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Turner MD, Shah MH. Dominique-Jean Larrey (1766-1842): The Founder of the Modern Triage System. Cureus 2024; 16:e62375. [PMID: 39006619 PMCID: PMC11246613 DOI: 10.7759/cureus.62375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2024] [Indexed: 07/16/2024] Open
Abstract
Dominique-Jean Larrey was a prominent French surgeon who rose to fame during the age of the Napoleonic Wars. During his service in the French military, he developed dozens of medical innovations. Most important of all were his improvements to the evacuation of the wounded from the battlefield, triage of the wounded, and rapid surgical intervention. His innovations revolutionized military medicine and are still the basis for modern practice today.
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Affiliation(s)
- Matthew D Turner
- Emergency Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Muhammad Hamza Shah
- Deanery of Biomedical Sciences, The University of Edinburgh, Edinburgh, GBR
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, GBR
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Thede K, Jensen C, Bettag L, Buck C, Saxe J. Cribari, does it apply in real time? An analysis of a community level 1 trauma center. Am J Surg 2024; 230:26-29. [PMID: 38040581 DOI: 10.1016/j.amjsurg.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Major Trauma Code 1 (TC1) activations require significant resources to provide immediate treatment to potentially unstable, critically ill, patients. The Cribari Matrix Method (CMM) and Need For Trauma Intervention (NFTI) are two ways to determine over and undertriage in trauma. We studied the overtriage rate at a community level 1 trauma center using these two methods to determine the efficacy of the triage criteria in TC1 activations. METHOD A retrospective review of all patients in the trauma registry of a level 1 American College of Surgeons trauma program from May to October 2021 was performed. Overtriage rates were determined using CMM and NFTI criteria. RESULTS The overtriage rate of 552 activations using CMM alone was 73%. CMM combined with NFTI resulted in a 56% overtriage rate. CONCLUSION The Cribari method can be used to determine the effectiveness of a system's trauma code 1 criteria but cannot delineate which criteria should be reviewed.
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Affiliation(s)
- Katrina Thede
- Ascension St. Vincent Hospital, Department of Surgery, United States.
| | | | - Luke Bettag
- Marian University College of Osteopathic Medicine, United States
| | - Christopher Buck
- Ascension St. Vincent Hospital, Department of Surgery, United States
| | - Jonathan Saxe
- Ascension St. Vincent Hospital, Department of Surgery, United States.
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Karamouzis K, Perdikakis M, Michaleas SN, Karamanou M. Baron Dominique-Jean Larrey (1766-1842): innovator of the triage. Acta Chir Belg 2024; 124:66-72. [PMID: 37815405 DOI: 10.1080/00015458.2023.2269343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/05/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND During times of war, it is common for some of the most valiant physicians to practice their skills at the battlefields. Only few of them, however, manage to excel. Among those physicians who seemed like the battlefield was their natural environment, was the military surgeon of the French army, Baron Dominique Jean Larrey (1766-1842). He studied medicine and served in the French Navy. Baron Larrey was one of the most significant medical innovators. METHODS International literature was digitally searched. DISCUSSION Larrey optimized a variety of procedures, even early neurosurgical ones. He also wrote medical treatises and most importantly invented the world famous 'flying ambulance'. During his 53-year service in the army he became the symbol of protection of the French warrior. That is why he was widely known as the 'protector of the soldier'. Nevertheless, his most eminent invention was the formation of the new 'triage' method. Due to Larrey's priceless impact in the domain of surgical innovation, a notable NATO award was created that is named after him. CONCLUSION All references presented describe clearly Baron Larrey's contribution to medicine. His innovations in the sphere of the medical science renovated radically the medical ideas of his era.
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Affiliation(s)
- Konstantinos Karamouzis
- Department of History of Medicine and Medical Ethics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Miltiadis Perdikakis
- Department of History of Medicine and Medical Ethics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyros N Michaleas
- Department of History of Medicine and Medical Ethics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianna Karamanou
- Department of History of Medicine and Medical Ethics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Barr J, Schalick WO, Horn CB, Marble WS, Devine S, Smith DC. 'Through and Through' History: The Management of Gunshot Wounds From the 14th Century to the Present. ANNALS OF SURGERY OPEN 2023; 4:e299. [PMID: 37746595 PMCID: PMC10513126 DOI: 10.1097/as9.0000000000000299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/20/2023] [Indexed: 09/26/2023] Open
Abstract
Gun violence killed over 46,000 Americans in 2021; almost 120,000 suffered gunshot wounds. This epidemic has attracted national attention and increasing concern from medical and surgical organizations, as evident in this special issue. 'Through and Through History' explores the surgical management of gunshot wounds from their earliest appearance in 14th-century Europe to the present. Interweaving the civilian and military experience, it details not only the evolution of care directly applied to patients but also the social, political, and scientific milieu that shaped decisions made and actions performed both in and out of the operating room. The article describes how surgeons have pushed the boundaries of medicine and science in each era, developing new therapies for their patients, a historical trend that persists today when such care has the potential to save tens of thousands of lives each year.
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Affiliation(s)
- Justin Barr
- From the Division of Transplant and Hepatobiliary Surgery, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada
| | - Walton O. Schalick
- Department of Orthopedics and Rehabilitation, Disability Studies, and Medieval Studies, University of Wisconsin, Madison, WI
| | | | | | - Shauna Devine
- Schulich School of Medicine, Western University, London, ON, Canada
| | - Dale C. Smith
- Professor Emeritus of Military Medicine and History, Uniformed Services University of the Health Sciences, Bethesda, MD
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Bickel A, Akinichev K, Weiss M, Ganam S, Biswas S, Waksman I, Kakiashvilli E. Challenges in abdominal re-exploration for war casualties following on-site abdominal trauma surgery and subsequent delayed arrival to definitive medical care abroad - an unusual scenario. BMC Emerg Med 2022; 22:132. [PMID: 35850737 PMCID: PMC9295351 DOI: 10.1186/s12873-022-00687-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 06/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background During the Syrian civil war, patients were initially treated on-site in Syria and later transferred to medical centers in Israel. Relevant details concerning the exact nature of injury and medical/surgical care received in Syria were unavailable to clinicians in Israel. Many of these patients required abdominal re-exploration for obvious or suspected problems related to their injury. Our aim is to present our approach to abdominal trauma patients who survived initial on-site surgery and needed subsequent abdominal re-exploration abroad, in our medical center. Methods Clinical data from all medical records were retrospectively analyzed. Each patient underwent total body computerized tomography on arrival, revealing diverse multi-organ trauma. We divided the patient population who had abdominal trauma into 4 sub-groups according to the location in which abdominal surgical intervention was performed (abdominal surgery performed only in Syria, surgery in Syria and subsequent re-laparotomy in Israel, abdominal surgery only in Israel, and management of patients without abdominal surgical intervention). We focused on missed injuries and post-operative complications in the re-laparotomy sub-group. Results By July 2018, 1331 trauma patients had been admitted to our hospital, of whom 236 had suffered abdominal trauma. Life-saving abdominal intervention was performed in 138 patients in Syria before arrival to our medical center. A total of 79 patients underwent abdominal surgery in Israel, of whom 46 (33%) required re-laparotomy. The absence of any communication between the surgical teams across the border markedly affected our medical approach. Indications for re-exploration included severe peritoneal inflammation, neglected or overlooked abdominal foreign bodies, hemodynamic instability and intestinal fistula. Mortality occurred in 37/236 patients, with severe abdominal trauma as the main cause of fatality in 10 of them (4.2%), usually following urgent re-laparotomy. Conclusions Lack of information about the circumstances of injury in an environment of catastrophe in Syria at the time and the absence of professional communication between the surgical teams across the border markedly dictated our medical approach. Our concerns were that some patients looked deceptively stable while others had potentially hidden injuries. We had no information on who had had definitive versus damage control surgery in Syria. The fact that re-operation was not performed by the same team responsible for initial abdominal intervention also posed major diagnostic challenges and warranted increased clinical suspicion and a change in our standard medical approach.
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Affiliation(s)
- Amitai Bickel
- Department of Surgery A, Galilee Medical Center, Nahariya, Israel. .,The Azrieli Faculty of Medicine, Bar-Ilan University, Tzfat, Israel.
| | | | - Michael Weiss
- Department of Surgery A, Galilee Medical Center, Nahariya, Israel
| | - Samer Ganam
- Department of Surgery A, Galilee Medical Center, Nahariya, Israel
| | - Seema Biswas
- Department of Surgery B, Galilee Medical Center, Nahariya, Israel
| | - Igor Waksman
- The Azrieli Faculty of Medicine, Bar-Ilan University, Tzfat, Israel.,Department of Surgery B, Galilee Medical Center, Nahariya, Israel
| | - Eli Kakiashvilli
- Department of Surgery A, Galilee Medical Center, Nahariya, Israel.,The Azrieli Faculty of Medicine, Bar-Ilan University, Tzfat, Israel
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Koehler U, Conradt R. [The Inventor of the "Triage": Dominique-Jean Larrey (1766-1842), Napoleon's Chief Military Doctor]. Pneumologie 2022; 76:365-369. [PMID: 35213925 DOI: 10.1055/a-1756-3879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
During the reign of Emperor Napoleon I, Dominique-Jean Larrey (1766-1842) was chief surgeon in the French army. He has become known as the father of modern military surgery and for the development of the "triage system". Larrey was an outstanding and dedicated physician who provided medical care not only to his own troops but also to those of the enemy. Without reliable analgesia and anaesthesia, speed and skill were the most salient characteristics of a surgeon at that time. Against the opposition of the administration, Larrey is credited with the introduction of first-aid on the battlefield as well as a quick rescue of the wounded with the help of the so-called "flying ambulances". He was considered the soldiers' greatest friend.
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Idilbi N, AboJabel H, Werner P. Examining hospital staff members' preferences for allocating a ventilator to a COVID-19 patient with and without Alzheimer's disease. Geriatr Nurs 2021; 42:787-791. [PMID: 34090221 PMCID: PMC8096197 DOI: 10.1016/j.gerinurse.2021.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 12/25/2022]
Abstract
The COVID 19 pandemic has led to an increase in the number of patients in need of ventilation. Limitations in the number of respirators may cause an ethical problem for the medical and nursing staff in deciding who should be connected to the available respirators. We conducted a cross-sectional survey among a convenience sample of 278 healthcare professionals at one medical center. They were asked to rank their preference in respirator allocation to three COVID-19 patients, one 80 years old with no cognitive illness, one 50 years old with Alzheimer's disease (AD), and one 80 years old with AD. Most respondents (75%) chose the 80-year-old AD patient as last preference, but were evenly divided on how to rank the other two patients. Medical staff have difficulty deciding whether age or cognitive status should be the deciding factor ventilator allocation. Determination of a set policy would help professionals with these decisions.
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Affiliation(s)
- Nasra Idilbi
- The Max Stern Yezreel Valley College, Mobile Post Emek Yezreel, 1930600, Israel; Galilee Medical Center, P.O. Box 21, Nahariya 22100, Israel.
| | - Hanan AboJabel
- Department of Community Mental Health, University of Haifa, Abba Khoushy Ave., Haifa 3498838, Israel
| | - Perla Werner
- Department of Community Mental Health, University of Haifa, Abba Khoushy Ave., Haifa 3498838, Israel
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Bajbouj M, Panneck P, Winter SM, Ajami C, Alabdullah J, Benedikt Burger M, Haberlandner A, Hahn E, Heinz A, Heuser I, Hoyer A, Kluge U, Aichberger M, Repantis D, Schreiter S, Seybold J, Sutej I. A Central Clearing Clinic to Provide Mental Health Services for Refugees in Germany. Front Public Health 2021; 9:635474. [PMID: 33634071 PMCID: PMC7901997 DOI: 10.3389/fpubh.2021.635474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/06/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To determine migration related distress pattern in refugees and feasibility of a de novo established, central low-threshold outpatient clinic serving more than 80,000 newly arrived refugees in the metropole of Berlin. Methods: In an observational cohort study the relative prevalence of major psychiatric disorders by age, place of living within berlin, language and region of origin were assessed in a refugee cohort from 63 nationalities speaking 36 languages. Findings: Within 18 months, a total of 3,096 cases with a mean age of 29.7 years (11.7) have been referred from all 12 districts and 165 of 182 subdistricts of Berlin to the CCC. 33.7% of the patients were female. The three most frequent diagnoses were unipolar depression (40.4%), posttraumatic stress disorder (24.3%), and adjustment disorder (19.6%). Conclusion: The present data gives insight into the distribution of mental disorders in a large sample of refugees and provides evidence that a CCC is an effective service to quickly and broadly provide psychiatric consultations and thus to overcome classical barriers refugees usually experience in the host communities. In Berlin, Germany, and Europe treatment resources for this population should focus on stress and trauma related disorders.
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Affiliation(s)
- Malek Bajbouj
- Department of Psychiatry, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Patricia Panneck
- Department of Psychiatry, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sibylle-Maria Winter
- Department of Child and Adolescent Psychiatry, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Carlos Ajami
- Department of Psychiatry, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jihad Alabdullah
- Department of Psychiatry, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Max Benedikt Burger
- Department of Psychiatry, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anja Haberlandner
- Department of Child and Adolescent Psychiatry, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Eric Hahn
- Department of Psychiatry, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Isabella Heuser
- Department of Psychiatry, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Armin Hoyer
- Department of Psychiatry, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrike Kluge
- Department of Psychiatry, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marion Aichberger
- Department of Psychiatry, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dimitris Repantis
- Department of Psychiatry, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Stefanie Schreiter
- Department of Psychiatry, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Seybold
- Medical Directorate, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Igor Sutej
- Department of Psychiatry, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Salunke AA, Nandy K, Kamani M, Puj K, Pathak S, Patel K, Bhalerao RH, Jain A, Sharma M, Warikoo V, Bhatt S, Rathod P, Pandya S. A proposed ''A to Z RAM (Radiograph Assessment Method)'' for triage of patients with a suspected bone tumour. Radiography (Lond) 2021; 27:823-830. [PMID: 33487526 DOI: 10.1016/j.radi.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/19/2020] [Accepted: 01/01/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION We propose a ''A to Z RAM (Radiograph Assessment Method)'' for evaluation of Radiograph of patients with a suspected bone tumour. METHODS In the current study, ten radiological features with letters 'A, B, C, D, E, F and Z' were used and which included the age of the patient, involved part of the bone, characteristics, content, distinctiveness, the exterior of the bone, fracture, and zone of transition. Four independent observers (orthopaedic oncologists and surgical oncologists) evaluated a set of 30 radiographs of bone tumour selected at random from our hospital database based on A to Z RAM. We classified the lesions into two groups according to the traffic signal system; Green (suspected benign lesion) and Red (suspected malignant lesion). RESULTS There were 18 (60%) benign bone lesions and 12 (40%) malignant lesions in the current study. 91.6% of malignant tumours and 88.8% of the benign tumours were identified correctly by the four observers. The inter-observer variability with Fleiss kappa was 0.884 (95% CI 0.7-1.03 p-value < 0.05), suggestive of agreement not by chance. These radiographs were again reassessed by the four observers after 3 months. The interobserver variability by Fleiss kappa was 1.0 (95% CI 0.8-1.1) suggesting complete agreement amongst the observers. Both orthopaedic oncologists had intra-observer kappa as 1.0 each and both surgical oncologists had 0.795 and 0.930 respectively. CONCLUSION The proposed A to Z RAM is an easy to use and reproducible method for reviewing radiographs in the out-patient department along with clinical findings for better management of patients with suspected bone lesions. The A to Z RAM can be a medical triage tool and subdivide bone lesions into two subgroups i.e. suspected benign lesion with a suggestion of further investigations with MRI and biopsy and suspected malignant lesion with a suggestion of MRI or early referral to a tertiary cancer center with expertise in orthopaedic oncology. IMPLICATIONS FOR PRACTICE The A to Z RAM (Radiologic Assessment Method) is a reproducible method for reviewing radiographs in the out-patient department and can be an aid for better management of patients. A to Z RAM is useful as a medical triage system, subdividing patients according to the probable diagnosis into a suspected benign lesion and suspected malignant lesion.
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Affiliation(s)
- A A Salunke
- Department of Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - K Nandy
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - M Kamani
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - K Puj
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - S Pathak
- Department of Orthopedics, MM University, Ambala, India.
| | - K Patel
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - R H Bhalerao
- Deptartment of Electrical Engineering, IITRAM, Ahmedabad, Gujarat, India.
| | - A Jain
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - M Sharma
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - V Warikoo
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - S Bhatt
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - P Rathod
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - S Pandya
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
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Cornfeld R, Keen R, Baxter A. The Drum Must Beat On: COVID-19 and the U.S. Military's Virtual Health Response in Europe. Telemed J E Health 2020; 27:712-713. [PMID: 33373551 DOI: 10.1089/tmj.2020.0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In response to COVID-19 international restriction of movement laws, the closure of health care facilities, and an ongoing need to support a medically ready force, the U.S. Department of Defense's Virtual Health Europe (VHE) program spearheaded a campaign for synchronous video virtual health (VH) across 42 specialties. Overcoming the challenges of a VH platform designed for nonclinical video teleconferencing, VHE augmented an existing pool of >300 VH-trained providers with an additional 276 providers who collectively performed >4,000 synchronous VH visits between 71 countries from April 2020 through May 2020. Providers proved eager to utilize VH to bring health care to the point of need, however, new challenges emerged highlighted by unreliable and poor connectivity, military-specific network security challenges, and an unfamiliarity with VH etiquette by patients. Addressing the hypothesized third wave of health care demand due to COVID-19 through VH is critical not only for ongoing military readiness requirements, but holds lessons both good and bad for civilian health care delivery as well.
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Affiliation(s)
- Robert Cornfeld
- Virtual Health Europe, Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Ronald Keen
- Virtual Health Europe, Landstuhl Regional Medical Center, Landstuhl, Germany
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Salunke AA, Warikoo V, Kumar Pathak S, Nandy K, Mujawar J, Mendhe H, Shah A, Kottakota V, Menon V, Pandya S. A proposed ABCD scoring system for better triage of patients with COVID-19: Use of clinical features and radiopathological findings. Diabetes Metab Syndr 2020; 14:1637-1640. [PMID: 32892061 PMCID: PMC7448768 DOI: 10.1016/j.dsx.2020.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 08/20/2020] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND AIMS Currently there are limited tools available for triage of patients with COVID -19. We propose a new ABCD scoring system for patients who have been tested positive for COVID-19. METHODS The ABCD score is for patients who have been tested positive for COVID-19 and admitted in a hospital. This score includes age of the patient, blood tests included leukopenia, lymphocytopenia, CRP level, LDH level,D-Dimer, Chest radiograph and CT Scan, Comorbidities and Dyspnea. RESULTS The triage score had letters from alphabets which included A, B, C, D. The score was developed using these variables which outputs a value from 0 to 1. We had used the code according to traffic signal system; green(mild), yellow moderate) and red(severe). The suggestions for mild (green)category: symptomatic treatment in ward, in moderate (yellow) category: active treatment, semi critical care and oxygen supplementation, in severe (red) category: critical care and intensive care. CONCLUSIONS This study is, to our knowledge, is the first scoring tool that has been prepared by Indian health care processional's and used alphabets A, B,C,D as variables for evaluation of admitted patients with COVID-19. This triage tool will be helpful in better management of patients with COVID-19. This score component includes clinical and radiopathological findings.A multi-centre study is required to validate all available scoring systems.
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Affiliation(s)
| | - Vikas Warikoo
- Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | | | - Kunal Nandy
- Gujarat Cancer and Research Institue, Ahmedabad, Gujarat, India
| | | | - Harshal Mendhe
- Department of Preventive and Social Medicine, GMC, Rajandgaon, Chattisgarh, India
| | - Anand Shah
- Department of Preventive and Social Medicine, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | | | - Vivek Menon
- Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Shashank Pandya
- Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
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Reddy DRS, Botz GH. Triage and Prognostication of Cancer Patients Admitted to the Intensive Care Unit. Crit Care Clin 2020; 37:1-18. [PMID: 33190763 DOI: 10.1016/j.ccc.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Cancer remains a leading cause of morbidity and mortality. Advances in cancer screening, early detection, targeted therapies, and supportive care have led to improvements in outcomes and quality of life. The rapid increase in novel cancer therapies can cause life-threatening adverse events. The need for intensive care unit (ICU) care is projected to increase. Until 2 decades ago, cancer diagnosis often precluded ICU admission. Recently, substantial cancer survival has been achieved; therefore, ICU denial is not recommended. ICU resources are limited and expensive; hence, appropriate utilization is needed. This review focuses on triage and prognosis in critically ill cancer patients requiring ICU admission.
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Affiliation(s)
- Dereddi Raja Shekar Reddy
- Department of Critical Care and Respiratory Care, Division of Anesthesiology, Critical Care and Pain Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 112, Houston, TX 77030, USA
| | - Gregory H Botz
- Department of Critical Care and Respiratory Care, Division of Anesthesiology, Critical Care and Pain Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 112, Houston, TX 77030, USA.
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Schiller M, Pilette M, Rahlf B, von See C, Gellrich NC. Management of pandemic or large-scale emergencies in Germany with a focus on the current and potential role of university schools of dentistry: Can it help in COVID-19 time? BULLETIN OF THE NATIONAL RESEARCH CENTRE 2020; 44:174. [PMID: 33024405 PMCID: PMC7530860 DOI: 10.1186/s42269-020-00427-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The study presented here systematically examines the potential involvement of dental, oral and maxillofacial centres (ZMK) in the management of pandemia or in large-scale emergencies. It looks at available material and infrastructural resources and how they can be brought to bear in such incidents or situations. The aim was to gain an initial scientific overview of how ZMK can potentially contribute to the handling of a pandemia or mass casualty (MASCAL) situation in terms of available resources as well as their location within the hospital as a whole and their integration into the existing infrastructure. The study was conducted on the basis of a questionnaire consisting of 70 individual questions, which was sent to all universities in Germany that offer a course of study in dental medicine. The responses were then statistically evaluated. RESULTS The study outlines the current status of ZMK and discusses what could be an important component of emergency medical care in the overall hospital context. CONCLUSION The involvement of ZMK-with their own resources and existing infrastructural links to the hospital as a whole-could lead to faster and more effective patient treatment in the event of a pandemic or MASCAL situation.
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Affiliation(s)
- Marcus Schiller
- Department of Craniomaxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Marijatta Pilette
- Department of Craniomaxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Björn Rahlf
- Department of Craniomaxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Constantin von See
- Department of Dentistry, Danube Privat University, Steiner Landstrasse 124, 3500 Krems-Stein, Austria
| | - N.-C. Gellrich
- Department of Craniomaxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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14
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Mitchell OJL, Edelson DP, Abella BS. Predicting cardiac arrest in the emergency department. J Am Coll Emerg Physicians Open 2020; 1:321-326. [PMID: 33000054 PMCID: PMC7493514 DOI: 10.1002/emp2.12015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 12/03/2022] Open
Abstract
In-hospital cardiac arrest remains a leading cause of death: roughly 300,000 in-hospital cardiac arrests occur each year in the United States, ≈10% of which occur in the emergency department. ED-based cardiac arrest may represent a subset of in-hospital cardiac arrest with a higher proportion of reversible etiologies and a higher potential for neurologically intact survival. Patients presenting to the ED have become increasingly complex, have a high burden of critical illness, and face crowded departments with thinly stretched resources. As a result, patients in the ED are vulnerable to unrecognized clinical deterioration that may lead to ED-based cardiac arrest. Efforts to identify patients who may progress to ED-based cardiac arrest have traditionally been approached through identification of critically ill patients at triage and the identification of patients who unexpectedly deteriorate during their stay in the ED. Interventions to facilitate appropriate triage and resource allocation, as well as earlier identification of patients at risk of deterioration in the ED, could potentially allow for both prevention of cardiac arrest and optimization of outcomes from ED-based cardiac arrest. This review will discuss the epidemiology of ED-based cardiac arrest, as well as commonly used approaches to predict ED-based cardiac arrest and highlight areas that require further research to improve outcomes for this population.
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Affiliation(s)
- Oscar J L Mitchell
- Division of Pulmonary, Allergy, and Critical Care Medicine and the Center for Resuscitation Science Hospital of the University of Pennsylvania Philadelphia Pennsylvania
| | - Dana P Edelson
- Department of Medicine University of Chicago Chicago Illinois
| | - Benjamin S Abella
- Department of Emergency Medicine and the Center for Resuscitation Science University of Pennsylvania School of Medicine Philadelphia Pennsylvania
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15
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Abstract
Since the dawn of humanity, wounds have afflicted humans, and healers have held responsibility for treating them. This article tracks the evolution of wound care from antiquity to the present, highlighting the roles of surgeons, scientists, culture, and society in the ever-changing management of traumatic and iatrogenic injuries.
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Affiliation(s)
- Tiffany Brocke
- Johns Hopkins University, 2418 East Baltimore Street, Baltimore, MD 21224, USA
| | - Justin Barr
- Department of Surgery, Duke University, DUMC 3443, Durham, NC 27710, USA; Department of History, Duke University, DUMC 3443, Durham, NC 27710, USA.
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16
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Linder F, Holmberg L, Bjorck M, Juhlin C, Thorbjornsen K, Wisinger J, Polleryd P, Eklof H, Mani K. A prospective stepped wedge cohort evaluation of the new national trauma team activation criteria in Sweden - the TRAUMALERT study. Scand J Trauma Resusc Emerg Med 2019; 27:52. [PMID: 31039800 PMCID: PMC6492485 DOI: 10.1186/s13049-019-0619-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/25/2019] [Indexed: 11/10/2022] Open
Abstract
Background Trauma triage based on prehospital information facilitates correct allocation of in-hospital resources. The Swedish national two-tier trauma team activation (TTA) criteria were revised in 2016. The current study aimed to evaluate the safety and efficacy of the new criteria. Methods Five centres covering trauma care for 1.2 million inhabitants registered all trauma patients prospectively in the Swedish trauma registry (SweTrau) prior to and after stepwise introduction of new TTA criteria within the cohort (a prospective stepped-wedge cohort study design; period August 2016–November 2017). Evaluation of full- and limited-TTA frequency, under- and overtriage were performed at equal duration before and after this change. Results The centres registered 1948 patients, 1882 (96.6%) of which were included in the study. With new criteria, frequency of full-TTA was unchanged, while limited-TTA decreased with 46.3% (from 988 to 531). 30-day trauma mortality was unchanged. The overtriage was 107/150 (71.3%) with former criteria, and 104/144 (72.2%) with new criteria, p = 0.866. Undertriage was 50/1037 (4.8%) versus 39/551 (7.1%), p = 0.063. Undertriage was consistently > 20% in patients with fall injury. Among patients with Injury Severity Score (ISS) > 15, 50/93 (53.8%) did not initiate full-TTA with former, vs 39/79 (49.4%) with new criteria, p = 0.565. Age > 60-years was a risk factor for undertriage (OR 2.89, p < 0.001), while low fall injuries indicated a trend (OR 2.70, p = 0.051). Conclusions The newly implemented Swedish TTA criteria result in a reduction in limited TTA frequency, indicating an increased efficiency in use of resources. The over- and undertriage is unchanged compared to former criteria, thus upholding patient safety. Electronic supplementary material The online version of this article (10.1186/s13049-019-0619-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fredrik Linder
- Department of Surgical Sciences, Uppsala University, 75185, Uppsala, Sweden.
| | - Lina Holmberg
- Department of Surgical Sciences, Uppsala University, 75185, Uppsala, Sweden
| | - Martin Bjorck
- Department of Surgical Sciences, Uppsala University, 75185, Uppsala, Sweden
| | - Claes Juhlin
- Department of Surgical Sciences, Uppsala University, 75185, Uppsala, Sweden
| | - Knut Thorbjornsen
- Department of Surgical Sciences, Uppsala University, 75185, Uppsala, Sweden.,Department of surgery, Gävle county hospital, Gävle, Sweden
| | - Jan Wisinger
- Department of surgery, Västerås county hospital, Västerås, Sweden
| | - Per Polleryd
- Department of surgery, Karlstad county hospital, Karlstad, Sweden
| | - Hampus Eklof
- Department of Surgical Sciences, Uppsala University, 75185, Uppsala, Sweden
| | - Kevin Mani
- Department of Surgical Sciences, Uppsala University, 75185, Uppsala, Sweden
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17
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Sergi C. Promptly reporting of critical laboratory values in pediatrics: A work in progress. World J Clin Pediatr 2018; 7:105-110. [PMID: 30479975 PMCID: PMC6242778 DOI: 10.5409/wjcp.v7.i5.105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/30/2018] [Accepted: 10/17/2018] [Indexed: 02/06/2023] Open
Abstract
In the 21st century, the determination of alert thresholds remains the most challenging and controversial issue in clinical pediatrics. Pre-analytical, analytical, and post-analytical matters will consolidate or undermine the fate of any laboratory process. Pre-analytical issues need to be cleared off before the laboratory physician can dispatch the result to the pediatrician in charge. Once it is cleared off, the classification of essential laboratory results is paramount. It is more than an academic exercise and may be subdivided in the order of priority we handle it to inform promptly and safely the primary physicians. Currently, we are applying new modes of making sure relevant information is transmitted without interrupting the standard workflow of the primary physicians in charge for the child, who eventually need a fast line of action for results that may be life-threatening.
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Affiliation(s)
- Consolato Sergi
- Department of Laboratory Medicine and Pathology, Stollery Children’s Hospital, University of Alberta, Edmonton, AB T6G 2B7, Canada
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18
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Khodaie SA, Ghaffari F, Zargaran A, Naseri M. Hakim Mohammad: A Persian Military Surgeon in Safavid Era (1501-1736 CE). World J Surg 2018; 42:2421-2427. [PMID: 29290071 DOI: 10.1007/s00268-017-4410-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Wars and injuries have accompanied mankind throughout history. Physicians and surgeons from various civilizations made difficult attempts to manage wounds and injuries. Among various civilizations, the Persian Empires had great armies which were well equipped. One of the most important organizations in Persian troops was the military surgery. METHODS This study presents a brief biography of Hakim Mohammad (a military surgeon in Safavid era) and introduces his book, Dhakhira-yi-Kamilah. RESULTS AND DISCUSSION Safavid kings (1501-1736 CE) with unifying all of Persian regions and provinces reconstructed the Persian Empire. Great scholars and physicians were raised in this era. It seems that Persian physicians and surgeons were well trained in Safavid era and many of them were even employed by other countries like Ottoman Empire and India. Hakim Mohammad as a military surgeon was one of such physicians who served in Ottoman Empire for some time. He gathered his surgical experiences and others in the book of Dhakhira-yi-Kamilah. This book was written in Persian. He has mainly written about the management of wounds and practical techniques. Later, he came back to his homeland and dedicated his book to the king of Persia.
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Affiliation(s)
- S-Ali Khodaie
- Department of Iranian Traditional Medicine, Faculty of Medicine, Shahed University, Tehran, Iran.,Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Farzaneh Ghaffari
- School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arman Zargaran
- Department of History of Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Research Office for the History of Persian Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Naseri
- Traditional Medicine Clinical Trial Research Center, Shahed University, Tehran, Iran.
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19
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Ramdhan RC, Rai R, Brooks KN, Iwanaga J, Loukas M, Tubbs RS. Dominique Jean Larrey (1766-1842) and His Contributions to Military Medicine and Early Neurosurgery. World Neurosurg 2018; 120:96-99. [PMID: 30172978 DOI: 10.1016/j.wneu.2018.08.159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 11/25/2022]
Abstract
Dr. Dominique Jean Larrey was a pioneer in the field of military surgery. His creative innovation and drive to improve the quality of medical services available to those injured during war guided his achievements in medicine. Dr. Larrey has often been referred to as "the father of emergency medical services" and "the father of modern military medicine." His contributions to medicine continue to live on in common procedures and healthcare systems today, such as aspiration of pericardial effusion and drainage of hemothorax and empyema. Based on his own writings, he treated multiple cases of intracranial injury, making him an early, but often forgotten, pioneer of neurosurgery.
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Affiliation(s)
- Rebecca C Ramdhan
- Department of Anatomical Sciences, St. George's University, Grenada, West Indies
| | - Rabjot Rai
- Department of Anatomical Sciences, St. George's University, Grenada, West Indies
| | | | - Joe Iwanaga
- Seattle Science Foundation, Seattle, Washington, USA.
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, Grenada, West Indies
| | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University, Grenada, West Indies; Seattle Science Foundation, Seattle, Washington, USA
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20
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Binder M, Quade L. Death on a Napoleonic battlefield - Peri-mortem trauma in soldiers from the Battle of Aspern 1809. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2018; 22:66-77. [PMID: 29886352 DOI: 10.1016/j.ijpp.2018.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/28/2018] [Accepted: 05/30/2018] [Indexed: 06/08/2023]
Abstract
On the 21st-22nd of May1809 Napoleon Bonaparte saw his first major defeat on land at the Battle of Aspern, just north-east of Vienna. Of the 167,000 soldiers who fought for the French and Austrian armies, a total of 55,000 died on the battlefield. Salvage excavations prior to the construction of large urban development project (2008-2016) have revealed several burial sites related to the Battle of Aspern. The skeletal remains of 30 soldiers were excavated and underwent a detailed bioarchaeological study to elucidate both the impact of 19th-century military conditions on soldiers in life, as well as how they died on the battlefield. This paper presents the analysis of peri-mortem trauma observed in 21 of the 30 skeletons (70.0%) excavated from the battlefield of Aspern. Following standard criteria in forensic and palaeopathological trauma studies, this study revealed a predominance of ballistic trauma (20 cases in 17 individuals), while only nine individuals (eleven cases) displayed evidence of blunt force trauma. By contrast, no evidence of sharp force trauma was identified in the skeletal remains. These results are discussed within the historic context of the Napoleonic Wars to reconstruct causes of injury and circumstances of death.
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Affiliation(s)
- Michaela Binder
- Austrian Archaeological Institute, Austrian Academy of Sciences, Franz Klein-Gasse 1, 1190, Vienna, Austria.
| | - Leslie Quade
- Department of Archaeology, Durham University, South Road, DH13LE, Durham, UK
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21
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START versus SALT Triage: Which is Preferred by the 21st Century Health Care Student? Prehosp Disaster Med 2018; 33:381-386. [PMID: 30001759 DOI: 10.1017/s1049023x18000547] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
IntroductionWhile the art and science of disaster triage continue to evolve, the education of the US health care student in matters pertaining to disaster preparedness and response remains stifled. Unfortunately, these students will be assuming major decision-making responsibilities regarding catastrophes that will be complicated by climate change, nuclear threats, global terrorism, and pandemics. Meanwhile, Sort, Assess, Life-Saving Interventions, Treatment, and/or Transport (SALT) triage is being advocated over the globally popular Simple Triage and Rapid Treatment (START) algorithm for multiple reasons: (1) it's an all-hazard approach; (2) it has four medical interventions; and (3) it has an additional triage color for victims with non-survivable injuries.Hypothesis/ProblemAs present-day threats become more ominous and health care education emphasizes the needs of vulnerable populations and palliative care, the authors hypothesize that, when given a choice, health care students will prefer SALT triage. METHODS A convenience sample of 218 interprofessional, disaster-naïve health care students received just-in-time, unbiased education on both START and SALT triage systems. Students then completed a survey asking them to decide which triage system they believe would be most effective in their community. RESULTS A total of 123 health care students (56.4%) preferred SALT while 95 (43.6%) preferred START; however, only the physician assistant students showed a statistically significantly preference (28 versus six, respectively; P=.042). Interestingly, there was also a statistically significant difference in preference by gender (Chi-square=5.02; P=.025) of the observed distribution versus expected distribution in SALT and START. The females preferred SALT (61.0%) while the males preferred START (55.9%).Among those who preferred START, START being easier to learn was the most important reason cited. Among those who preferred SALT, the most important reason cited was that the number of patient triage categories seemed more logical, comprehensible, and consistent with traditional medical care. CONCLUSION While SALT's preference among females and physician assistant students was based on the addition of medical interventions and the provision of palliative care, START's preference was related to expediency. Based on this research, incorporating disaster concepts into US health care students' curricula encourages thoughtful consideration among the future health care leaders about the most effective approach to triage care. It is critical that further research be completed to determine, without reservation, which triage system will not only save the most lives but provide the most humane care to victims.Fink BN, Rega PP, Sexton ME, Wishner C. START versus SALT triage: which is preferred by the 21st century health care student? Prehosp Disaster Med. 2018;33(4):381-386.
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22
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23
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Ranjan CK, Renjhen P. Casualty Air Evacuation: Sine quo non of combat casualty. Med J Armed Forces India 2017; 73:394-399. [PMID: 29386717 DOI: 10.1016/j.mjafi.2017.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 08/24/2017] [Indexed: 11/16/2022] Open
Abstract
Management of combat casualties has always been a challenging task. Armed Forces world over have developed effective casualty air evacuation mechanisms. The history of casualty evacuation dates back to 1870s. The first evacuation of casualty by air was during the First World War. The paper highlights the background and evolution of air evacuation in the world and discusses the Indian Scenario of casualty air evacuation. The casualty evacuation capabilities of the aircrafts in the Indian Air Force (IAF) are highlighted. To ensure prompt casualty evacuation, the Armed Forces have a chain of casualty air evacuation, thus ensuring that the injured reach the health care center in the least possible time. An indigenously developed patient transfer unit (PTU) comprising of a trauma care recovery trolley with a complement of a portable ventilator, multipara monitor, infusion pumps and oxygen system is also discussed. In addition, the paper discusses the aeromedical considerations while evacuating casualties by air and contraindications for air evacuation. The advancements in the field of medical technology and medical care has ensured safe air evacuation of casualties and has reduced the morbidity and mortality of casualties, thus boosting the morale of the troops.
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Affiliation(s)
- C K Ranjan
- Director & Commandant, Armed Forces Medical College, Pune 411040, India.,Chairman, Editorial Board, Medical Journal Armed Forces India, Armed Forces Medical College, Pune 411040, India
| | - Piush Renjhen
- Senior Adviser (Aviation Medicine), Air HQ, New Delhi, India
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24
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Nakao H, Ukai I, Kotani J. A review of the history of the origin of triage from a disaster medicine perspective. Acute Med Surg 2017; 4:379-384. [PMID: 29123897 PMCID: PMC5649292 DOI: 10.1002/ams2.293] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/30/2017] [Indexed: 12/12/2022] Open
Abstract
We usually associate triage with the Simple Triage and Rapid Treatment method, but much of its origin is still unknown. Therefore, French studies and the origin of triage shown in domestic and foreign published works have been investigated and its significance reaffirmed. The etymology of the word “triage” means “to break into three pieces.” It was suggested by a literature review that the rise of Napoleon led to military tactical changes, and that the prototype of triage arose from the experience gained in the difficult campaign in Egypt and Syria. Subsequently, triage was refined by Napoleon's military surgeon, D. J. Larrey, who created the ambulance transport system. Although there is a clash between the ruthless and philanthropic aspects of triage, triage is in accordance with the primary purpose of evacuation or treatment. We should choose the triage method that is consistent with the purpose of each disaster situation.
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Affiliation(s)
- Hiroyuki Nakao
- Department of Emergency Disaster and Critical Care Medicine Hyogo Medical College of Medicine Nishinomiya Hyogo Japan
| | - Isao Ukai
- Trauma and Resuscitation Center Hyogo Prefectural Nishinomia Hospital Nishinomiya Hyogo Japan
| | - Joji Kotani
- Department of Emergency Disaster and Critical Care Medicine Hyogo Medical College of Medicine Nishinomiya Hyogo Japan
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25
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Abstract
IMPORTANCE The role of obstetric triage in the care of pregnant women has expanded significantly. Factors driving this change include the Emergency Medical Treatment and Active Labor Act, improved methods of testing for fetal well-being, increasing litigation risk, and changes in resident duty hour guidelines. The contemporary obstetric triage facility must have processes in place to provide a medical screening examination that complies with regulatory statues while considering both the facility's maternal level of care and available resources. OBJECTIVE This review examines the history of the development of obstetric triage, current considerations in a contemporary obstetric triage paradigm, and future areas for consideration. An example of a contemporary obstetric triage program at an academic medical center is presented. RESULT A successful contemporary obstetric triage paradigm is one that addresses the questions of "sick or not sick" and "labor or no labor," for every obstetric patient that presents for care. Failure to do so risks poor patient outcome, poor patient satisfaction, adverse litigation outcome, regulatory scrutiny, and exclusion from federal payment programs. CONCLUSIONS Understanding the role of contemporary obstetric triage in the current health care environment is important for both providers and health care leadership. TARGET AUDIENCE This study is for obstetricians and gynecologists as well as family physicians. LEARNING OBJECTIVES After completing this activity, the learner should be better able to understand the scope of a medical screening examination within the context of contemporary obstetric triage; understand how a facility's level of maternal care influences clinical decision making in a contemporary obstetric triage setting; and understand the considerations necessary for the systematic evaluation of the 2 basic contemporary obstetric questions, "sick or not sick?" and "labor or no labor?"
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26
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Kumutha J, Rao GVR, Sridhar BN, Vidyasagar D. The GVK EMRI maternal and neonatal transport system in India: a mega plan for a mammoth problem. Semin Fetal Neonatal Med 2015. [PMID: 26212526 DOI: 10.1016/j.siny.2015.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Maternal and infant mortality has been a major concern in India with the Government taking serious efforts to achieve the Millennium Development Goals by 2015. Ganapathy Venkata Krishna Reddy Emergency Management and Research Institute (GVK EMRI) is one such effort and is the country's first emergency service provider working under the public-private partnership model to provide emergency response services and quality pre-hospital care to any sick person, pregnant mothers, and sick neonates. Since the introduction of the emergency medical services, institutional deliveries have increased in all states and union territories where the ambulances have been deployed and the majority of mothers have been provided the required emergency care at the appropriate time. This in turn has helped in considerably reducing the maternal mortality. GVK EMRI has partnered with the government of Tamil Nadu and deployed specialized neonatal ambulances to ensure safe transport of newborns. The safe transport of sick, vulnerable neonates and the improvement in survival of transported neonates over the years advocate scaling up of this program to other states, which would greatly contribute towards reducing infant and neonatal mortality.
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Affiliation(s)
- J Kumutha
- Department of Neonatology, Institute of Child Health & Hospital for Children, Chennai, Tamil Nadu, India.
| | - G V Ramana Rao
- Emergency Medicine Learning Centre (EMLC) & Research, GVK Emergency Management and Research Institute, Secunderabad, Andhra Pradesh, India
| | - B N Sridhar
- Emergency Medicine Learning Centre (EMLC) & Research, GVK Emergency Management and Research Institute, Secunderabad, Andhra Pradesh, India
| | - D Vidyasagar
- Division of Neonatology, University of Illinois at Chicago, Chicago, IL, USA
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27
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Staruch RM, Hettiaratchy S. Military plastic surgery. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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28
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Goniewicz M. Effect of military conflicts on the formation of emergency medical services systems worldwide. Acad Emerg Med 2013; 20:507-13. [PMID: 23672366 DOI: 10.1111/acem.12129] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 08/20/2012] [Accepted: 12/02/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This article briefly reviews the evolution of medical support during wars and conflicts from ancient to modern times and discusses the effect warfare has had on the development of civilian health care and emergency medical services (EMS). Medical breakthroughs and discoveries made of necessity during military conflicts have developed into new paradigms of medical care, including novel programs of triage and health assessment, emergency battlefield treatment and stabilization, anesthesia, and other surgical and emergency procedures. The critical role of organizations that provide proper emergency care to help the sick and injured both on the battlefield and in the civilian world is also highlighted.
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Affiliation(s)
- Mariusz Goniewicz
- Faculty of Health Sciences; School of Economics and Law; Kielce; Poland
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29
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Katoch R, Rajagopalan S. Warfare Injuries: History, Triage, Transport and Field Hospital Setup in the Armed Forces. Med J Armed Forces India 2010; 66:304-8. [PMID: 27365730 PMCID: PMC4919805 DOI: 10.1016/s0377-1237(10)80003-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The treatment of war wounds has been an ancient art, constantly refined and adapted to reflect improvements in warfare strategies, weapons technology, transportation and damage control surgical practices. Throughout history, more soldiers died from disease than combat wounds, and misconceptions regarding the best timing and mode of treatment for injuries often resulted in more harm than good. Since the 19th century, mortality from war wounds steadily decreased as surgeons developed systems for rapidly moving the wounded from the battlefield to frontline hospitals. This article reviews the trends in military trauma management including triage, evacuation and field hospital setup in the Armed Forces.
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Affiliation(s)
- R Katoch
- Commandant, Military Hospital, Jabalpur
| | - S Rajagopalan
- Professor & HOD, Department of Surgery, AFMC, Pune-40
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30
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Dominique-Jean Larrey: the effects of therapeutic hypothermia and the first ambulance. Resuscitation 2009; 81:268-71. [PMID: 20036046 DOI: 10.1016/j.resuscitation.2009.11.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2009] [Revised: 10/15/2009] [Accepted: 11/05/2009] [Indexed: 11/21/2022]
Abstract
The fields of emergency medicine and resuscitation are indebted to the Baron Dominique-Jean Larrey (1766-1842) for significant advances in patient care. Larrey was a great surgeon who served in the French army during Napoleon's rule. He developed one of the first ambulance services, utilized positive pressure ventilation, and introduced hypothermia as a form of therapy. He dedicated his professional life to improving the care of wounded soldiers on the battlefield. Larrey coined the term "Triage" to allocate resources to those most in need of emergent care. Today, many of his techniques still prevail in modern medicine.
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31
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Manring MM, Hawk A, Calhoun JH, Andersen RC. Treatment of war wounds: a historical review. Clin Orthop Relat Res 2009; 467:2168-91. [PMID: 19219516 PMCID: PMC2706344 DOI: 10.1007/s11999-009-0738-5] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Accepted: 01/27/2009] [Indexed: 01/31/2023]
Abstract
The treatment of war wounds is an ancient art, constantly refined to reflect improvements in weapons technology, transportation, antiseptic practices, and surgical techniques. Throughout most of the history of warfare, more soldiers died from disease than combat wounds, and misconceptions regarding the best timing and mode of treatment for injuries often resulted in more harm than good. Since the 19th century, mortality from war wounds steadily decreased as surgeons on all sides of conflicts developed systems for rapidly moving the wounded from the battlefield to frontline hospitals where surgical care is delivered. We review the most important trends in US and Western military trauma management over two centuries, including the shift from primary to delayed closure in wound management, refinement of amputation techniques, advances in evacuation philosophy and technology, the development of antiseptic practices, and the use of antibiotics. We also discuss how the lessons of history are reflected in contemporary US practices in Iraq and Afghanistan.
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Affiliation(s)
- M. M. Manring
- Department of Orthopaedic Surgery, University of Missouri-Columbia, Columbia, MO USA
| | - Alan Hawk
- National Museum of Health and Medicine, Armed Forces Institute of Pathology, Washington, DC USA
| | - Jason H. Calhoun
- Department of Orthopaedic Surgery, The Ohio State University, N1043 Doan Hall, 410 W 10th Ave, Columbus, OH 43210-1228 USA
| | - Romney C. Andersen
- Orthopaedic Traumatology, Walter Reed National Military Medical Center, Bethesda, MD USA
- Orthopaedic Traumatology, Walter Reed National Military Medical Center, Washington, DC USA
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Allison CE, Trunkey DD. Battlefield trauma, traumatic shock and consequences: war-related advances in critical care. Crit Care Clin 2009; 25:31-45, vii. [PMID: 19268793 DOI: 10.1016/j.ccc.2008.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Over the course of history, while the underlying causes for wars have remained few, mechanisms of inflicting injury and our ability to treat the consequent wounds have dramatically changed. Success rates in treating war-related injuries have improved greatly, although the course of progress has not proceeded linearly. From Homer's Iliad to the Civil War to Vietnam, there have been significant improvements in mortality, despite a concurrent increase in the lethality of weapons. These improvements have occurred primarily as a result of progress in three key areas: management of wounds, treatment of shock, and systems of organization.
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Affiliation(s)
- Carrie E Allison
- Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
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Nicoli Aldini N, Fini M, Giardino R. From Hippocrates to tissue engineering: surgical strategies in wound treatment. World J Surg 2009; 32:2114-21. [PMID: 18581166 DOI: 10.1007/s00268-008-9662-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The history of wound treatment has been virtually the history of surgery for many centuries and also is a history of alliance and conflicts between the physician and nature. The Hippocratic statement about natura medicatrix has been well known since antiquity, but often was neglected. Suppuration was considered a necessary event in the healing process and was elicited by the surgeons with traumatic and painful procedures. The concept of simplicity in treating the wounds was suggested by Teodorico Borgognone and Henry de Mondeville in 13th century and was confirmed only three centuries later by the works of Ambroise Paré and Cesare Magati. The history of wound management has been characterized by empiricism since the 18th century, but it took a physiopathological direction during the 19th century when Virchow investigated tissue reaction to injuries, and Lister introduced antiseptic procedures in surgery. By establishing the basis for a biological method to treat wounds, the seeds were sown to enhance the pathways involved in tissue repair, also with the support of new strategies and technology.
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Affiliation(s)
- Nicolò Nicoli Aldini
- Department of Experimental Surgery, Research Institute Codivilla-Putti - Rizzoli Orthopaedic Institute, Via di Barbiano, 1/10, 40136 Bologna, Italy.
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