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INTRODUCTION: Coronavirus Disease 2019 (COVID-19) is spreading all over the world. Health systems around the globe have to deal with decreased capabilities and exhausted resources because of the surge of patients. The need to identify COVID-19 patients to achieve a timely opportunity to treat and isolate them is an ongoing challenge for health care professionals everywhere. A lack of testing capabilities forces clinicians to make the crucial initial decision on the basis of clinical findings and routine diagnostic laboratory test. This article reviews the current literature and presents a new adapted protocol for diagnosing and triaging COVID-19 patients. A special emphasis lies on the stepwise approach guiding the medical provider to a triage decision that is suitable for the individual patient and the situation of the local medical treatment facility. MATERIALS AND METHODS: On March 30, 2020, a PubMed based literature research on COVID-19 following the preferred reporting items for systematic reviews and meta-analyses guidelines was performed. A diagnostic and triage tool for COVID-19 was designed based on the major findings in the reviewed literature. RESULTS: After a selection process, focusing on the topics "epidemiology," "clinical characteristics," and "diagnostic tools," 119 out of a total amount of 1,241 publications were selected to get an overview of the growing evidence. CONCLUSIONS: The designed Early Recognition and Triage Tool enables the medical provider to use the applicable modules of the protocol for capabilities of the local setting to get the most appropriate diagnostic and triage done. The tool should give guidance for the initial approach until specific testing for the COVID-19 virus is available.
RESUMO
INTRODUCTION: The medical treatment facilities (MTF) represent the equivalent of the healthcare system in the home countries, but they face the limitations of an outpost at the end of the supply chain. The capabilities are limited, and the necessary effort to extend the treatment capacity is tremendous. Algorithms based on scientific evidence or at least profound medical expertise are a tool to facilitate the decision-making process in triage under difficult circumstances. The aim of this article is to present a protocol that regards the specific entities military MTF abroad have to deal with in context of the COVID-19 pandemic. MATERIAL AND METHODS: To prepare our own health system within the Resolute Support mission, an interdisciplinary team of consultants and nurses located at the multinational role 2E, Camp Marmal, Mazar-e-Sharif, Afghanistan, individually reviewed medical databases and the current literature concerning triage on intensive care units. The identified literature was evaluated by all authors. In the next step, an adapted flow chart for triage on intensive care unit in MTF abroad was set up on the basis of existing triage tools found in the reviewed literature. RESULTS: The authors created the "Structured Approach for Intensive Care Unit Triage (SAINT)" protocol. It is an approach that fits to the specific entities (e.g., limited medical resources in the whole system, limited intensive care unit capabilities for long-term stay or organ replacement therapy, etc.) that determine the framework of the special military health system abroad. CONCLUSIONS: The presented triage protocol may be a tool for medical personnel to facilitate the difficult task of triaging. It provides guidance along patient-centered criteria like individual medical, ethical, and legal issues while taking into account the available resources. Future studies are needed to investigate the effectiveness of the SAINT protocol.