Experiences of civilian nurses in triage during the Iran-Iraq War: An oral history.

PURPOSE: Nurses played a critical role in performing triage during the Iran-Iraq War. However, their experiences in triage have not been discussed. Therefore, the current study aimed to investigate the triage experiences of civilian nurses during the Iran-Iraq War. METHODS: Oral history method and in-depth interviews were used to collect data to gain the nurses' experiences in triage. RESULTS: Four themes were extracted from the data, which were the development of triage, challenging environment to perform triage, development of mobile triage teams, and challenges of triage chemical victims for nurses. CONCLUSION: Triage is an important skill for nurses to manage critical situations such as disasters and wars. Nurses have to be competent in performing triage. Involvement in critical situations helps the nurses learn and gain more experience on how to manage unexpected events.

[The evolution of the emergency medical services system - from ancient to modern times]. / Ewolucja systemu ratownictwa medycznego - od starozytnosci do czasów wspólczesnych.

The paper discusses the historical perspective - from ancient to modern times - on the evolution of military medicine and its support during the wars and battles as well as its impact on the development of civilian health care and emergency medical services. Indicated breakthroughs related to conducting military operations and pointed to the visionaries who have developed new paradigms of medical care, including programs designed to assess the health status of patients, treatment in the battlefield, medical transport, anesthesia, surgery and emergency procedures. Highlighted the important role of proper organization and urgent help to victims.

[Treatment organization for patients with gunshot wounds of the maxillo-facial region evacuated during the military operations in the Far East (1938-1939) and the war with Finland (1939-1940)].

This article describes the path of the maxillo-facial surgery to becoming an independent part of the general surgery. We will look closely at the experience, gained y field surgeons during the events at Lake Hasan and Halkin-Gol river. The war with Finland, that enabled the surgeons to develop the system of specialized dental help for the gunshot wounds, to create standarts of specialized equipment, examples of splints, etc, which were widely used during the World War II.

Baron Dominique-Jean Larrey (1766-1842): founder of military surgery and trauma care.

Dominique-Jean Larrey was a distinguished surgeon in chief of Napoleon's army and a faithful servant of the Empire. His surgical skills and inventions, his absolute attachment and devotion to his profession, his humanitarian spirit and courage entitled him as one of history's greatest military surgeons.

A Review of "Prehospital Hypotension as a Valid Indicator of Trauma Team Activation" (2000).

Prehospital hypotension has been utilized for decades as a surrogate marker of injury severity. Several studies have discussed the correlation between injury and hypotension both in the field as well as in the emergency department. Increases have been noted in injury severity score and mortality. Resource utilization is higher in this patient population. This study revisits our original work from 2000 and reviews the current literature regarding hypotension and injury severity. We also examine the role of prehospital hypotension as an indicator of trauma team activation and resource allocation. This review serves as a part of a Literary Festschrift in honor of Dr J David Richardson's role as the Editor-in-Chief of The American Surgeon.

Notes from a war diary--the filter system of sorting casualties from the battle of Cassino--Italy May 1944.

This is the second extract taken from the War Diaries of Brigadier JG Morgan CBE TD MD and is specifically taken from papers he used to prepare a talk for a Civil Defence Audience in the 1950's. Having introduced a system of filtering in Tripoli in 1943 when in command of 48th General Hospital, he was specifically appointed to oversee the medical arrangements for the Battle of Cassino and was awarded the CBE for his work which is outlined below. It has been prepared from the original documents and edited by his sons.

D-day on board a tank landing ship: meat, cheese and blood transfusion.

Tank Landing Ships were used as evacuation station hospitals during D-Day of World War Two. This historical vignette describes how difficulties were overcome in blood transfusion and trauma surgery aboard these ships. Their place in the evacuation chain is discussed in relation to previous experiences in military medicine.

Triage in medicine, part I: Concept, history, and types.

This 2-article series offers a conceptual, historical, and moral analysis of the practice of triage. Part I distinguishes triage from related concepts, reviews the evolution of triage principles and practices, and describes the settings in which triage is commonly practiced. Part II identifies and examines the moral values and principles underlying the practice of triage.

The value of war for medicine: questions and considerations concerning an often endorsed proposition.

This paper examines the relationship, often claimed as beneficial, between war and advances in medicine and surgery. Some of the conflicting opinions that have been expressed are discussed. Military medicine in general is conservative and non-innovative. Some medical advances have indeed originated in war, but many other efforts were failures and are forgotten. The application of others is limited to their particular time and place, while some would have been made sooner or later in any case. In additon, the basic objective of military medicine is to maintain the strength of the fighting force rather than to help the individual, and some doctors have indeed been involved in developing means of destruction.

Military intensive care part 1. A historical review.

ICU is a product of clinical developments, technological advances, social changes and history. Military ICU reflects all of these as well as deployed operational experience. Having considered how military ICU got to where it is, the next article will consider current practice.

Military surgery in the 21st century.

The battlefield has changed. UK and US Forces in Iraq and Afghanistan are engaged in asymmetric, three bloc warfare. Three bloc warfare indicates that what is effectively war-fighting occurs in parallel with peace-keeping and humanitarian operations. Casualties are numerically lower than in previous conflicts but many survivors are horrifically mutilated as body armour prevents the fatal injury in this severely injured group. Rapid evacuation of severely injured from the point of injury, usually by helicopter, provides extreme challenges for surgical teams. Damage control surgery requires support in the form of environmental control, adequate diagnostics (including computerised tomography) and effective intensive care facilities if the patient is to survive. Teams need to be highly trained and to have experience of complex surgery and trauma. They must be adequately resourced if lives are to be saved.

Contemporary Obstetric Triage.

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?"

Triage: Napoleon to the present day.

Triage, the sorting of patients according to the severity of their injuries and the need for urgent surgery was a concept developed by Dr. Larrey, a military surgeon in Napoleon's army. The evolution of the concept in military medicine from that time to the present is described. Triage in civilian practice first became a serious issue with the development of dialysis for chronic renal failure in the 1960s and the problem of the allocation of this scarce and very expensive treatment. With new developments in organ transplantation and technology it continues to be an issue today.

Triage and equality: an historical reassessment of utilitarian analyses of triage.

We distinguish and review aspects of the history of two models of triage: egalitarian and utilitarian. Egalitarian triage is widely and successfully practiced in battlefield medicine, as well as in the emergency room and the ICU. Utilitarian triage has been sporadically practiced and typically collapses under the pressure of public scrutiny. Unfortunately, the two models tend to be conflated, confusing our understanding of the past and confounding our ability to plan for the future.

[War casualty triage during the First World War]. / Le triage des blessés pendant la Grande Guerre.

Along with the front hospitals (HOE), the action of sorting out the injured was one of the most important innovations of the Great War. Progressively, it was implemented and codified on each level of the evacuating chain, with variations due to the different phases of the conflict, such as in Verdun or in the Somme. From 1917 onwards, specific sorting centers, managed by experimented soldiers, were set up in the evacuating hospitals.

Los orígenes militares del triaje / Triage origins in the military

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