-PLUS prehospital mass-casualty triage: a strategy for addressing unusual injury mechanisms.
Introduction: Simple Triage and Rapid Treatment (START) and more recently developed prehospital casualty triage algorithms are widely used, in part because they are easy to teach and learn, and can be performed rapidly. Every rapid triage protocol has inherent, significant limitations: (1) no mechan...
| Publicado en: | Prehospital & Disaster Medicine Vol. 25; no. 3; pp. 227 - 237 |
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| Autores principales: | , , , , , |
| Formato: | algorithm research tables/charts Journal Article |
| Publicado: |
Cambridge University Press
2010 May-Jun
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105065094&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 105065094 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 1049023X YX6 jtl: Prehospital & Disaster Medicine issn: 1049023X maglogo: N pubinfo: dt: 2010 May-Jun vid: 25 iid: 3 pid: 15979 pub: Cambridge University Press artinfo: ui: 105065094 105065094 NLM20586016 2010727197 10.1017/s1049023x00008086 NLM20586016 105065094 ppf: 227 ppct: 10 formats: tig: atl: -PLUS prehospital mass-casualty triage: a strategy for addressing unusual injury mechanisms. aug: au: Neal DJ Barbera JA Harrald JR Neal, Daniel J Barbera, Joseph A Harrald, John R affil: George Washington University, Washington, DC, USA sug: subj: Mass Casualty Incidents Prevention and Control Triage Methods Wounds and Injuries Physiopathology Academic Medical Centers Burn Patients Evaluation Delphi Technique Early Intervention Emergency Medical Services Methods Female Health Personnel Mass Casualty Training Methods Pregnancy Evaluation Prehospital Care Smoke Inhalation Injury Prevention and Control Wounds and Injuries Therapy Wounds, Penetrating Diagnosis Female ab: Introduction: Simple Triage and Rapid Treatment (START) and more recently developed prehospital casualty triage algorithms are widely used, in part because they are easy to teach and learn, and can be performed rapidly. Every rapid triage protocol has inherent, significant limitations: (1) no mechanism of injury (MOI) considerations; (2) limited assessment points; and (3) no refinement in truly mass-casualty situations where transport of "minor" or "moderate" patients may be delayed.Hypothesis: When rapid initial triage protocols are utilized, a significant triage deficiency ("under-triage") may occur when "minor" or "moderate" casualties actually are more severely injured than initially triaged. Some MOI produce casualties with subtle or latent (i.e., hidden or delayed) signs and symptoms not considered in the commonly used prehospital triage algorithms. This research did not focus on START or other initial triage screening methods. Instead, it focuses on developing follow-on triage guidance to more specifically prioritize "delayed transport" casualties based upon signs and symptoms related to their MOI.Methods: Using expert opinion and accepted clinical criteria, triage algorithms were developed to re-evaluate patients triaged to "minor" and "moderate" cohorts. A detailed literature search produced a draft list of relevant signs and symptoms for each selected MOI. The lists then were evaluated by a multi-disciplinary panel of experts via an anonymous, mail-based Delphi method. The input shaped triage algorithms for each selected MOI, which then were subjected to a second stage Delphi process.Results: Consensus was achieved using the Delphi method. The algorithms extend patient assessment beyond the rapid initial triage protocols and incorporate triage criteria specific to each selected injury mechanism or condition: (1) penetrating injuries; (2) unconventional MOI (burns, blast, chemical, radiation); (3) smoke and other inhalation exposure; and (4) injuries with concomitant pregnancy. The full list of triage protocols is designated by the acronym "-PLUS".Conclusions: "-PLUS" Prehospital Casualty Triage may supplement the strengths of already existing, widely accepted mass-casualty triage strategies. It does not displace START or other rapid initial triage protocols, but in mass-casualty situations with extensive delays in transport, it provides a method to identify under-triage of seriously injured casualties. "-PLUS" also presents a framework for capturing the triage considerations used by experienced medical providers, and so may provide a valuable teaching tool for training future triage professionals. Further research and field assessment is required. pubtype: Academic Journal doctype: algorithm research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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