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1.
Cir. Esp. (Ed. impr.) ; 98(8): 433-441, oct. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-188970

RESUMO

La infección por el nuevo coronavirus SARS-CoV-2 (enfermedad por coronavirus 2019 [COVID-19]) ha determinado la necesidad de la reorganización de muchos centros hospitalarios en el mundo. España, como uno de los epicentros de la enfermedad, ha debido asumir cambios en la práctica totalidad de su territorio. Sin embargo, y desde el inicio de la pandemia, en todos los centros que atienden urgencias quirúrgicas ha sido necesario el mantenimiento de su cobertura, aunque igualmente ha sido inevitable introducir directrices especiales de ajuste al nuevo escenario que permitan el mantenimiento de la excelencia en la calidad asistencial. Este documento desarrolla una serie de indicaciones generales para la cirugía de urgencias y la atención al politraumatizado desarrolladas desde la literatura disponible y consensuadas por un subgrupo de profesionales desde el grupo general Cirugía-AEC-COVID-19. Estas medidas van encaminadas a contemplar un riguroso control de la exposición en pacientes y profesionales, a tener en cuenta las implicaciones de la pandemia sobre diferentes escenarios perioperatorios relacionados con la urgencia y a una adaptación ajustada a la situación del centro en relación con la atención a pacientes infectados


New coronavirus SARS-CoV-2 infection (coronavirus disease 2019 [COVID-19]) has determined the necessity of reorganization in many centers all over the world. Spain, as an epicenter of the disease, has been forced to assume health policy changes in all the territory. However, and from the beginning of the pandemic, every center attending surgical urgencies had to guarantee the continuous coverage adopting correct measures to maintain the excellence of quality of care. This document resumes general guidelines for emergency surgery and trauma care, obtained from the available bibliography and evaluated by a subgroup of professionals designated from the general group of investigators Cirugía-AEC-COVID-19 from the Spanish Association of Surgeons, directed to minimize professional exposure, to contemplate pandemic implications over different urgent perioperative scenarios and to adjust decision making to the occupational pressure caused by COVID-19 patients


Assuntos
Humanos , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pandemias , Serviços Médicos de Emergência/organização & administração , Equipamentos de Proteção/normas , Gestão da Segurança , Procedimentos Cirúrgicos Operatórios/normas , Traumatismo Múltiplo/cirurgia , Infecções por Coronavirus/prevenção & controle , Pneumonia Viral/prevenção & controle
2.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(5): 507-512, 2020 May 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-32879098

RESUMO

OBJECTIVES: To discuss the demands and countermeasures for outpatients and emergency patients during the outbreak of coronavirus disease 2019 (COVID-19) in large general hospital. METHODS: By analyzing patients' demands, outpatient service system and emergency system complemented each other with the help of "internet medical" to provide online medical treatment, self-diagnosed pneumonia program, online pharmacies, outpatient appointment and online pre-examination services, open green channels for special patients, and to provide referral services for critical patients. The COVID-19 suspected patients and other common fever patients were separated from other patients. RESULTS: From January 28 to March 1, we have received 26 000 patients online, 1 856 special patients, 2 929 suspected patients and common fever patients including 31 confirmed patients, 0 case of misdiagnosis and cross-infection. CONCLUSIONS: Targeting patient's demands and taking appropriate measures are effective on meeting the needs of outpatients' and emergency patients' medical services.


Assuntos
Infecções por Coronavirus/epidemiologia , Necessidades e Demandas de Serviços de Saúde , Hospitais Gerais/organização & administração , Pacientes Ambulatoriais , Pneumonia Viral/epidemiologia , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Serviços Médicos de Emergência/organização & administração , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle
3.
PLoS One ; 15(9): e0238491, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32936804

RESUMO

As the most visible face of health expertise to the general public, health agencies have played a central role in alerting the public to the emerging COVID-19 threat, providing guidance for protective action, motivating compliance with health directives, and combating misinformation. Social media platforms such as Twitter have been a critical tool in this process, providing a communication channel that allows both rapid dissemination of messages to the public at large and individual-level engagement. Message dissemination and amplification is a necessary precursor to reaching audiences, both online and off, as well as inspiring action. Therefore, it is valuable for organizational risk communication to identify strategies and practices that may lead to increased message passing among online users. In this research, we examine message features shown in prior disasters to increase or decrease message retransmission under imminent threat conditions to develop models of official risk communicators' messages shared online from February 1, 2020-April 30, 2020. We develop a lexicon of keywords associated with risk communication about the pandemic response, then use automated coding to identify message content and message structural features. We conduct chi-square analyses and negative binomial regression modeling to identify the strategies used by official risk communicators that respectively increase and decrease message retransmission. Findings show systematic changes in message strategies over time and identify key features that affect message passing, both positively and negatively. These results have the potential to aid in message design strategies as the pandemic continues, or in similar future events.


Assuntos
Betacoronavirus , Doenças Transmissíveis Emergentes , Comunicação , Infecções por Coronavirus , Disseminação de Informação/métodos , Pandemias , Pneumonia Viral , Mídias Sociais , Distribuição de Qui-Quadrado , Emergências , Serviços Médicos de Emergência/organização & administração , Órgãos Governamentais , Humanos , Internet , Meios de Comunicação de Massa , Modelos Estatísticos , Modelos Teóricos , Administração em Saúde Pública , Gestão da Segurança , Mídias Sociais/estatística & dados numéricos
6.
Arch. argent. pediatr ; 118(4): 234-239, agosto 2020. tab, ilus
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1118171

RESUMO

Introducción. El abordaje de las emergencias pediátricas requiere recursos especializados y son frecuentes los errores relacionados con la medicación.Objetivos. Describir el contenido de los carros de emergencia (CE) en un hospital pediátrico y compararlo luego de una intervención educativa.Métodos. Se incluyeron CE de 9 salas de internación. Se elaboró una lista de cotejo con 30 drogas. Se relevaron los CE determinando presencia o ausencia de drogas y si las cantidades eran suficientes. Luego se realizó una intervención educativa y relevamientos 30 y 90 días posintervención.Resultados. La medición basal arrojó una proporción global de drogas adecuadas del 43,9 % (intervalo de confianza ­IC­ del 95 %: 38,4-49,4) con una variación entre CE del 29 % al 54,8 % y del 15 % al 85 % en los grupos de drogas. A los 30 días, la proporción correcta alcanzó el 70,3 % (IC 95 %: 65,2-75,4), con amplia variación entre los diferentes CE y grupos de drogas (del 51,6 % al 93,5 % y del 50 % al 95 %, respectivamente). A los 90 días, los porcentajes fueron similares. La comparación entre la primera y segunda medición mostró mejoría en todos los CE (rango: del 3,2 % al 45,1 %), odds ratio 3,73 (IC 95 %: 2,5-5,6), p < 0,001. Los resultados fueron similares entre la segunda y tercera medición.Conclusiones. En la medición inicial, se evidenció bajo nivel de adecuación de drogas de los CE. Luego de la intervención, mejoró significativamente y se mantuvo durante el período evaluado.


Introduction. The approach to pediatric emergencies requires specialized resources, and medication errors are common.Objectives. To describe the contents of emergency trolleys (ETs) in a children's hospital and compare them after an educational intervention.Methods. The ETs from 9 hospitalization wards were included. A checklist of 30 drugs was developed. ETs were assessed by determining whether drugs were present or absent and their amount. An educational intervention was conducted and assessments were repeated 30 and 90 days after the intervention.Results. The baseline measurement indicated an overall ratio of adequate drugs of 43.9 % (95 % confidence interval [CI]: 38.4-49.4) with a variation among ETs from 29 % to 54.8 %, and from 15 % to 85 % among drug groups. At 30 days, the adequate ratio reached 70.3 % (95 % CI: 65.2-75.4), with a wide variation among the different ETs and drug groups (from 51.6 % to 93.5 % and from 50 % to 95 %, respectively). At 90 days, the percentages were similar. The comparison between the first and second measurementshowed an improvement in all ETs (range: 3.2 %-45.1 %), odds ratio: 3.73 (95 % CI: 2.5-5.6), p < 0.001. Results were similar between the second and third measurement.Conclusions. The baseline measurement showed a low level of adequate ET drugs. After the intervention, this improved significantly and was maintained during the studied period


Assuntos
Humanos , Preparações Farmacêuticas , Reanimação Cardiopulmonar/instrumentação , Serviços Médicos de Emergência/normas , Garantia da Qualidade dos Cuidados de Saúde , Emergências , Serviços Médicos de Emergência/organização & administração , Equipamentos e Provisões , Lista de Checagem , Ensaios Clínicos Controlados não Aleatórios como Assunto
7.
Emergencias (Sant Vicenç dels Horts) ; 32(4): 269-277, ago. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-190943

RESUMO

La investigación es una de las labores inalienables al ejercicio de la profesión médica. En el ámbito de la medicina de urgencias y emergencias (MUE), durante las últimas décadas se ha producido un aumento progresivo de esta actividad, liderada por los propios profesionales que trabajan en servicios de urgencias hospitalarios (SUH) y en los sistemas médicos de emergencias. No obstante, su producción científica se ha fundamentado más en la actividad de grupos unicéntricos que en redes de colaboración entre centros. Los últimos años, no obstante, han aparecido líneas de investigación exclusivamente dedicadas a la MUE en diversos institutos de investigación sanitaria españoles, reconocidos por el Instituto de Salud Carlos III, y también grupos de investigación de procesos específicos con una producción mantenida en el tiempo, muchos de ellos vinculados a la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES). En el contexto de la pandemia de COVID-19 generada por el SARS-CoV-2, ha surgido la necesidad de que estos elementos investigadores unan sus fuerzas para hacer frente a los principales retos investigadores que supone esta pandemia desde la perspectiva de los SUH. Ello ha conducido a la fundación de la red de investigación SIESTA (Spanish Investigators on Emergency Situacions TeAm), cuyo primer reto es la realización del macroproyecto UMC-19 (Unusual Manifestations of Covid-19) en el plazo de un mes. A continuación se describen los pasos seguidos y los principales hitos de esta experiencia primigenia


Research is an inalienable part of medicine. The last few decades have seen a steady increase in research relevant to emergency medicine, led by professionals working in hospital emergency departments and related medical services. Most of the work has been done by groups in individual rather than networked centers. However, several Spanish institutions recognized by the Carlos III Health Institute (ISCIII) have developed lines of research that focus exclusively on emergency medicine. In addition, stable research groups - many of them associated with the Spanish Society of Emergency Medicine (SEMES) - have been engaged in ongoing studies of processes specific to our field. The coronavirus disease 2019 (COVID-19) pandemic caused by the acute respiratory syndrome coronavirus 2 (SARSCoV-2) created a need to focus all our efforts on the main challenges facing emergency departments. In response, the SIESTA (Spanish Investigators in Emergency Situations TeAm) network was created. The network's first challenge has been to complete the UMC-19 (Unusual Manifestations of COVID-19) macroproject within a single month. This paper describes the steps SIESTA followed and the main goals of this pioneering experience


Assuntos
Humanos , Colaboração Intersetorial , Serviços Médicos de Emergência/organização & administração , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Serviços Médicos de Emergência/ética , Serviços Médicos de Emergência/métodos , Planos e Programas de Saúde/organização & administração , Formulação de Projetos , Espanha/epidemiologia
8.
Epidemiol Infect ; 148: e174, 2020 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-32762783

RESUMO

Coronavirus disease 2019 (COVID-19) is a global health threat. A hospital in Zhuhai adopted several measures in Fever Clinic Management (FCM) to respond to the outbreak of COVID-19. FCM has been proved to be effective in preventing nosocomial cross infection. Faced with the emergency, the hospital undertook creative operational steps in relation to the control and spread of COVID-19, with special focuses on physical and administrative layout of buildings, staff training and preventative procedures. The first operational step was to set up triaging stations at all entrances and then complete a standard and qualified fever clinic, which was isolated from the other buildings within our hospital complex. Secondly, the hospital established its human resource reservation for emergency response and the allocation of human resources to ensure strict and standardised training methods through the hospital for all medical staff and ancillary employees. Thirdly, the hospital divided the fever clinic into partitioned areas and adapted a three-level triaging system. The experiences shared in this paper would be of practical help for the facilities that are encountering or will encounter the challenges of COVID-19, i.e. to prevent nosocomial cross infection among patients and physicians.


Assuntos
Infecções por Coronavirus/terapia , Serviços Médicos de Emergência/métodos , Arquitetura Hospitalar/métodos , Pneumonia Viral/terapia , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Surtos de Doenças , Serviços Médicos de Emergência/organização & administração , Serviços Médicos de Emergência/normas , Febre/diagnóstico , Febre/etiologia , Febre/terapia , Arquitetura Hospitalar/normas , Humanos , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Ensino , Fatores de Tempo , Triagem/métodos , Ventilação/normas , Fluxo de Trabalho , Recursos Humanos/organização & administração , Recursos Humanos/normas
9.
Isr Med Assoc J ; 8(22): 410-416, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32812714

RESUMO

BACKGROUND: The potential excess flow of patients into emergency departments and community clinics for testing and examination during a pandemic poses a major issue. These additional patients may lead to the risk of viral transmission to other patients and medical teams. To contain the spread of coronavirus disease-2019 (COVID-19), the Israeli Ministry of Health initiated a plan spearheaded by Magen David Adom (MDA), Israel's national emergency medical services (EMS) organization. OBJECTIVES: To describe outbreak containment actions initiated by MDA, including a COVID-19 tele-triage center and home testing by paramedics. METHODS: Retrospective analysis was conducted of de-identified data from the call management and command and control systems during the first period of the COVID-19 outbreak in Israel (23 February 2020-15 March 2020). RESULTS: During the study period, the total number of calls to the dispatch centers was 477,321 with a daily average of 21,696, compared to 6000-6500 during routine times. The total number of COVID-19 related calls was 334,230 (daily average 15,194). There were 28,454 calls (8.51% of all COVID-19 related calls, average 1293/day) transferred to the COVID-19 call center. Of the COVID-19 call center inquiries, 8390 resulted in the dispatch of a dedicated vehicle, including a paramedic wearing personal protective equipment, to collect samples for testing (daily average 381). CONCLUSIONS: Maximizing EMS during a pandemic using phone triage, in addition to dispatching paramedics to perform home testing, may significantly distance infected patients from the public and health care system. These steps can further minimize the spread of disease.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Serviços Médicos de Emergência/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Serviços Médicos de Emergência/organização & administração , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Israel/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Estudos Retrospectivos , Telemedicina/métodos , Telemedicina/organização & administração , Triagem/métodos , Triagem/organização & administração
12.
Front Health Serv Manage ; 37(1): 27-32, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32842086

RESUMO

As community transmission of COVID-19 first emerged in the United States and then quickly spread, America's military accepted an important role in responding to the growing pandemic. The Department of Defense (DOD) rapidly mobilized and deployed personnel, expeditionary medical capabilities, supplies, and equipment to hot spots across the country. How does a military with an expeditionary focus and armed for war abroad quickly pivot to support national response efforts to a public health crisis here at home? Coinciding with the DOD's established flexible response methodology, the US Army adapted a three-pronged approach to prevent, detect, and treat COVID-19 while protecting the force and safeguarding the American people. This approach is providing strategic and operational lessons for improving healthcare delivery, informing public health decisions, and allocating healthcare resources for future pandemic response and civil emergency support efforts.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Assistência à Saúde/organização & administração , Serviços Médicos de Emergência/organização & administração , Medicina Militar/organização & administração , Militares , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Papel Profissional , Estados Unidos
13.
Front Health Serv Manage ; 37(1): 39-44, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32842088

RESUMO

Catastrophic weather, like a pandemic, can wreak havoc on hospital operations. NYU Langone Health in New York City has experienced the extremes of both phenomena. In 2012, Superstorm Sandy severely damaged the system's core facilities, disabled operations, and forced the evacuation of more than 220 patients to other health systems. In 2020, the arrival of the novel coronavirus severely disrupted operations again-but this time, we were better prepared. Our experience in dealing with Superstorm Sandy taught us critical lessons that supported our readiness for COVID-19. Those lessons can be summed up as preparation, organization, and innovation.


Assuntos
Defesa Civil/organização & administração , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Tempestades Ciclônicas , Planejamento em Desastres/organização & administração , Serviços Médicos de Emergência/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Betacoronavirus , Humanos , Cidade de Nova Iorque
14.
J Bus Contin Emer Plan ; 14(1): 65-74, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-32847655

RESUMO

Each year, millions of individuals participate in emergency management training courses. Training opportunities are plentiful and offered by a variety of governmental, public and private providers, in a variety of locations and teaching environments, using a multitude of different topics, styles and methodologies. Training opportunities are vast and often designed to support a broad audience of learners, including those seeking to attain new skills as well as those seeking to retrain or change career. Yet, despite the abundant opportunities for training, including education, instruction, exercises and drills (including training on how to train), in the period following the activation of the emergency operations centre, when the time has come to implement the tools and actions taught, there remain problems. With all this training available, what exactly are workers learning and what are they forgetting? This paper will look at the need for an evolution in traditional emergency management training methods, such as what is working, what is not working, and how methods could evolve to enhance training engagement, increase knowledge retention, and improve worker performance.


Assuntos
Planejamento em Desastres , Serviços Médicos de Emergência , Serviços Médicos de Emergência/organização & administração , Humanos
15.
Emerg Med J ; 37(10): 642-643, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32753393

RESUMO

The COVID-19 pandemic has taken the world by storm and overwhelmed healthcare institutions even in developed countries. In response, clinical staff and resources have been redeployed to the areas of greatest need, that is, intensive care units and emergency rooms (ER), to reinforce front-line manpower. We introduce the concept of close air support (CAS) to augment ER operations in an efficient, safe and scalable manner. Teams of five comprising two on-site junior ER physicians would be paired with two CAS doctors, who would be off-site but be in constant communication via teleconferencing to render real-time administrative support. They would be supervised by an ER attending. This reduces direct viral exposure to doctors, conserves precious personal protective equipment and allows ER physicians to focus on patient care. Medical students can also be involved in a safe and supervised manner. After 1 month, the average time to patient disposition was halved. General feedback was also positive. CAS improves efficiency and is safe, scalable and sustainable. It has also empowered a previously untapped group of junior clinicians to support front-line medical operations, while simultaneously protecting them from viral exposure. Institutions can consider adopting our novel approach, with modifications made according to their local context.


Assuntos
Resgate Aéreo/organização & administração , Infecções por Coronavirus/prevenção & controle , Serviços Médicos de Emergência/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Recursos Humanos/organização & administração , Infecções por Coronavirus/epidemiologia , Medicina de Emergência/organização & administração , Feminino , Humanos , Masculino , Inovação Organizacional , Avaliação de Resultados em Cuidados de Saúde , Pandemias/estatística & dados numéricos , Projetos Piloto , Pneumonia Viral/epidemiologia , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade
16.
Crit Care Med ; 48(11): e1147-e1157, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32858530

RESUMO

OBJECTIVES: To identify and appraise articles describing criteria used to prioritize or withhold a critical care admission. DATA SOURCES: PubMed, Embase, Medline, EBM Reviews, and CINAHL Complete databases. Gray literature searches and a manual review of references were also performed. Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed. STUDY SELECTION: We sought all articles and abstracts of original research as well as local, provincial, or national policies on the topic of ICU resource allocation. We excluded studies whose population of interest was neonatal, pediatric, trauma, or noncritically ill. Screening of 6,633 citations was conducted. DATA EXTRACTION: Triage and/or transport criteria were extracted, based on type of article, methodology, publication year, and country. An appraisal scale was developed to assess the quality of identified articles. We also developed a robustness score to further appraise the robustness of the evidence supporting each criterion. Finally, all criteria were extracted, evaluated, and grouped by theme. DATA SYNTHESIS: One-hundred twenty-nine articles were included. These were mainly original research (34%), guidelines (26%), and reviews (21%). Among them, we identified 200 unique triage and transport criteria. Most articles highlighted an exclusion (71%) rather than a prioritization mechanism (17%). Very few articles pertained to transport of critically ill patients (4%). Criteria were classified in one of four emerging themes: patient, condition, physician, and context. The majority of criteria used were nonspecific. No study prospectively evaluated the implementation of its cited criteria. CONCLUSIONS: This systematic review identified 200 criteria classified within four themes that may be included when devising triage programs including the coronavirus disease 2019 pandemic. We identified significant knowledge gaps where research would assist in improving existing triage criteria and guidelines, aiming to decrease arbitrary decisions and variability.


Assuntos
Infecções por Coronavirus/terapia , Cuidados Críticos/organização & administração , Estado Terminal/terapia , Unidades de Terapia Intensiva/organização & administração , Transferência de Pacientes/organização & administração , Pneumonia Viral/terapia , Triagem/organização & administração , Betacoronavirus , Serviços Médicos de Emergência/organização & administração , Humanos , Avaliação de Resultados em Cuidados de Saúde , Pandemias , Segurança do Paciente
18.
J Orthop Trauma ; 34(9): e330-e335, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32815847

RESUMO

Although elective surgeries and in-person office visits were greatly reduced during the COVID-19 crisis, orthopaedic surgeons continue to play a critical role in caring for both orthopaedic and nonorthopaedic problems during this pandemic. Orthopaedic departments provide the ability to off-load emergency departments of orthopaedic issues, redeploy staff to areas of need across the hospital system, and provide direct care to COVID-19 patients. The following will discuss the experience of a large academic orthopaedic surgery department within the epicenter of the COVID-19 pandemic with respect to redeployment of human capital and unique resources such as the United States Naval Ship Comfort as well as our recommended strategy for handling future disaster situations.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Serviços Médicos de Emergência/organização & administração , Militares , Ortopedia/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Navios , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Humanos , Cidade de Nova Iorque/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia
19.
Am J Disaster Med ; 15(1): 33-41, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32804384

RESUMO

BACKGROUND: Recent mass-casualty events have exposed errors with common assumptions about response proc-esses, notably triage and transport of patients. Response planners generally assume that the majority of patients from a mass-casualty event will have received some level of field triage and transport from the scene to the hospital will have been coordinated through on-scene incident command. When this is not the case, emergency response at the hospital is hampered as staff must be pulled to handle the influx of untriaged patients. OBJECTIVE: Determine whether the use of emergency medical service (EMS) field resources in hospital triage could enhance the overall response to active-shooter and other mass-casualty events. DESIGN: A proof of concept study was planned in conjunction with a regularly scheduled mass-casualty hospital ex-ercise conducted by an urban level II trauma center in Utah. This was a cross-over study with triage initially performed by hospital staff, and at the midpoint of the exercise, triage was transferred to EMS field units. General performance was judged by exercise planners with limited additional data collection. RESULTS: EMS crews at the hospital significantly enhanced the efficiency and efficacy of the triage operation in both qualitative and quantitative assessment. CONCLUSIONS: Hospital planners deemed the proof of concept exercise a success and are now experimenting with implementation of this alternate approach to triage. However, much additional work remains to fully implement this change in processes.


Assuntos
Planejamento em Desastres/organização & administração , Serviços Médicos de Emergência/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Incidentes com Feridos em Massa , Triagem/organização & administração , Estudos Cross-Over , Humanos
20.
Am J Disaster Med ; 15(1): 43-48, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32804385

RESUMO

BACKGROUND: While mass-casualty incidents (MCIs) may have competing absolute definitions, a universally accepted criterion is one that strains locally available resources. In the fall of 2017, a MCI occurred in New York and Bellevue Hospi-tal received multiple injured patients within minutes; lessons learned included the need for a formalized, efficient patient and injury tracking system. Our objective was to create an organized MCI clinical tracking form for civilian trauma centers. METHODS: After the MCI, the notes of the surgeon responsible for directing patient triage were analyzed. A suc-cinct, organized template was created that allows MCI directors to track demographics, injuries, interventions, and other important information for hmultiple patients in a real-time fashion. This tool was piloted during a subsequent MCI. RESULTS: In late 2018, the hospital received six patients following another MCI. They arrived within a 4-minute window, with 5 patients being critically injured. Two emergent surgeries and angioembolizations were performed. The tool was used by the MCI director to prioritize and expedite care. All physicians agreed that the tool assisted in organizing diagnostic and therapeutic triage. CONCLUSIONS: During MCIs, a streamlined patient tracking template assists with information recall and communica-tion between providers and may allow for expedited care.


Assuntos
Planejamento em Desastres/organização & administração , Serviços Médicos de Emergência/organização & administração , Incidentes com Feridos em Massa , Triagem/organização & administração , Hospitais , Humanos , New York , Cirurgiões
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