development process.

Al-Damouk, M; Bleetman, A

2005-01-01

416

Participatory user centered design techniques for a large scale ad-hoc health information system  

Microsoft Academic Search

During mass casualty incidents, an enormous amount of data, including the vital signs of the patients, the location of the patients, and the location of the first responders must be gathered and communicated efficiently. The Advanced Health and Disaster Aid Network (AID-N) used participatory design methods to develop an electronic triage system that changed how emergency personnel interacted, collected, and

Tia Gao; Tammara Massey; Majid Sarrafzadeh; Leo Selavo; Matt Welsh

2007-01-01

417

Use of surgisis for abdominal wall reconstruction/closure in battlefield casualties during Operation Iraqi Freedom.  

PubMed

A case series and discussion based on experiences gained during Operation Iraqi Freedom are presented. The Army previously published an article on the use of Gore-Tex mesh in the staged closure of open abdominal wounds. We thought that use of a biomaterial could shorten the overall course of abdominal closure and improve outcomes. This is mainly a "proof of concept" type of study. Although class I data are not presented, a useful concept is discussed. To our knowledge, no other report of the use of biomaterials for battle casualties has been published. Several issues that are faced by the military medical system are presented. The use of Surgisis (lyophilized porcine small intestinal submucosa; Cook Biotech, West Lafayette, Indiana) in the described setting is presented as one possible solution. PMID:17985779

Johnson, Eric K; Paquette, Edmond L

2007-10-01

418

Socio-demographic Characteristics and Leading Causes of Death Among the Casualties of Meteorological Events Compared With All-cause Deaths in Korea, 2000-2011  

PubMed Central

Objectives This study investigated the socio-demographic characteristics and medical causes of death among meteorological disaster casualties and compared them with deaths from all causes. Methods Based on the death data provided by the National Statistical Office from 2000 to 2011, the authors analyzed the gender, age, and region of 709 casualties whose external causes were recorded as natural events (X330-X389). Exact matching was applied to compare between deaths from meteorological disasters and all deaths. Results The total number of deaths for last 12 years was 2 728 505. After exact matching, 642 casualties of meteorological disasters were matched to 6815 all-cause deaths, which were defined as general deaths. The mean age of the meteorological disaster casualties was 51.56, which was lower than that of the general deaths by 17.02 (p<0.001). As for the gender ratio, 62.34% of the meteorological event casualties were male. While 54.09% of the matched all-cause deaths occurred at a medical institution, only 7.6% of casualties from meteorological events did. As for occupation, the rate of those working in agriculture, forestry, and fishery jobs was twice as high in the casualties from meteorological disasters as that in the general deaths (p<0.001). Meteorological disaster-related injuries like drowning were more prevalent in the casualties of meteorological events (57.48%). The rate of amputation and crushing injury in deaths from meteorological disasters was three times as high as in the general deaths. Conclusions The new information gained on the particular characteristics contributing to casualties from meteorological events will be useful for developing prevention policies.

Lee, Kyung Eun; Myung, Hyung-Nam; Na, Wonwoong

2013-01-01

419

Alcohol and casualties: a comparison of emergency room and coroner data.  

PubMed

Data from a probability sample of casualty patients treated at a county hospital emergency room (ER) during a 1 year period (N = 1124) are compared to data from coroner reports of all fatalities arising from unnatural causes during the same time period in the same county (N = 304). The two samples are compared on: demographic characteristics, causes of casualty (fall, laceration/puncture wound, motor vehicle, fire, ingestion, other cause), place of injury, and alcohol and drug use prior to the event. Alcohol and drug use data were obtained by breathalyzer and self-reports in the ER sample and by toxicology screening of blood upon autopsy in the coroner sample. The coroner sample was significantly more likely to be male, younger and white compared to the ER sample. A significantly larger proportion of the coroner sample was positive for alcohol (43%) compared to those breathalyzed within 6 hr of injury who reported no drinking after the event (11%) and to those who reported drinking within the 6 hr prior to the event (28%) in the ER sample. Among those who were alcohol positive no difference was found between the coroner sample and the ER sample for the proportion of those who were also drug positive (24% in each). Cases in the coroner sample were no more likely to involve violence (17%) than those in the ER sample (20%). Violence-related fatalities were more likely to involve alcohol (47%) than non-fatal injuries (19%), but were no more likely to involve drug use in combination with alcohol (39% vs. 31%, respectively). PMID:8080603

Cherpitel, C J

1994-03-01

420

Evaluation of the Triage Micro Parasite Panel for Detection of Giardia lamblia, Entamoeba histolytica\\/Entamoeba dispar, and Cryptosporidium parvum in Patient Stool Specimens  

Microsoft Academic Search

A study comparing the Triage Micro Parasite Panel (Biosite Diagnostics, Inc., San Diego, Calif.) to con- ventional O&P examination (O&P) was performed using patient fecal specimens. Five hundred twenty-three stool samples were compared. Nineteen specimens were found to be positive by Triage, and 29 were found to be positive by O&P. Seven specimens were positive for Giardia lamblia, four were

SUSAN E. SHARP; CLARISA A. SUAREZ; YOLANDA DURAN; ROBERT J. POPPITI

2001-01-01

421

Reduced overtriage and undertriage with a new triage system in an urban accident and emergency department in Botswana: a cohort study.  

PubMed

BACKGROUND: Improvements in triage have demonstrated improved clinical outcomes in resource-limited settings. In 2009, the Accident and Emergency (A&E) Department at the Princess Marina Hospital (PMH) in Botswana identified the need for a more objective triage system and adapted the South African Triage Scale to create the PMH A&E Triage Scale (PATS). AIM: The primary purpose was to compare the undertriage and overtriage rates in the PATS and pre-PATS study periods. METHODS: Data were collected from 5 April 2010 to 1 May 2011 for the PATS and compared with a database of patients triaged from 1 October 2009 to 24 March 2010 for the pre-PATS. Data included patient disposition outcomes, demographics and triage level assignments. RESULTS: 14 706 (pre-PATS) and 25 243 (PATS) patient visits were reviewed. Overall, overtriage rates improved from 53% (pre-PATS) to 38% (PATS) (p<0.001); likewise, undertriage rates improved from 47% (pre-PATS) to 16% (PATS) (p<0.001). Statistically significant decreases in both rates were found when paediatric and adult cases were analysed separately. PATS was more predictive of inpatient admission, Intensive Care Unit (ICU) admission and death rates in the A&E than was the pre-PATS. The lowest acuity category of each system had a 0.6% (pre-PATS) and 0% (PATS) chance of death in the A&E or ICU admission (p<0.001). No change in death rate was seen between the pre-PATS and PATS, but ICU admission rates decreased from 0.35% to 0.06% (p<0.001). CONCLUSIONS: PATS is a more predictive triage system than pre-PATS as evidenced by improved overtriage, undertriage and patient severity predictability across triage levels. PMID:23407375

Mullan, Paul C; Torrey, Susan B; Chandra, Amit; Caruso, Ngaire; Kestler, Andrew

2013-02-13

422

A low-bandwidth graphical user interface for high-speed triage of potential items of interest in video imagery  

NASA Astrophysics Data System (ADS)

In this paper, we introduce a user interface called the "Threat Chip Display" (TCD) for rapid human-in-the-loop analysis and detection of "threats" in high-bandwidth imagery and video from a list of "Items of Interest" (IOI), which includes objects, targets and events that the human is interested in detecting and identifying. Typically some front-end algorithm (e.g., computer vision, cognitive algorithm, EEG RSVP based detection, radar detection) has been applied to the video and has pre-processed and identified a potential list of IOI. The goal of the TCD is to facilitate rapid analysis and triaging of this list of IOI to detect and confirm actual threats. The layout of the TCD is designed for ease of use, fast triage of IOI, and a low bandwidth requirement. Additionally, a very low mental demand allows the system to be run for extended periods of time.

Huber, David J.; Khosla, Deepak; Martin, Kevin; Chen, Yang

2013-06-01

423

Triage and Management of the Injured in World War I: The Diuturnity of Antoine De Page and a Belgian Colleague  

PubMed Central

A system of orderly triage of the injured in World War I and a protocol for early wound management of war injuries were introduced by Antoine De Page in 1914 at the beginning of World War I. The five steps of the De Page protocol (coined by the author as Ordre de Triage) were to be followed in detail by the French and Belgian armies. A younger Belgian colleague, Robert Danis, was recruited to aid in the management of the ambulance corps to transport the injured from dressing (“clearing”) stations to centers of more advanced care, away from the Franco-Belgian front. Danis, also from Brussels, introduced the principles of osteosynthesis of bone a little over a decade later. De Page and Danis, both surgeons, tendered immense carry-forwards for future generations.

Pollock, Richard A.

2008-01-01

424

Assessing the need for hospital admission by the cape triage discriminator presentations and the simple clinical score  

Microsoft Academic Search

AimThere is uncertainty about how to assess unselected acutely ill medical patients at the time of their admission to hospital. This study examined the use of the Simple Clinical Score (SCS) and the medically relevant Cape Triage discriminator clinical presentations to determine the need for admission to an acute medical unit.MethodA prospective study of 270 unselected consecutive acute medical admissions.

Andrew Emmanuel; Asyik Ismail; John Kellett

2010-01-01

425

The DUNDRUM-1 structured professional judgment for triage to appropriate levels of therapeutic security: retrospective-cohort validation study  

Microsoft Academic Search

Background  The assessment of those presenting to prison in-reach and court diversion services and those referred for admission to mental\\u000a health services is a triage decision, allocating the patient to the appropriate level of therapeutic security. This is a critical\\u000a clinical decision. We set out to improve on unstructured clinical judgement. We collated qualitative information and devised\\u000a an 11 item structured

Grainne Flynn; Conor O’Neill; Clare McInerney; Harry G Kennedy

2011-01-01

426

Multicenter evaluation of the Roche NT-proBNP assay and comparison to the Biosite Triage BNP assay  

Microsoft Academic Search

Background: Brain natriuretic peptides (BNPs) are useful in the assessment of heart failure, left ventricular dysfunction, and acute coronary syndromes. Methods: We performed a multicenter evaluation of the automated Roche NT-proBNP assay and compared its performance to the Biosite Triage BNP assay. Results: The N-terminal (1–76) pro brain natriuretic peptide (NT-proBNP) method is precise (CV?6.1%), has a wide dynamic measuring

Kiang-Teck J. Yeo; Alan H. B. Wu; Fred S. Apple; Martin H. Kroll; Robert H. Christenson; Kent B. Lewandrowski; Frank A. Sedor; Anthony W. Butch

2003-01-01

427

Triage effect on wait time of receiving treatment services and patients satisfaction in the emergency department: Example from Iran  

PubMed Central

Background: Long wait time interval in emergency department (ED) of hospitals, from the patients’ point of view in ED is a major problem causing patients’ dissatisfaction and may result increasing in patient morbidity and indirectly nurses dissatisfaction. Evaluation of wait time intervals in ED and giving nursing feedback may improve the quality of services, as well as patient satisfaction. The present study was designed to investigate the effect of nursing triage on receiving treatment of wait time interval and satisfaction of the patients referring to ED in Shahid Rajaee hospital. Materials and Methods: This study was conducted on patients those referring to Shahid Rajaee hospital in Karaj, Iran employing quasi experimental design d ividing in two experiment and control groups during 2009. This is a quasi-experimental study of which the data were collected by standard questionnaire covering patient satisfaction and measuring wait time. T-test, Mann-Whitney and frequency analysis were used to evaluate the effect of triage on wait time from receiving treatment services and patients’ satisfaction. Results: The findings showed that there was a significant difference between experiment and control groups regarding wait time from receiving treatment services and patients’ satisfaction. Conclusions: Triage could significantly reduce the wait time interval between patients’ entrance to ED to receive treatment services and enhance patients’ satisfaction. It may help nursing in emergency ward to have better performance and indirectly their satisfaction.

Khankeh, Hamid-Reza; Khorasani-Zavareh, Davoud; Azizi-Naghdloo, Farah; Hoseini, Mohammad-Ali; Rahgozar, Mahdi

2013-01-01

428

Characteristics of Veterans Accessing the Veterans Affairs Telephone Triage Who Have Depression or Suicidal Ideation: Opportunities for Intervention  

PubMed Central

Objective To characterize Veterans who call telephone triage because of suicidal ideation (SI) or depression and to identify opportunities for suicide prevention efforts among these telephone triage users using a biosurveillance application. Introduction Veterans accessing Veterans Affairs (VA) health care have higher suicide rates and more characteristics associated with suicide risk, including being male, having multiple medical and psychiatric comorbidities, and being an older age, compared with the general U.S. population. The Veterans Crisis Line is a telephone hotline available to Veterans with urgent mental health concerns; however, not all Veterans are aware of this resource. By contrast, telephone triage is a national telephone-based triage system used by the VA to assess and triage all Veterans with acute medical or mental health complaints. Methods The VA Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE) was queried for telephone triage calls during January 1–June 30, 2012. Calls were classified as SI or depression when the triage nurse selected SI or depression as the Veteran’s chief complaint from a set of fixed options. Demographic and recommended follow-up time and location information was reviewed. A random sample of 20 SI calls and 50 depression calls were selected for chart review to determine whether Veterans were examined in a clinic or followed up by a clinician by telephone within 2 weeks of the veteran’s call. Results During January 1–June 30, 2012, 253,573 total calls were placed to telephone triage. Among these calls, 2,460 unique Veterans placed 417 calls for SI and 2,290 calls for depression. This represents 1% (2,707/253,573) of all calls placed during the period. All encounter information is available in the surveillance application within 24 hours of the call being placed. Median age of callers was 55 years (range: 19–94); 86% were male; and 6% placed repeat calls. The median number of repeat calls was 2 (range: 2–10). Among the 2,707 calls for SI or depression, 1,286 (48%) were made after routine business hours (5:00 p.m.–8:00 a.m.), and 646 (24%) were made on weekends. The greatest proportion of calls were from Wisconsin and Northern Illinois (17%) and the Southeastern United States (14%). Among the 2,290 calls for depression, 1,401 callers (61%) were recommended for urgent follow up or within 24 hours. 771 (34%) were assigned a follow up location of an emergency department; 117 (5%) an urgent care; 1,332 (58%) a physician’s office or clinic; 52 (2%) self-care at home; and 18 (1%) were unspecified. Among the 417 calls for SI, callers 410 (98%) were recommended for urgent follow-up or within 24 hours. 330 (79%) were assigned a follow-up location of an emergency department; 38 (9%) an urgent care; 43 (10%) a physician’s office or clinic; 3 (1%) self-care at home; and 3 (1%) unspecified. Among the 20 SI and 50 depression calls for which the charts were reviewed, 1 (5%) SI call and 6 (12%) depression calls had no documented follow-up by telephone or in person with a clinician within 2 weeks of initial call. Conclusions Telephone triage represents an additional data source available to surveillance applications. Although telephone triage is not the traditional method provided by the VA for triage of urgent mental health concerns, >2,000 Veterans called it with acute symptoms of SI or depression during January–June 2012. Training for suicide prevention should be prioritized for operators working during the high-volume periods of off-hours and weekends when approximately half and one-quarter of calls were received, respectively. We recommend standard notification of suicide prevention coordinators regarding calls to telephone triage for SI or depression to prevent loss to follow-up among Veterans at risk for suicide. Further investigation into reasons for increased call burden in identified geographic areas also is recommended.

Ludwig, Alison; Lucero-Obusan, Cynthia; Schirmer, Patricia; Holodniy, Mark

2013-01-01

429

Development of a triage engine enabling behavior recognition and lethal arrhythmia detection for remote health care system.  

PubMed

For ubiquitous health care systems which continuously monitor a person's vital signs such as electrocardiogram (ECG), body surface temperature and three-dimensional (3D) acceleration by wireless, it is important to accurately detect the occurrence of an abnormal event in the data and immediately inform a medical doctor of its detail. In this paper, we introduce a remote health care system, which is composed of a wireless vital sensor, multiple receivers and a triage engine installed in a desktop personal computer (PC). The middleware installed in the receiver, which was developed in C++, supports reliable data handling of vital data to the ethernet port. On the other hand, the human interface of the triage engine, which was developed in JAVA, shows graphics on his/her ECG data, 3D acceleration data, body surface temperature data and behavior status in the display of the desktop PC and sends an urgent e-mail containing the display data to a pre-registered medical doctor when it detects the occurrence of an abnormal event. In the triage engine, the lethal arrhythmia detection algorithm based on short time Fourier transform (STFT) analysis can achieve 100 % sensitivity and 99.99 % specificity, and the behavior recognition algorithm based on the combination of the nearest neighbor method and the Naive Bayes method can achieve more than 71 % classification accuracy. PMID:22254766

Sugano, Hiroto; Hara, Shinsuke; Tsujioka, Tetsuo; Inoue, Tadayuki; Nakajima, Shigeyoshi; Kozaki, Takaaki; Namkamura, Hajime; Takeuchi, Kazuhide

2011-01-01

430

Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage  

PubMed Central

Inadequate dietary intakes of vitamins and minerals are widespread, most likely due to excessive consumption of energy-rich, micronutrient-poor, refined food. Inadequate intakes may result in chronic metabolic disruption, including mitochondrial decay. Deficiencies in many micronutrients cause DNA damage, such as chromosome breaks, in cultured human cells or in vivo. Some of these deficiencies also cause mitochondrial decay with oxidant leakage and cellular aging and are associated with late onset diseases such as cancer. I propose DNA damage and late onset disease are consequences of a triage allocation response to micronutrient scarcity. Episodic shortages of micronutrients were common during evolution. Natural selection favors short-term survival at the expense of long-term health. I hypothesize that short-term survival was achieved by allocating scarce micronutrients by triage, in part through an adjustment of the binding affinity of proteins for required micronutrients. If this hypothesis is correct, micronutrient deficiencies that trigger the triage response would accelerate cancer, aging, and neural decay but would leave critical metabolic functions, such as ATP production, intact. Evidence that micronutrient malnutrition increases late onset diseases, such as cancer, is discussed. A multivitamin-mineral supplement is one low-cost way to ensure intake of the Recommended Dietary Allowance of micronutrients throughout life.

Ames, Bruce N.

2006-01-01

431

Longitudinal characterization of Acinetobacter baumannii-calcoaceticus complex, Klebsiella pneumoniae, and methicillin-resistant Staphylococcus aureus colonizing and infecting combat casualties.  

PubMed

Drug-resistant Acinetobacter baumannii-calcoaceticus complex, Klebsiella pneumoniae, and methicillin-resistant Staphylococcus aureus colonize and infect combat casualties from Iraq and Afghanistan. We retrospectively evaluated relatedness, by pulsed-field gel electrophoresis and antibiotic susceptibility testing, of isolates colonizing and infecting casualties over 2 years. Colonizing organisms were unrelated to isolates producing later infection in up to 27% of cases; most isolates underwent change in antibiotic susceptibilities. The same is true for serial infecting isolates recovered during hospitalization. PMID:21802175

Sensenig, Rebekah A; Murray, Clinton K; Mende, Katrin; Wolf, Steven E; Chung, Kevin K; Hospenthal, Duane R; Yun, Heather C

2011-07-28

432

Implications of ICU triage decisions on patient mortality: a cost-effectiveness analysis  

PubMed Central

Introduction Intensive care is generally regarded as expensive, and as a result beds are limited. This has raised serious questions about rationing when there are insufficient beds for all those referred. However, the evidence for the cost effectiveness of intensive care is weak and the work that does exist usually assumes that those who are not admitted do not survive, which is not always the case. Randomised studies of the effectiveness of intensive care are difficult to justify on ethical grounds; therefore, this observational study examined the cost effectiveness of ICU admission by comparing patients who were accepted into ICU after ICU triage to those who were not accepted, while attempting to adjust such comparison for confounding factors. Methods This multi-centre observational cohort study involved 11 hospitals in 7 EU countries and was designed to assess the cost effectiveness of admission to intensive care after ICU triage. A total of 7,659 consecutive patients referred to the intensive care unit (ICU) were divided into those accepted for admission and those not accepted. The two groups were compared in terms of cost and mortality using multilevel regression models to account for differences across centres, and after adjusting for age, Karnofsky score and indication for ICU admission. The analyses were also stratified by categories of Simplified Acute Physiology Score (SAPS) II predicted mortality (< 5%, 5% to 40% and >40%). Cost effectiveness was evaluated as cost per life saved and cost per life-year saved. Results Admission to ICU produced a relative reduction in mortality risk, expressed as odds ratio, of 0.70 (0.52 to 0.94) at 28 days. When stratified by predicted mortality, the odds ratio was 1.49 (0.79 to 2.81), 0.7 (0.51 to 0.97) and 0.55 (0.37 to 0.83) for <5%, 5% to 40% and >40% predicted mortality, respectively. Average cost per life saved for all patients was $103,771 (€82,358) and cost per life-year saved was $7,065 (€5,607). These figures decreased substantially for patients with predicted mortality higher than 40%, $60,046 (€47,656) and $4,088 (€3,244), respectively. Results were very similar when considering three-month mortality. Sensitivity analyses performed to assess the robustness of the results provided findings similar to the main analyses. Conclusions Not only does ICU appear to produce an improvement in survival, but the cost per life saved falls for patients with greater severity of illness. This suggests that intensive care is similarly cost effective to other therapies that are generally regarded as essential.

2011-01-01

433

Abnormal vital signs are strong predictors for intensive care unit admission and in-hospital mortality in adults triaged in the emergency department - a prospective cohort study  

PubMed Central

Background Assessment and treatment of the acutely ill patient have improved by introducing systematic assessment and accelerated protocols for specific patient groups. Triage systems are widely used, but few studies have investigated the ability of the triage systems in predicting outcome in the unselected acute population. The aim of this study was to quantify the association between the main component of the Hillerød Acute Process Triage (HAPT) system and the outcome measures; Admission to Intensive Care Unit (ICU) and in-hospital mortality, and to identify the vital signs, scored and categorized at admission, that are most strongly associated with the outcome measures. Methods The HAPT system is a minor modification of the Swedish Adaptive Process Triage (ADAPT) and ranks patients into five level colour-coded triage categories. Each patient is assigned a triage category for the two main descriptors; vital signs, Tvitals, and presenting complaint, Tcomplaint. The more urgent of the two determines the final triage category, Tfinal. We retrieved 6279 unique adult patients admitted through the Emergency Department (ED) from the Acute Admission Database. We performed regression analysis to evaluate the association between the covariates and the outcome measures. Results The covariates, Tvitals, Tcomplaint and Tfinal were all significantly associated with ICU admission and in-hospital mortality, the odds increasing with the urgency of the triage category. The vital signs best predicting in-hospital mortality were saturation of peripheral oxygen (SpO2), respiratory rate (RR), systolic blood pressure (BP) and Glasgow Coma Score (GCS). Not only the type, but also the number of abnormal vital signs, were predictive for adverse outcome. The presenting complaints associated with the highest in-hospital mortality were 'dyspnoea' (11.5%) and 'altered level of consciousness' (10.6%). More than half of the patients had a Tcomplaint more urgent than Tvitals, the opposite was true in just 6% of the patients. Conclusion The HAPT system is valid in terms of predicting in-hospital mortality and ICU admission in the adult acute population. Abnormal vital signs are strongly associated with adverse outcome, while including the presenting complaint in the triage model may result in over-triage.

2012-01-01

434

Did the defeat of Saddam Hussein reduce suicide bombing casualties and attacks in Israel? A statistical analysis.  

PubMed

It was hypothesized that one of the reasons for the U.S. invasion of Iraq was to stop the payments being made by Saddam Hussein to the families of suicide (homicide) bombers in Israel. The consequences of suicide (homicide) bombing attacks against Israel between March 2001 and August 2004 were evaluated as related to the time of the U.S. invasion of Iraq. On average per month during this period, there were fewer overall casualties after the invasion than before it. As many as nearly 1,100 casualties may have been prevented in Israel as a consequence of the U.S. invasion of Iraq, suggesting that at least one possible goal of the U.S. invasion may have been achieved, at least as averaged over the first 17 months after the invasion. PMID:15666913

Schumm, Walter R

2004-12-01

435

EDs credit drills, community engagement with helping them manage casualties from tornado crises.  

PubMed

Emergency department leaders at DCH Regional Medical Center in Tuscaloosa, AL, and Cullman Regional Medical Center in Cullman, AL, credit their regular practice drills with helping them deal with unprecedented demand when deadly tornadoes swept through the South this past April. Both facilities used the hospital instant command structure (HICS) to mobilize the resources needed to care for the surge in patients, and say the approach worked well in helping them meet the needs of their communities. However, the crises also showcased opportunities for improvement. The ED at DCH Regional Medical Center saw more than 600 patients on the day of the storm, a three-fold increase in the hospital's typical volume. CRMC treated 99 patients in the seven hours immediately following the storm when it usually treats 114 patients per day. In addition to a big surge in patients, both hospitals dealt with power outages that limited access to some services such as radiology. Triage proved particularly challenging at DCH Regional Medical Center, as patients flowed into the hospital from numerous access points. The hospital plans to assign coordinators to each area of the hospital to better manage the influx in the future. When reviewing emergency operations plans, Joint Commission reviewers often find deficiencies in hazard vulnerability analyses as well as the processes used to determine the emergency credentials of licensed independent practitioners. PMID:21749003

2011-07-01

436

Broadening access to medical care during a severe influenza pandemic: the CDC nurse triage line project.  

PubMed

The impact of a severe influenza pandemic could be overwhelming to hospital emergency departments, clinics, and medical offices if large numbers of ill people were to simultaneously seek care. While current planning guidance to reduce surge on hospitals and other medical facilities during a pandemic largely focuses on improving the "supply" of medical care services, attention on reducing "demand" for such services is needed by better matching patient needs with alternative types and sites of care. Based on lessons learned during the 2009 H1N1 pandemic, the Centers for Disease Control and Prevention and its partners are currently exploring the acceptability and feasibility of using a coordinated network of nurse triage telephone lines during a pandemic to assess the health status of callers, help callers determine the most appropriate site for care (eg, hospital ED, outpatient center, home), disseminate information, provide clinical advice, and provide access to antiviral medications for ill people, if appropriate. As part of this effort, the integration and coordination of poison control centers, existing nurse advice lines, 2-1-1 information lines, and other hotlines are being investigated. PMID:23458098

Koonin, Lisa M; Hanfling, Dan

2013-03-04

437

Improved triage and emergency care for children reduces inpatient mortality in a resource-constrained setting.  

PubMed Central

PROBLEM: Early assessment, prioritization for treatment and management of sick children attending a health service are critical to achieving good outcomes. Many hospitals in developing countries see large numbers of patients and have few staff, so patients often have to wait before being assessed and treated. APPROACH: We present the example of a busy Under-Fives Clinic that provided outpatient services, immunizations and treatment for medical emergencies. The clinic was providing an inadequate service resulting in some inappropriate admissions and a high case-fatality rate. We assessed the deficiencies and sought resources to improve services. LOCAL SETTING: A busy paediatric outpatient clinic in a public tertiary care hospital in Blantyre, Malawi. RELEVANT CHANGES: The main changes we made were to train staff in emergency care and triage, improve patient flow through the department and to develop close cooperation between inpatient and outpatient services. Training coincided with a restructuring of the physical layout of the department. The changes were put in place when the department reopened in January 2001. LESSONS LEARNED: Improvements in the process and delivery of care and the ability to prioritize clinical management are essential to good practice. Making the changes described above has streamlined the delivery of care and led to a reduction in inpatient mortality from 10-18% before the changes were made (before 2001) to 6-8% after.

Molyneux, Elizabeth; Ahmad, Shafique; Robertson, Ann

2006-01-01

438

Use of triage strategies in the WHO signal-detection process.  

PubMed

An important role for the WHO Programme for International Drug Monitoring is to identify signals of international drug safety problems as early as possible. Since 1998, Bayesian Confidence Propagation Neural Network (BCPNN) data mining has been in routine use for screening of the WHO adverse reaction database, Vigibase. The identification of drug/adverse drug reaction combinations that have disproportionately high reporting relative to the background of all reports constitutes the first, quantitative step in the Uppsala Monitoring Centre (UMC) signal-detection process. In order to improve the signal-to-noise ratio and to focus on possible signals that are less likely to be detected by individual national pharmacovigilance centres, an expert group considered a number of possible subsidiary selection algorithms to be added as a second filtering step before potential signals were sent to the UMC expert panel for clinical review. As a result of these deliberations, three selection algorithms were implemented for routine use in 2001: 'serious reaction and new drug', 'rapid reporting increase' and 'special interest terms'. The effect of applying these algorithms has been critically evaluated on the basis of the ratio of associations selected to signals found and some modifications decided. Bearing in mind that any filtering strategy is likely to exclude some potential true signals from consideration, we think that triage strategies based on a combination of pragmatic thinking and experience are effective, provided that the results are reviewed at regular intervals and the algorithms adjusted on the basis of performance. PMID:17604420

Lindquist, Marie

2007-01-01

439

A Deployable In Vivo EPR Tooth Dosimeter for Triage After a Radiation Event Involving Large Populations  

PubMed Central

In order to meet the potential need for emergency large-scale retrospective radiation biodosimetry following an accident or attack, we have developed instrumentation and methodology for in vivo electron paramagnetic resonance spectroscopy to quantify concentrations of radiation-induced radicals within intact teeth. This technique has several very desirable characteristics for triage, including independence from confounding biologic factors, a non-invasive measurement procedure, the capability to make measurements at any time after the event, suitability for use by non-expert operators at the site of an event, and the ability to provide immediate estimates of individual doses. Throughout development there has been a particular focus on the need for a deployable system, including instrumental requirements for transport and field use, the need for high throughput, and use by minimally trained operators. Numerous measurements have been performed using this system in clinical and other non-laboratory settings, including in vivo measurements with unexposed populations as well as patients undergoing radiation therapies. The collection and analyses of sets of three serially-acquired spectra with independent placements of the resonator, in a data collection process lasting approximately five minutes, provides dose estimates with standard errors of prediction of approximately 1 Gy. As an example, measurements were performed on incisor teeth of subjects who had either received no irradiation or 2 Gy total body irradiation for prior bone marrow transplantation; this exercise provided a direct and challenging test of our capability to identify subjects who would be in need of acute medical care.

Williams, Benjamin B.; Dong, Ruhong; Flood, Ann Barry; Grinberg, Oleg; Kmiec, Maciej; Lesniewski, Piotr N.; Matthews, Thomas P.; Nicolalde, Roberto J.; Raynolds, Tim; Salikhov, Ildar K.; Swartz, Harold M.

2011-01-01

440

Global Earthquake Casualties due to Secondary Effects: A Quantitative Analysis for Improving PAGER Losses  

USGS Publications Warehouse

This study presents a quantitative and geospatial description of global losses due to earthquake-induced secondary effects, including landslide, liquefaction, tsunami, and ?re for events during the past 40 years. These processes are of great importance to the US Geological Survey’s (USGS) Prompt Assessment of Global Earthquakes for Response (PAGER) system, which is currently being developed to deliver rapid earthquake impact and loss assessments following large/signi?cant global earthquakes. An important question is how dominant are losses due to secondary effects (and under what conditions, and in which regions)? Thus, which of these effects should receive higher priority research efforts in order to enhance PAGER’s overall assessment of earthquakes losses and alerting for the likelihood of secondary impacts? We ?nd that while 21.5% of fatal earthquakes have deaths due to secondary (non-shaking) causes, only rarely are secondary effects the main cause of fatalities. The recent 2004 Great Sumatra–Andaman Islands earthquake is a notable exception, with extraordinary losses due to tsunami. The potential for secondary hazards varies greatly, and systematically, due to regional geologic and geomorphic conditions. Based on our ?ndings, we have built country-speci?c disclaimers for PAGER that address potential for each hazard (Earle et al., Proceedings of the 14th World Conference of the Earthquake Engineering, Beijing, China, 2008). We will now focus on ways to model casualties from secondary effects based on their relative importance as well as their general predictability.

David J Wald

2010-01-01

441

Global earthquake casualties due to secondary effects: A quantitative analysis for improving rapid loss analyses  

USGS Publications Warehouse

This study presents a quantitative and geospatial description of global losses due to earthquake-induced secondary effects, including landslide, liquefaction, tsunami, and fire for events during the past 40 years. These processes are of great importance to the US Geological Survey's (USGS) Prompt Assessment of Global Earthquakes for Response (PAGER) system, which is currently being developed to deliver rapid earthquake impact and loss assessments following large/significant global earthquakes. An important question is how dominant are losses due to secondary effects (and under what conditions, and in which regions)? Thus, which of these effects should receive higher priority research efforts in order to enhance PAGER's overall assessment of earthquakes losses and alerting for the likelihood of secondary impacts? We find that while 21.5% of fatal earthquakes have deaths due to secondary (non-shaking) causes, only rarely are secondary effects the main cause of fatalities. The recent 2004 Great Sumatra-Andaman Islands earthquake is a notable exception, with extraordinary losses due to tsunami. The potential for secondary hazards varies greatly, and systematically, due to regional geologic and geomorphic conditions. Based on our findings, we have built country-specific disclaimers for PAGER that address potential for each hazard (Earle et al., Proceedings of the 14th World Conference of the Earthquake Engineering, Beijing, China, 2008). We will now focus on ways to model casualties from secondary effects based on their relative importance as well as their general predictability. ?? Springer Science+Business Media B.V. 2009.

Marano, K. D.; Wald, D. J.; Allen, T. I.

2010-01-01

442

Performance and reliability of the CPB/ECMO Initiative Forward Lines Casualty Management System.  

PubMed

The Cleveland Clinic Foundation CPB/ECMO Initiative Forward Casualty Management System is an economical, compact, transportable, disposable system designed to permit a rapid expansion of trauma management services requiring cardiopulmonary bypass (CPB) or extracorporeal membrane oxygenation (ECMO) pulmonary support. The system, composed of a rotary blood pump, a pump motor driver, and an electronic control console as the blood pumping subsystem, also includes commonly used compatible commercial oxygenators, venous reservoirs, and cannulae. In vitro durability testing accumulated over 100 hours without failure. In vivo reliability was tested in 10 calves under general anesthesia during 6 hours of CPB and ECMO under full heparinization at nominal operating conditions of 4-5 l/min and 2-4 l/min blood flow respectively, and mean arterial pressures between 65 and 100 mm Hg. A mean time to failure of 57 hours was reached during the animal series. Results of these test series demonstrated that this system has the capability to reliably operate during a 6-hour conventional CPB or ECMO procedure, while providing flexibility and ease of use for the operator. PMID:16340350

Casas, Fernando; Reeves, Andrew; Dudzinski, David; Weber, Stephan; Lorenz, Markus; Akiyama, Masatoshi; Kamohara, Keiji; Kopcak, Michael; Ootaki, Yoshio; Zahr, Firas; Sinkewich, Martin; Foster, Robert; Fukamachi, Kiyotaka; Smith, William A

443

A Critical Assessment of the Out-of-Hospital Trauma Triage Guidelines for Physiologic Abnormality  

PubMed Central

Background It remains unclear whether the American College of Surgeons Committee on Trauma (ACSCOT) “step 1” field physiologic criteria could be further restricted without substantially sacrificing sensitivity. We assessed whether more restrictive physiologic criteria would improve the specificity of this triage step without missing high-risk patients. Methods We analyzed an out-of-hospital, consecutive patient, prospective cohort of injured adults ?15 years collected from December 1, 2005, to February 28, 2007, by 237 emergency medical service agencies transporting to 207 acute care hospitals in 11 sites across the United States and Canada. Patients were included based on ACSCOT field decision scheme physiologic criteria systolic blood pressure ?90, respiratory rate <10 or >29 breaths/min, Glasgow Coma Scale score ?12, or field intubation. Seven field physiologic variables and four additional demographic and mechanism variables were included in the analysis. The composite outcome was mortality (field or in-hospital) or hospital length of stay >2 days. Results Of 7,127 injured persons, 6,259 had complete outcome information and were included in the analysis. There were 3,631 (58.0%) persons with death or LOS >2 days. Using only physiologic measures, the derived rule included advanced airway intervention, shock index >1.4, Glasgow Coma Scale <11, and pulse oximetry <93%. Rule validation demonstrated sensitivity 72% (95% confidence interval: 70%–74%) and specificity 69% (95% confidence interval: 67%–72%). Inclusion of demographic and mechanism variables did not significantly improve performance measures. Conclusions We were unable to omit or further restrict any ACSCOT step 1 physiologic measures in a decision rule practical for field use without missing high-risk trauma patients.

Newgard, Craig D.; Rudser, Kyle; Hedges, Jerris R.; Kerby, Jeffrey D.; Stiell, Ian G.; Davis, Daniel P.; Morrison, Laurie J.; Bulger, Eileen; Terndrup, Tom; Minei, Joseph P.; Bardarson, Berit; Emerson, Scott

2013-01-01

444

A multidisciplinary approach to teach responses to weapons of mass destruction and terrorism using combined simulation modalities  

Microsoft Academic Search

Study objectiveTo reinforce concepts presented in the lectures; understand the complexity and speed of casualty and information generation during a Weapons of Mass Destruction and Terrorism (WMD\\/T) event; experience the novelty of combined weapons' effects; recognize the time course of the various chemical, biological, and radiation agents; and make challenging decisions with incomplete and conflicting information.

Richard R Kyle; Darin K Via; R. Joel Lowy; James M Madsen; Aileen M Marty; Paul D Mongan

2004-01-01

445

Accuracy of fine needle aspiration cytology (FNAC) of axillary lymph nodes as a triage test in breast cancer staging  

Microsoft Academic Search

Introduction  Axillary node fine needle aspiration cytology (FNAC) has the potential to triage women with operable breast cancer to initial\\u000a nodal surgical procedure. Because of variability in the reported accuracy of this test its role and clinical utility in pre-operative\\u000a staging remains controversial.\\u000a \\u000a \\u000a \\u000a Methods  We retrospectively evaluated the accuracy of ultrasound-guided axillary FNAC in all consecutive clinically T1–2 N0–1 breast\\u000a cancers that

Stefano Ciatto; Beniamino Brancato; Gabriella Risso; Daniela Ambrogetti; Paolo Bulgaresi; Cristina Maddau; Patricia Turco; Nehmat Houssami

2007-01-01

446

Clinical review: Tokyo – protecting the health care worker during a chemical mass casualty event: an important issue of continuing relevance  

Microsoft Academic Search

Determine the effectiveness of decontamination, and perform thorough dry or wet decontamination, depending on the circumstances. Always remain cognizant of the fact that, even after decontamination has been completed, contamination may not have been completely eliminated. Perform periodic monitoring to determine whether secondary exposure has occurred in health care workers; if it appears that secondary exposure has occurred, then the

Sumie Okumura; Tetsu Okumura; Shinichi Ishimatsu; Kunihisa Miura; Hiroshi Maekawa; Toshio Naito

2005-01-01

447

Incorporating bioterrorism training into dental education: report of ADA-ADEA terrorism and mass casualty curriculum development workshop.  

PubMed

Numerous areas have been identified in which the dental profession may be called upon to assist in the event of a major terrorism attack. In order to successfully fulfill these roles, dentists and dental students must be adequately prepared. Dental schools play a vital role in this preparation. Participants in an ADA-ADEA workshop reached consensus that all dental students should be trained in a core set of competencies enabling them to respond to a significant bioterrorism attack, help contain the spread of the attack, and participate in surveillance activities as appropriate upon direction of proper authorities. Further emergency response training should be available to individuals interested in gaining additional knowledge and skills to assist in response to an attack. Participants also concluded that, where possible, training should be seamlessly implemented into the current curriculum without the addition of new courses; however, the group also recognized the possible need for alternative models at some dental schools. Challenges to implementing bioterrorism training into the dental school curriculum include regional variation, management of the basic science curriculum, and financial considerations. The development of an exportable training package will be considered and funding sources explored in moving forward with the development of a curriculum. PMID:15520240