ABSTRACT
BACKGROUND: Medical professionals can use mass-casualty triage systems to assist them in prioritizing patients from mass-casualty incidents (MCIs). Correct triaging of victims will increase their chances of survival. Determining the triage system that has the best performance has proven to be a difficult question to answer. The Advanced Prehospital Triage Model (Modelo Extrahospitalario de Triaje Avanzado; META) and Sort, Assess, Lifesaving Interventions, Treatment/Transport (SALT) algorithms are the most recent triage techniques to be published. The present study aimed to evaluate the META and SALT algorithms' performance and statistical agreement with various standards. The secondary objective was to determine whether these two MCI triage systems predicted patient outcomes, such as mortality, length-of-stay, and intensive care unit (ICU) admission. METHODS: This retrospective study used patient data from the trauma registry of an American College of Surgeons Level 1 trauma center, from January 1, 2018 through December 31, 2020. The sensitivity, specificity, and statistical agreement of the META and SALT triage systems to various standards (Revised Trauma Score [RTS]/Sort Triage, Injury Severity Score [ISS], and Lerner criteria) when applied using trauma patients. Statistical analysis was used to assess the relationship between each triage category and the secondary outcomes. RESULTS: A total of 3,097 cases were included in the study. Using Sort triage as the standard, SALT and META showed much higher sensitivity and specificity in the Immediate category than for Delayed (Immediate sensitivity META 91.5%, SALT 94.9%; specificity 60.8%, 72.7% versus Delayed sensitivity 28.9%, 1.3%; specificity 42.4%, 28.9%). With the Lerner criteria, in the Immediate category, META had higher sensitivity (77.1%, SALT 68.6%) but lower specificity (61.1%) than SALT (71.8%). For the Delayed category, SALT showed higher sensitivity (META 61.4%, SALT 72.2%), but lower specificity (META 75.1%, SALT 67.2%). Both systems showed a positive, though modest, correlation with ISS. For SALT and META, triaged Immediate patients tended to have higher mortality and longer ICU and hospital lengths-of-stay. CONCLUSION: Both META and SALT triage appear to be more accurate with Immediate category patients, as opposed to Delayed category patients. With both systems, patients triaged as Immediate have higher mortality and longer lengths-of-stay when compared to Delayed patients. Further research can help refine MCI triage systems and improve accuracy.
Subject(s)
Mass Casualty Incidents , Triage , Humans , Retrospective Studies , Male , Female , Adult , Middle Aged , Algorithms , Wounds and Injuries/therapy , Wounds and Injuries/mortality , Emergency Medical Services , Registries , Trauma Centers , Injury Severity Score , AgedABSTRACT
Los terremotos ocurridos en Turquía en febrero de 2023 han sido unos de los de mayor impacto en los últimos años. Las autoridades del país, tras activar sus recursos locales y nacionales, hicieron una solicitud de ayuda internacional. Dentro de la Organización de Naciones Unidas (ONU) se encuentra el Grupo Asesor Internacional de Búsqueda y Rescate (INSARAG), cuyos objetivos son establecer las normas internacionales mínimas para los equipos de rescate e implementar una metodología para la coordinación internacional ante terremotos, maremotos y otros desastres naturales, especialmente la coordinación operativa sobre el terreno. El objetivo de este trabajo es ofrecer una visión sobre la epidemiología de los terremotos, la gestión de los equipos de emergencias, la Asociación de Ayuda a Desastres y Emergencias (AFAD) de Turquía, y abordar cómo es el rescate en estructuras colapsadas. Además, se expone la experiencia de Bomberos Unidos Sin Fronteras (BUSF) en dicho terremoto y se describe un rescate que duró 14 horas. (AU)
The earthquakes that occurred in February 2023 in Türkiye had some of the worst consequences of recent years. The Turkish authorities first deployed local resources and then appealed for international help. The International Search and Rescue Group of the United Nations aims to establish minimum international standards for search and rescue teams and a methodology for coordinating responses to earthquakes, tsunamis, and other natural disasters. A main concern of the group is to coordinate operations on the ground. This article offers perspectives on the epidemiology of earthquakes, the management of emergency response teams and Türkiyes disaster management agency (AFAD); it also explains how rescues are carried out in collapsed buildings. The experience of Firefighters Without Borders after the recent earthquakes and a rescue that took 14 hours are also described. (AU)
Subject(s)
Humans , Earthquakes , Search and Rescue , Turkey , Rescue Work , Tretinoin , DisastersABSTRACT
TEXT: The earthquakes that occurred in February 2023 in Türkiye had some of the worst consequences of recent years. The Turkish authorities first deployed local resources and then appealed for international help. The International Search and Rescue Group of the United Nations aims to establish minimum international standards for search and rescue teams and a methodology for coordinating responses to earthquakes, tsunamis, and other natural disasters. A main concern of the group is to coordinate operations on the ground. This article offers perspectives on the epidemiology of earthquakes, the management of emergency response teams and Türkiye's disaster management agency (AFAD); it also explains how rescues are carried out in collapsed buildings. The experience of Firefighters Without Borders after the recent earthquakes and a rescue that took 14 hours are also described.
TEXTO: Los terremotos ocurridos en Turquía en febrero de 2023 han sido unos de los de mayor impacto en los últimos años. Las autoridades del país, tras activar sus recursos locales y nacionales, hicieron una solicitud de ayuda internacional. Dentro de la Organización de Naciones Unidas (ONU) se encuentra el Grupo Asesor Internacional de Búsqueda y Rescate (INSARAG), cuyos objetivos son establecer las normas internacionales mínimas para los equipos de rescate e implementar una metodología para la coordinación internacional ante terremotos, maremotos y otros desastres naturales, especialmente la coordinación operativa sobre el terreno. El objetivo de este trabajo es ofrecer una visión sobre la epidemiología de los terremotos, la gestión de los equipos de emergencias, la Asociación de Ayuda a Desastres y Emergencias (AFAD) de Turquía, y abordar cómo es el rescate en estructuras colapsadas. Además, se expone la experiencia de Bomberos Unidos Sin Fronteras (BUSF) en dicho terremoto y se describe un rescate que duró 14 horas.
Subject(s)
Earthquakes , Humans , Rescue Work , TretinoinABSTRACT
Se analiza el uso de los desfibriladores externos automáticos (DEA) de uso público en caso de parada cardiaca en el Principado de Asturias desde enero del 2012 hasta diciembre del 2014, así como el manejo hospitalario y el estado neurológico al alta de los pacientes. Para ello se realizó un estudio observacional retrospectivo poblacional sobre la utilización de DEA de uso público en el Principado de Asturias en tres fases: 1) cuestionario telefónico a todas las entidades con DEA; 2) análisis de las historias clínicas del SAMU-Asturias; y 3) análisis de las historias clínicas hospitalarias. Se han identificado 13 usos de un DEA público. En cuanto al ritmo inicial, 11 (84,5%) eran desfibrilables, 3 pacientes (23%) fallecieron a nivel prehospitalario, 1 (7,6%) en el hospital y 9 (69,2%) sobrevivieron, todos con un ritmo inicial desfibrilable y todos con una puntuación en la escala Cerebral Performance Categories (CPC) al alta de 1. Ocho de los 10 pacientes que llegaron con vida al hospital fueron sometidos a angioplastia primaria y 3 a hipotermia. La estancia hospitalaria media de los supervivientes fue de 9,4 días (DE = 4,88). Se concluye que el uso de DEA público mejora notablemente la supervivencia de la parada cardiorrespiratoria extrahospitalaria, probablemente relacionado con la reducción del tiempo de espera hasta la desfibrilación
On-site bystander use of automated external defibrillators (AEDs) was analized in Asturias, Spain, between January 2012 and December 2014. Hospital management and neurologic state on discharge were also studied. Our retrospective observational population-based design had 3 phases comrpising: 1) a telephone survey of facilities with onsite public-access AEDsc, 2) analysis of relevant case records held by the Asturian emergency medical service, and 3) analysis of relevant hospital case records. Thirteen cases of AED use by bystanders were found. Eleven patients (84.5%) had initial shockable rhythms. Three patients (23%) died before reaching the hospital, 1 (7.6%) died in hospital, and 9 (69.2%) survived. All of the survivors had a shockable rhythm and all had a score of 1 on the Cerebral Performance Category scale on discharge. Eight of the 10 patients who were alive on arrival at the hospital were treated with primary angioplasty; therapeutic hypothermia was applied in 3 cases. The mean (SD) hospital stay of survivors was 9.4 (4.88) days. We conclude that bystander use of an AED notably improves survival in out-of-hospital sudden cardiac arrest, probably related to shortening the delay in starting defibrillation
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Defibrillators , Cardiopulmonary Resuscitation/instrumentation , Emergency Service, Hospital , Heart Arrest/mortality , Defibrillators/statistics & numerical data , Spain , Cardiopulmonary Resuscitation , Retrospective Studies , Observational StudyABSTRACT
EN: On-site bystander use of automated external defibrillators (AEDs) was analized in Asturias, Spain, between January 2012 and December 2014. Hospital management and neurologic state on discharge were also studied. Our retrospective observational population-based design had 3 phases comrpising: 1) a telephone survey of facilities with onsite public-access AEDsc, 2) analysis of relevant case records held by the Asturian emergency medical service, and 3) analysis of relevant hospital case records. Thirteen cases of AED use by bystanders were found. Eleven patients (84.5%) had initial shockable rhythms. Three patients (23%) died before reaching the hospital, 1 (7.6%) died in hospital, and 9 (69.2%) survived. All of the survivors had a shockable rhythm and all had a score of 1 on the Cerebral Performance Category scale on discharge. Eight of the 10 patients who were alive on arrival at the hospital were treated with primary angioplasty; therapeutic hypothermia was applied in 3 cases. The mean (SD) hospital stay of survivors was 9.4 (4.88) days. We conclude that bystander use of an AED notably improves survival in out-of-hospital sudden cardiac arrest, probably related to shortening the delay in starting defibrillation.
ES: Se analiza el uso de los desfibriladores externos automáticos (DEA) de uso público en caso de parada cardiaca en el Principado de Asturias desde enero del 2012 hasta diciembre del 2014, así como el manejo hospitalario y el estado neurológico al alta de los pacientes. Para ello se realizó un estudio observacional retrospectivo poblacional sobre la utilización de DEA de uso público en el Principado de Asturias en tres fases: 1) cuestionario telefónico a todas las entidades con DEA; 2) análisis de las historias clínicas del SAMU-Asturias; y 3) análisis de las historias clínicas hospitalarias. Se han identificado 13 usos de un DEA público. En cuanto al ritmo inicial, 11 (84,5%) eran desfibrilables, 3 pacientes (23%) fallecieron a nivel prehospitalario, 1 (7,6%) en el hospital y 9 (69,2%) sobrevivieron, todos con un ritmo inicial desfibrilable y todos con una puntuación en la escala Cerebral Performance Categories (CPC) al alta de 1. Ocho de los 10 pacientes que llegaron con vida al hospital fueron sometidos a angioplastia primaria y 3 a hipotermia. La estancia hospitalaria media de los supervivientes fue de 9,4 días (DE = 4,88). Se concluye que el uso de DEA público mejora notablemente la supervivencia de la parada cardiorrespiratoria extrahospitalaria, probablemente relacionado con la reducción del tiempo de espera hasta la desfibrilación.
