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This board is owned by Matt Holland, LKS ASE, Librarian. Contact Matt.Holland@nwas.nhs.uk

PINBOARD SUMMARY

Recent research on the prehospital response to major incidents, disasters, CBRN and major incidents.

Coverage

This board collates published research on the prehospital response to major incidents, disasters, Chemical Biological Radiological and Nuclear (CBRN) incidents and mass casualty events.

Audience

The board is aimed at those working in the area of Emergency Preparedness Resilience and Response. Anyone can look.

Updates

The board is updated regularly. Somewhere between daily and weekly depending on the volume of publication.

Who is responsible

This board is maintained and run by Matt Holland, Librarian LKS ASE Matt.Holland@nwas.nhs.uk

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Check the LKS ASE website to find out more about us. Follow us on Twitter, our Twitter handle is @NWASLibrary.

342 ITEMS PINNED

Research participation among state and local public health emergency preparedness and response programs.

Abstract: The objective of our study was to assess whether state and local health staff participated in public health emergency preparedness research activities and what partner organizations they collaborated with on research. This is a cross-sectional study. Data were derived from a 2014 web-based survey of state, territorial, and local health departments conducted by the Centers for Disease Control and Prevention and NORC at the University of Chicago as part of a larger project to assess the public health emergency preparedness and response research priorities of state and local health departments. Overall, 30% of survey respondents indicated that health department staff were involved in public health preparedness and response research-related activities. Thirty-four percent indicated that they were extremely or moderately familiar with emergency preparedness research and literature. Approximately 67% of respondents reported interest in receiving additional information and/or training related to the preparedness research and literature. The most frequently reported partners for collaboration in preparedness research-related activities were schools of public health (34%). Our findings suggest that there is health department interest in learning more about preparedness and response science and that additional efforts are needed to increase health department participation in public health emergency preparedness and response research-related activities. Published by Elsevier Ltd.

Pub.: 21 Apr '18, Pinned: 29 Apr '18

Influence of Entrapment on Prehospital Management and the Hospital Course in Polytrauma Patients: A Retrospective Analysis in Air Rescue.

Abstract: Entrapment is a challenging and crucial factor in the prehospital setting. Few studies have addressed whether entrapment has an influence on on-scene treatment or on the following hospital course. Here we aimed to investigate the influence of entrapment on prehospital management and on the hospital course of polytrauma patients. We performed a retrospective analysis of consecutive patients with an Injury Severity Score ≥16 and aged 16-65 years that were admitted between 2005 and 2013 to a Level I trauma center. Two groups were built: entrapped (E) and nonentrapped patients (nE). These groups were evaluated for multiple prehospital and clinical parameters, including on-scene time, prehospital interventions, and posttraumatic complications. There were 310 patients (n = 194 no entrapment [Group nE], n = 116 with entrapment [Group E]) enrolled. The on-scene time was significantly longer in Group E than Group nE. Moreover, this group received a significantly higher volume of colloidal solution. Regarding the Injury Severity Score and Abbreviated Injury Scale (AIS), there were no significant differences between the groups, except for the AIS, which was significantly increased in Group E. The overall hospital stay and the initial theater time were significantly longer in Group E than Group nE. No significant differences were present for the occurrence of systemic inflammatory response syndrome, multiple organ dysfunction syndrome, and acute respiratory distress syndrome, nor for Acute Physiology and Chronic Health Evaluation II and estimated and final mortality. In polytraumatized patients, entrapment has a minor influence on the outcome and treatment in the prehospital and hospital setting when using physician-based air rescue. However, entrapped patients are prone to sustain more severe trauma to the extremities. Copyright © 2018 Elsevier Inc. All rights reserved.

Pub.: 24 Apr '18, Pinned: 29 Apr '18

Fatal Wounding Pattern and Causes of Potentially Preventable Death Following the Pulse Night Club Shooting Event.

Abstract: Mortality following shooting is related to time to provision of initial and definitive care. An understanding of the wounding pattern, opportunities for rescue, and incidence of possibly preventable death is needed to achieve the goal of zero preventable deaths following trauma. A retrospective study of autopsy reports for all victims involved in the Pulse Nightclub Shooting was performed. The site of injury, probable site of fatal injury, and presence of potentially survivable injury (defined as survival if prehospital care is provided within 10 minutes and trauma center care within 60 minutes of injury) was determined independently by each author. Wounds were considered fatal if they involved penetration of the heart, injury to any non-extremity major blood vessel, or bihemispheric, mid-brain, or brainstem injury. There were an average of 6.9 wounds per patient. Ninety percent had a gunshot to an extremity, 78% to the chest, 47% to the abdomen/pelvis, and 39% to the head. Sixteen patients (32%) had potentially survivable wounds, 9 (56%) of whom had torso injuries. Four patients had extremity injuries, 2 involved femoral vessels and 2 involved the axilla. No patients had documented tourniquets or wound packing prior to arrival to the hospital. One patient had an isolated C6 injury and 2 victims had unihemispheric gunshots to the head. A comprehensive strategy starting with civilian providers to provide care at the point of wounding along with a coordinated public safety approach to rapidly evacuate the wounded may increase survival in future events.

Pub.: 26 Apr '18, Pinned: 29 Apr '18

Analysis of Medical Responses in Mass Gatherings: The Commemoration Ceremonies for the 100th Anniversary of the Battle of Gallipoli.

Abstract: IntroductionMass crowds outside the routine population create a burden of disease on Emergency Medical Services (EMS). The need for EMS in various mass-crowd events may vary. It is especially important to determine the EMS requirement that emerges during the historic commemoration ceremonies in Çanakkale (Turkey).Hypothesis/ProblemThis study aims to determine the unique challenges in the planning of EMS responses provided for people from various countries at the commemoration ceremony for a 100-year-old war and to identify the medical provision of those services. This descriptive study examined the patient applications in the Çanakkale EMS at the commemoration ceremonies for the 100th anniversary of Gallipoli Wars (Çanakkale Amphibious Wars - Turkey) on April 24-25, 2015. A total of 221 cases were handled by 112 EMS in the ceremony area. Of those, 87.3% of the cases applied to a mobile operating room (MOR) stationed in the ceremony area while 12.7% of them applied directly to the health care team in a large area in the ceremony area. Overall, 13.1% of the cases were transferred to the hospital for further evaluation and treatment. Patient presentation rate (PPR) of the patients who were treated during the two days was 4.42, and transfer to hospital rate (TTHR) of the cases transferred to the hospital was calculated to be 0.58. Further studies may create models in regard to the estimations on mass and needs based on the data of previous organizations. KoçakH, ÇalışkanC, SönmezlerMS, EliuzK, KüçükdurmazF. Analysis of medical responses in mass gatherings: the commemoration ceremonies for the 100th anniversary of the Battle of Gallipoli.

Pub.: 26 Apr '18, Pinned: 29 Apr '18

International Emergency Medical Teams Training Workshop Special Report.

Abstract: The World Health Organization's (WHO; Geneva, Switzerland) Emergency Medical Team (EMT) Initiative created guidelines which define the basic procedures to be followed by personnel and teams, as well as the critical points to discuss before deploying a field hospital. However, to date, there is no formal standardized training program established for EMTs before deployment. Recognizing that the World Association of Disaster and Emergency Medicine (WADEM; Madison, Wisconsin USA) Congress brings together a diverse group of key stakeholders, a pre-Congress workshop was organized to seek out collective expertise and to identify key EMT training competencies for the future development of training programs and protocols. The future of EMT training should include standardization of curriculum and the recognition or accreditation of selected training programs. The outputs of this pre-WADEM Congress workshop provide an initial contribution to the EMT Training Working Group, as this group works on mapping training, competencies, and curriculum. Common EMT training themes that were identified as fundamental during the pre-Congress workshop include: the ability to adapt one's professional skills to low-resource settings; context-specific training, including the ability to serve the needs of the affected population in natural disasters; training together as a multi-disciplinary EMT prior to deployment; and the value of simulation in training. AlbinaA, ArcherL, BoivinM, CranmerH, JohnsonK, KrishnarajG, ManeshiA, OddyL, Redwood-CampbellL, RussellR. International Emergency Medical Teams training workshop special report.

Pub.: 27 Apr '18, Pinned: 29 Apr '18

Primary mass casualty incident triage: evidence for the benefit of yearly brief re-training from a simulation study

Abstract: Triage is a mainstay of early mass casualty incident (MCI) management. Standardized triage protocols aim at providing valid and reproducible results and, thus, improve triage quality. To date, there is little data supporting the extent and content of training and re-training on using such triage protocols within the Emergency Medical Services (EMS). The study objective was to assess the decline in triage skills indicating a minimum time interval for re-training. In addition, the effect of a one-hour repeating lesson on triage quality was analyzed.A dummy based trial on primary MCI triage with yearly follow-up after initial training using the ASAV algorithm (Amberg-Schwandorf Algorithm for Primary Triage) was undertaken. Triage was assessed concerning accuracy, sensitivity, specificity, over-triage, under-triage, time requirement, and a comprehensive performance measure. A subgroup analysis of professional paramedics was made.Nine hundred ninety triage procedures performed by 51 providers were analyzed. At 1 year after initial training, triage accuracy and overall performance dropped significantly. Professional paramedic’s rate of correctly assigned triage categories deteriorated from 84 to 71%, and the overall performance score decreased from 95 to 90 points (maximum = 100). The observed decline in triage performance at 1 year after education made it necessary to conduct re-training. A brief didactic lecture of 45 min duration increased accuracy to 88% and the overall performance measure to 97.To improve disaster preparedness, triage skills should be refreshed yearly by a brief re-education of all EMS providers.

Pub.: 27 Apr '18, Pinned: 29 Apr '18

Comparison of Electronic Versus Manual Mass-Casualty Incident Triage.

Abstract: IntroductionMass-casualty incidents (MCIs) easily overwhelm a health care facility's human and material resources through the extraordinary influx of casualties. Efficient and accurate triage of incoming casualties is a critical step in the hospital disaster response.Hypothesis/ProblemTraditionally, triage during MCIs has been manually performed using paper cards. This study investigated the use of electronic Simple Triage and Rapid Treatment (START) triage as compared to the manual method. This observational, crossover study was performed during a live MCI simulation at an urban, Canadian, Level 1 trauma center on May 26, 2016. Health care providers (two medical doctors [MDs], two paramedics [PMs], and two registered nurses [RNs]) each triaged a total of 30 simulated patients - 15 by manual (paper-based) and 15 by electronic (computer-based) START triage. Accuracy of triage categories and time of triage were analyzed. Post-simulation, patients and participating health care providers also completed a feedback form. There was no difference in accuracy of triage between the electronic and manual methods overall, 83% and 80% (P=1.0), between providers or between triage categories. On average, triage time using the manual method was estimated to be 8.4 seconds faster (P<.001) for PMs; and while small differences in triage times were observed for MDs and RNs, they were not significant. Data from the participant feedback survey showed that the electronic method was preferred by most health care providers. Patients had no preference for either method. However, patients perceived the computer-based method as "less personal" than the manual triage method, but they also perceived the former as "better organized." Hospital-based electronic START triage had the same accuracy as hospital-based manual START triage, regardless of triage provider type or acuity of patient presentations. Time of triage results suggest that speed may be related to provider familiarity with a modality rather than the modality itself. Finally, according to patient and provider perceptions, electronic triage is a feasible modality for hospital triage of mass casualties. Further studies are required to assess the performance of electronic hospital triage, in the context of a rapid surge of patients, and should consider additional efficiencies built in to electronic triage systems. This study presents a framework for assessing the accuracy, triage time, and feasibility of digital technologies in live simulation training or actual MCIs. BolducC, MaghrabyN, FokP, LuongTM, HomierV. Comparison of electronic versus manual mass-casualty incident triage.

Pub.: 18 Apr '18, Pinned: 24 Apr '18

Comparison of Thermal Manikin Modeling and Human Subjects' Response During Use of Cooling Devices Under Personal Protective Ensembles in the Heat.

Abstract: IntroductionPersonal protective equipment (PPE) recommended for use in West Africa during the Ebola outbreak increased risk for heat illness, and countermeasures addressing this issue would be valuable.Hypothesis/ProblemThe purpose of this study was to examine the physiological impact and heat perception of four different personal cooling devices (PCDs) under impermeable PPE during low-intensity exercise in a hot and humid environment using thermal manikin modeling and human testing. Six healthy male subjects walked on a treadmill in a hot/humid environment (32°C/92% relative humidity [RH]) at three metabolic equivalents (METs) for 60 minutes wearing PPE recommended for use in West Africa and one of four different personal cooling devices (PCDs; PCD1, PCD2, PCD3, and PCD4) or no PCD for control (CON). The same ensembles were tested with thermal manikin modeling software in the same conditions to compare the results. All PCDs seemed to reduce physiological heat stress characteristics when worn under PPE compared to CON. Both the manikin and human testing provided similar results in core temperature (Tc) and heat sensation (HS) in both magnitude and relationship. While the manikin and human data provided similar skin temperature (Tsk) characterization, Tsk estimation by the manikin seemed to be slightly over-estimated. Weight loss, as estimated by the manikin, was under-estimated compared to the human measurement. Personal cooling device use in conjunction with impermeable PPE may be advantageous in mitigating physiological and perceptual burdens of heat stress. Evaluation of PCDs worn under PPE can be done effectively via human or manikin testing; however, Tsk may be over-estimated and weight loss may be under-estimated. Thermal manikin testing of PCDs may provide fast and accurate information to persons recommending or using PCDs with PPE. QuinnT, KimJH, SeoY, CocaA. Comparison of thermal manikin modeling and human subjects' response during use of cooling devices under personal protective ensembles in the heat.

Pub.: 20 Apr '18, Pinned: 24 Apr '18

The effect of an active shooter response intervention on hospital employees' response knowledge, perceived program usefulness, and perceived organizational preparedness.

Abstract: Active shooter events occur frequently across the United States in a variety of locations, including health care facilities. Hospital health care worker response to an active shooter event may mean the difference in life or death for self or others. There is little research on how hospitals prepare nonmanagers to respond to active shooter events. We conducted a study to explore differences in knowledge, perceived organizational preparedness, and program utility following participation in an active shooter response program. Self-efficacy, personal characteristics, and professional characteristics were also explored. Program evaluation was conducted via a one-group pretest/posttest design. There was a significant increase in knowledge and perceived organizational preparedness postintervention. Trait-level self-efficacy did not have a significant effect on retained knowledge and perceived organizational preparedness. The current study is the first known to evaluate the efficacy of an active shooter response program for nonmanagers within an inpatient health care facility. Findings from this study may inform risk managers on how to educate employees on what to expect and how to react should an active shooter event occur. © 2018 American Society for Healthcare Risk Management of the American Hospital Association.

Pub.: 03 Apr '18, Pinned: 13 Apr '18

The Gillette Stadium Experience: A Retrospective Review of Mass Gathering Events From 2010 to 2015.

Abstract: Mass gathering events can substantially impact public safety. Analyzing patient presentation and transport rates at various mass gathering events can help inform staffing models and improve preparedness. A retrospective review of all patients seeking medical attention across a variety of event types at a single venue with a capacity of 68,756 from January 2010 through September 2015. We examined 232 events with a total of 8,260,349 attendees generating 8157 medical contacts. Rates were 10 presentations and 1.6 transports per 10,000 attendees with a non-significant trend towards increased rates in postseason National Football League games. Concerts had significantly higher rates of presentation and transport than all other event types. Presenting concern varied significantly by event type and gender, and transport rate increased predictably with age. For cold weather events, transport rates increased at colder temperatures. Overall, on-site physicians did not impact rates. At a single venue hosting a variety of events across a 6-year period, we demonstrated significant variations in presentation and transport rates. Weather, gender, event type, and age all play important roles. Our analysis, while representative only of our specific venue, may be useful in developing response plans and staffing models for similar mass gathering venues. (Disaster Med Public Health Preparedness. 2018;page 1 of 7).

Pub.: 20 Mar '18, Pinned: 23 Mar '18

Effective International Medical Disaster Relief: A Qualitative Descriptive Study.

Abstract: Purpose The aim of this study was to assist organizations seeking to develop or improve their medical disaster relief effort by identifying fundamental elements and processes that permeate high-quality, international, medical disaster relief organizations and the teams they deploy. A qualitative descriptive design was used. Data were gathered from interviews with key personnel at five international medical response organizations, as well as during field observations conducted at multiple sites in Jordan and Greece, including three refugee camps. Data were then reviewed by the research team and coded to identify patterns, categories, and themes. The results from this qualitative, descriptive design identified three themes which were key characteristics of success found in effective, well-established, international medical disaster relief organizations. These characteristics were first, ensuring an official invitation had been extended and the need for assistance had been identified. Second, the response to that need was done in an effective and sustainable manner. Third, effective organizations strived to obtain high-quality volunteers. By following the three key characteristics outlined in this research, organizations are more likely to improve the efficiency and quality of their work. In addition, they will be less likely to impede the overall recovery process. Broby N , Lassetter JH , Williams M , Winters BA . Effective international medical disaster relief: a qualitative descriptive study.

Pub.: 15 Mar '18, Pinned: 23 Mar '18

An Effective Risk Minimization Strategy Applied to an Outdoor Music Festival: A Multi-Agency Approach.

Abstract: Specific Event Identifiers a. Event type: Outdoor music festival. b. Event onset date: December 3, 2016. c. Location of event: Regatta Point, Commonwealth Park. d. Geographical coordinates: Canberra, Australian Capital Territory (ACT), Australia (-35.289002, 149.131957, 600m). e. Dates and times of observation in latitude, longitude, and elevation: December 3, 2016, 11:00-23:00. f. Response type: Event medical support. Abstract Introduction Young adult patrons are vulnerable to risk-taking behavior, including drug taking, at outdoor music festivals. Therefore, the aim of this field report is to discuss the on-site medical response during a music festival, and subsequently highlight observed strategies aimed at minimizing substance abuse harm. The observed outdoor music festival was held in Canberra (Australian Capital Territory [ACT], Australia) during the early summer of 2016, with an attendance of 23,008 patrons. First aid and on-site medical treatment data were gained from the relevant treatment area and service. The integrated first aid service provided support to 292 patients. Final analysis consisted of 286 patients' records, with 119 (41.6%) males and 167 (58.4%) females. Results from this report indicated that drug intoxication was an observed event issue, with 15 (5.1%) treated on site and 13 emergency department (ED) presentations, primarily related to trauma or medical conditions requiring further diagnostics. This report details an important public health need, which could be met by providing a coordinated approach, including a robust on-site medical service, accepting intrinsic risk-taking behavior. This may include on-site drug-checking, providing reliable information on drug content with associated education. Luther M , Gardiner F , Lenson S , Caldicott D , Harris R , Sabet R , Malloy M , Perkins J . An effective risk minimization strategy applied to an outdoor music festival: a multi-agency approach.

Pub.: 22 Mar '18, Pinned: 23 Mar '18

Determining training and education needs pertaining to highly infectious disease preparedness and response: A gap analysis survey of US emergency medical services practitioners.

Abstract: The Ebola virus disease outbreak highlighted the lack of consistent guidelines and training for workers outside of hospital settings. Specifically, emergency medical services (EMS) workers, who are frequently the first professionals to evaluate patients, often do not have advanced notice of patient diagnosis, and have limited time in their national curricula devoted to highly infectious disease (HID) identification and containment. All of these can place them at increased risk. To explore the depth of US EMS practitioners' HID training and education, a pilot gap analysis survey was distributed to determine where the aforementioned can be bolstered to increase occupational safety. Electronic surveys were distributed to EMS organization members. The survey collected respondent willingness to encounter HID scenarios; current policies and procedures; and levels of knowledge, training, and available resources to address HIDs. A total of 2,165 surveys were initiated and collected. Eighty percent of frontline personnel were aware that their agency had an HID standard operating guideline. Almost 85% of respondents correctly marked routes of exposure for select HIDs. More than half of respondents indicated no maximum shift times in personal protective equipment. This research suggests EMS practitioners could benefit from enhanced industry-specific education, training, and planning on HID mitigation and management. Strengthening EMS preparedness in response to suspected or confirmed HID cases may not only improve patient outcomes, but also worker and community safety. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Pub.: 04 Mar '18, Pinned: 06 Mar '18

Famine relief, public order, and revolts: interaction between government and refugees as a result of drought/flood during 1790–1911 in the North China Plain

Abstract: As a direct result of climate change and extreme weather events, refugee migration has attracted worldwide concern. In this study, we select the North China Plain (NCP) as the case area, where the capital (Beijing) is located during the late Qing dynasty (1790–1911). Based on records of porridge charity, public order (inside Beijing), and revolt events (outside Beijing) in ancient official documents, the interaction between behavior of refugees and the governmental management after floods and droughts is analyzed. The main conclusions can be summarized as follows. (1) Flood/drought has become an important triggering factor of refugee migration during 1790–1911 besides the social factors (e.g., man-land contradiction, fiscal crisis). (2) A negative interaction has existed between the government and refugees throughout the late nineteenth century, which leads to social disorder in the mid-1890s in Beijing and large-scale revolt (the Boxers Movement) in 1900 in the NCP. (3) The negative interaction has been finally ended by the adjustment of migration policy at the beginning of the twentieth century, which officially permits the refugees from the NCP to emigrate to Manchuria and Mongolia outside the Great Wall. The historical case study may provide valuable lessons for the successful adaptation of human societies to future similar occurrences, and will enhance our understanding of the interactions between climate change and social vulnerability.

Pub.: 17 Feb '18, Pinned: 25 Feb '18

Meta-evaluation of published studies on evaluation of health disaster preparedness exercises through a systematic review.

Abstract: Exercise evaluation is one of the most important steps and sometimes neglected in designing and taking exercises, in this stage of exercise, it systematically identifying, gathering, and interpreting related information to indicate how an exercise has fulfilled its objectives. The present study aimed to assess the most important evaluation techniques applied in evaluating health exercises for emergencies and disasters.This was meta-evaluation study through a systematic review. In this research, we searched papers based on specific and relevant keywords in research databases including ISI web of science, PubMed, Scopus, Science Direct, Ovid, ProQuest, Wiley, Google Scholar, and Persian database such as ISC and SID. The search keywords and strategies are followed; "simulation," "practice," "drill," "exercise," "instrument," "tool," "questionnaire," " measurement," "checklist," "scale," "test," "inventory," "battery," "evaluation," "assessment," "appraisal," "emergency," "disaster," "cricise," "hazard," "catastrophe,: "hospital", "prehospital," "health centers," "treatment centers," were used in combination with Boolean operators OR and AND.The research findings indicate that there are different techniques and methods for data collection to evaluate performance exercises of health centers and affiliated organizations in disasters and emergencies including debriefing inventories, self-report, questionnaire, interview, observation, shooting video, and photographing, electronic equipment which can be individually or collectively used depending on exercise objectives or purposes.Taking exercise in the health sector is one of the important steps in preparation and implementation of disaster risk management programs. This study can be thus utilized to improve preparedness of different sectors of health system according to the latest available evaluation techniques and methods for better implementation of disaster exercise evaluation stages.

Pub.: 09 Feb '18, Pinned: 25 Feb '18

The Use of Field Triage in Disaster and Mass Casualty Incidents: A Survey of Current Practices by EMS Personnel.

Abstract: Mass casualty incident (MCI) triage and the use of triage tags to assign treatment priorities are not fully implemented despite emergency medical services (EMS) personnel training during drills and exercises.To compare current field triage practices during both training and actual MCIs and identify any potential barriers to use.During training sessions from November 2015 through March 2016, an anonymous survey was distributed to personnel in 3 distinct types of paid full-time EMS systems: Boston EMS (2-tiered, municipal third-service); Portland Fire Department (fire department-based ALS); and Stokes County EMS (county-based ALS) combined with Forsyth County EMS (county-based ALS). Data included personnel demographics and previous participation experiences in both drill and actual MCIs. Personnel with any prior MCI experience were queried regarding triage tag use and type of algorithm used. Data on barriers to use of triage tags and methods of communication of patient information were also collected. Descriptive statistics were used to analyze responses.Overall survey participation rate was 77.9% (464/596). Among all respondents, 38.7% (179/464) reported participating in both a drill and actual MCI's. In these cases, respondents reported less likely use of triage tags during actual MCI's compared to drills, (34.1 vs. 91.8%, p < 0.01), less likely to complete full triage (16.3 vs. 68.7%, p < 0.01) and less likely to employ geographical triage (56.8 vs. 90.4% p < 0.01). Verbal report was the most common communication method to hospitals (93.1%) when triage tags were not used. Responders reported proximity to the hospital as the most common reason for not using triage tags during an actual MCI (29.5%).Despite being a fundamental skill in MCI response, triage and other standard practices have not always been utilized in actual events despite training. EMS educators and disaster planners should consider strategies to better incorporate MCI practices during real world events.

Pub.: 10 Feb '18, Pinned: 25 Feb '18

Introduction of Pediatric Physiological and Anatomical Triage Score in Mass-Casualty Incident.

Abstract: Triage has an important role in providing suitable care to the largest number of casualties in a disaster setting, but there are no secondary triage methods suitable for children. This study developed a new secondary triage method named the Pediatric Physiological and Anatomical Triage Score (PPATS) and compared its accuracy with current triage methods.A retrospective chart review of pediatric patients under 16 years old transferred to an emergency center from 2014 to 2016 was performed. The PPATS categorized the patients, defined the intensive care unit (ICU)-indicated patients if the category was highest, and compared the accuracy of prediction of ICU-indicated patients among PPATS, Physiological and Anatomical Triage (PAT), and Triage Revised Trauma Score (TRTS).Among 137 patients, 24 (17.5%) were admitted to ICU. The median PPATS score of these patients was significantly higher than that of patients not admitted to ICU (11 [IQR: 9-13] versus three [IQR: 2-4]; P<.001). The optimal cut-off value of the PPTAS was six, yielding a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 95.8%, 86.7%, 60.5%, and 99.0%. The area under the receiver-operating characteristic curve (AUC) was larger for PPTAS than for PAT or TRTS (0.95 [95% CI, 0.87-1.00] versus 0.65 [95% CI, 0.58-0.72]; P<.001 and 0.79 [95% CI, 0.69-0.89]; P=.003, respectively). Regression analysis showed a significant association between the PPATS and the predicted mortality rate (r2=0.139; P<.001), ventilation time (r2=0.320; P<.001), ICU stay (r2=0.362; P<.001), and hospital stay (r2=0.308; P<.001).The accuracy of PPATS was superior to other methods for secondary triage of children. Toida C , Muguruma T , Abe T , Shinohara M , Gakumazawa M , Yogo N , Shirasawa A , Morimura N . Introduction of pediatric physiological and anatomical triage score in mass-casualty incident.

Pub.: 13 Feb '18, Pinned: 23 Feb '18