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Prehospital Patient Triage in Mass Casualty Incidents: An engineering management analysis and prototype strategy recommendation.

机译：重大伤亡事件中的院前患者分类：工程管理分析和原型策略建议。

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摘要

A significant triage deficiency ("under-triage") may occur when "minor" or "moderate" casualties are actually injured worse than those initially triaged as immediate at the prehospital mass casualty scene. Some mechanisms of injury will produce casualties with subtle or latent (i.e. hidden or delayed) signs and symptoms not considered in the most commonly used pre-hospital triage algorithm, Simple Triage and Rapid Treatment (START). These include casualties suffering penetrating wounds with initially stable vital signs, pregnant casualties, casualties from unconventional mechanisms such as chemical burns, and smoke and other inhalation exposures. Using expert opinion and accepted clinical criteria, triage algorithms were developed to re-evaluate patients triaged by START to "minor" and "moderate" categories, and re-direct select casualties to the "immediate" category. A detailed search of the clinical literature for clinical guidance in early indicators of the above casualty categories was used to develop the algorithms, which were then evaluated via expert clinical judgment. The panel of experts provided further input into triage guidance for the selected mechanisms of injury. An extension of the triage process beyond START protocols was developed, incorporating triage criteria for each selected injury mechanism or condition: penetrating injuries, unconventional mechanisms of injury (chemical and radiation), and smoke and other inhalation exposure, and pregnant casualties. The full triage protocol, which is designed for use after START triage when casualty transport is delayed, is called the PLUS Follow-on Prehospital Triage Strategy for Mass Casualty Incidents. The PLUS Follow-on Prehospital Triage Strategy for Mass Casualty Incidents was tested using actual casualty data from EMS data sets, case studies, and historical accounts by practicing paramedics. The reproducibility, sensitivity, and specificity of PLUS Follow-on Strategy were calculated. The PLUS Follow-on Prehospital Triage Strategy for Mass Casualty Incidents may supplement the strengths of an already existing, widely accepted triage strategy, whether it is START or one of the recently developed initial triage algorithms. PLUS may provide a mechanism to more accurately assess casualties from penetrating trauma, unconventional MOIs, smoke and other inhalational exposure, and pregnant casualties. This extended triage strategy may minimize under-triage of seriously injured casualties. The PLUS Follow-on Prehospital Triage Strategy for Mass Casualty Incidents also captures the use of expert thinking of "experienced" personnel doing triage.
机译：当“轻度”或“中度”伤亡实际受伤的程度比最初在院前大规模伤亡现场被初步伤亡的伤者严重时，可能会发生重大的伤检分类缺陷（“检伤分类不足”）。某些伤害机制会导致人员伤亡，并带有最常见的院前分诊算法，简单分诊和快速治疗（START）中未考虑的细微或潜在（即隐藏或延迟）的体征和症状。这些伤亡包括穿透伤口并最初具有稳定生命体征的伤亡，孕妇伤亡，非常规机制（如化学灼伤，烟雾和其他吸入暴露）造成的伤亡。利用专家意见和公认的临床标准，开发了分类算法，以重新评估经START进行分类的患者为“轻微”和“中度”类别，并将选定的伤亡人员重新定向为“立即”类别。在上述伤亡类别的早期指标中，对临床文献进行了详细的搜索以寻求临床指导，以开发算法，然后通过专家的临床判断对其进行评估。专家小组进一步为选定的伤害机制提供了分类诊断指南。开发了将分诊程序扩展到START协议之外的方法，并为每种选定的伤害机制或状况纳入了分诊标准：穿透性伤害，非常规伤害机制（化学和放射），烟雾和其他吸入暴露以及孕妇伤亡。完整的分类协议设计为在伤亡运输被延迟的START分类之后使用，被称为PLUS大规模伤亡事故院前分类报告策略。通过实践医疗人员的服务，使用EMS数据集，案例研究和历史记录中的实际伤亡数据，对PLUS大规模伤亡事件院前分诊策略进行了测试。计算了PLUS后续策略的可重复性，敏感性和特异性。无论是START还是最近开发的初始分类算法之一，PLUS大规模伤亡事故的院前分诊策略都可以补充现有的广泛接受的分诊策略的优势。 PLUS可以提供​​一种机制，以更准确地评估穿透伤，非常规MOI，烟雾和其他吸入性暴露以及孕妇伤亡的人员伤亡。这种扩展的分类策略可以最大程度地减少严重受伤人员的分类不足。 PLUS大规模伤亡事故的院前分诊策略还抓住了专家对“有经验”人员进行分诊的想法。

著录项

  • 作者

    Neal, Daniel James.;

  • 作者单位

    The George Washington University.;

  • 授予单位 The George Washington University.;
  • 学科 Health Sciences Health Care Management.;Engineering System Science.
  • 学位 D.Sc.
  • 年度 2009
  • 页码 398 p.
  • 总页数 398
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 预防医学、卫生学;系统科学;
  • 关键词

  • 入库时间 2022-08-17 11:38:29

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