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Triage criteria rely on physiologic, anatomic, and mechanistic indicators of injury to minimize over-triage and under-triage, which remain persistendy high (35%—65%). The Visensia Index Score (VIS) is a proprietary algorithm in a bedside monitor (OBS Medical, IN) mat integrates five vital signs: (1) heart rate; (2) respiratory rate; (3) blood pressure; (4) pulse oximetry; and (5) temperature. It calculates a score ranging from 1 (no abnormality) to 5 (severe abnormalities). The aim of this study was to explore the utility of VIS in identifying trauma patients likely to have a poor prognosis on arrival to the emergency departments.
Methods:
After Institutional Review Board approval, the trauma registry was used to review 117 patients admitted to a Level-1 Trauma Center over a six month period. The first set of vital signs was obtained upon arrival to the emergency department. An initial VIS and a mean VIS (based on multiple VS) was calculated. The analysis included a multivariate mathematical technique and k-means cluster analysis. Clusters of populations with different Visensia scores were compared and differences in their outcomes were analyzed.
Results:
Two major clusters were identified: VIS Scores >3 increased the risk of mortality as compared to those with scores <3; odds ratio 3.3 [1.04–10.3; p <0.001). There was no association with length of intensive care unit stay, hospital days; or Injury Severity Scale (ISS) scores.
Conclusions:
Cluster analysis, a novel multidimensional approach, shows association of a higher VIS (>3) as a useful point-of-care parameter to identify trauma patients likely to have a poorer prognosis, much more than retrospectively computed ISS and Trauma and Injury Severity Scores (TRISS).
The World Association for Disater and Emergency Medicine (WADEM) Oceania Regional Chapter is the first WADEM Chapter to be formed. This paper describes the journey experienced in the formation of this Chapter.
Methods:
This is a descriptive, historical review.
Results:
The Chapter had its origins in WADEM's 13th World Congress in Melbourne (2003). In Edinburgh (2005), the WADEM General Assembly approved the establishment of Chapters to promote both the discipline and WADEM activities. WADEM Vice President, Professor Frederick (Skip) Burkle Jr, led the development of guidelines for establishing WADEM Chapters, which were considered by the WADEM Board in Amsterdam (2007) and subsequendy approved by the WADEM Officers in August 2007.
Three “Chapter co-sponsors”, later expanded to a steering group of five to include members from Australia, New Zealand, and the Pacific Island Nations, led the process. Three constituting meetings were conducted by teleconference, the general geography of the Oceania region defined, and draft Chapter Charter and Chapter bylaws were distributed for input from WADEM members in the region. The Chapter was launched in November 2008.
Nominations for the inaugural Chapter Council have been called in advance of an election to be finalized in February 2009. The first Chapter Council will meet before the WADEM World Congress in Victoria, Canada (May, 2009). The Council has a list of activities proposed in the constituting meetings, upon which to base an initial strategy plan for the young Chapter.
The WADEM Chapter guidelines have been most useful and the concept of Chapter co-sponsors has proved essential. Enthusiasm in the region has been promoted by the formation of the Chapter and membership in WADEM increased.
Conclusions:
The model and process experienced in the Oceania region may prove useful for other potential WADEM Chapters. Experience to date would suggest that WADEM Chapters are viable, achievable, and useful in promoting WADEM and its members.
The Sacco Triage Method (STM) is a mathematical model of resource-constrained triage. The objective of this presentation is to apply STM-Age, an age-augmented version of STM, to blunt trauma victims and compare it to Simple Triage and Rapid Treatment (START) and START-like protocols.
Methods:
The objective of STM is to maximize the number of expected survivors given constraints on the timing and availability of resources. The STM incorporates estimates of time-dependent victim survival probabilities based on an initial assessment and expected deteriorations.
For the STM-Age application, an “RPM-Age” score (based on respiratory rate, pulse rate, best motor response, and coded age) was used to estimate survival probability. Logistic function-generated survival probability estimates for RPM-Age values were determined from 76,444 patients with blunt injuries from the Pennsylvania Trauma Outcome Study. The Delphi Method provided expert consensus on victim deterioration rates, and the model was solved using linear programming.
The STM-Age was compared to START and START-like methods with respect to process and to outcome, as measured by expected number of survivors, in simulated resource-constrained casualty incidents.
Results:
The RPM-Age was a more accurate predictor of survivability for blunt trauma than RPM, as measured by calibration and discrimination statistics. In simulations, STM-Age exhibited substantially more expected survivors than START and START-like protocols.
Conclusions:
Resource-constrained triage is modeled precisely as an evidence-based, outcome-driven method (STM-Age) that maximizes expected survivors in consideration of resources. The STM-Age offers life-saving and operational advantages over current methods.
On 15 August 2007, a 7.0 Richter earthquake struck the southern coast of Peru. The national government reported 519 people dead, >1,500 injured, and 192,492 homes affected (78% of all homes in the eight provinces in the regions of Huancavelica, lea, and Lima).The province of Pisco in the region of lea was the most affected.
Methods:
The estimation of damages to healthcare facilities was based on a review of the assessment of the national and regional health authorities and recovery projects proposed by the South Reconstruction Fund.
Results:
At least 60 primary healthcare facilities were affected (18% of the total in the affected area), as well as four Ministry of Health hospitals. Three Social Security hospitals had moderate and severe structural and non-structural damages. Sixty-two percent (515) of the total number of beds available (834) in three lea provinces were lost in a few minutes after the earthquake.
Conclusions:
The effect of the earthquake on hospital services was large. It included damages to the infrastructure and the loss of furniture and biomedicai equipment. Foreign field hospitals and temporary strategies were adopted to assure the continuation of healthcare services and to reduce the risk of public health problems associated with the disaster.
To demonstrate features of the mental health care during the acute phase of a disaster due to natural hazards in Japan. This report will discuss issues in devastated area of Chuetsu in Niigata Prefecture after an offshore earthquake.
Methods:
The earthquake of 16 July 2007 had a magnitude 6.8. It injured 2,153 people, including 192 with severe injuries, and caused 14 deaths. The Tokyo Medical Association (TMA) deployed disaster medical relief teams on the day of the event, and performed mental care in internally displaced person (IDP) camps. Other mental care teams took over the mission three days after the event.
Results:
There were 27 medical teams was 27. They visited 88 IDP camps. Medical teams treated 2,288 cases during first four days. Forty-seven cases included psychiatric problems. Three of 13 refugees who had psychiatric symptoms needed new mediane. Four were under psychiatric treatment and could continue their treatment with their attending physicians.
Earthquake victims displayed the following characteristics during the acute phase: (1) poor adaptation in the elderly; (2) fluctuation of compliance for medications; (3) occult anxiety and complaints; and (4) unconsciousness of sleep disturbance.
Conclusions:
The development and education of liaison methods about mental health care during the acute phase of a disaster is needed for emergency physicians and general surgeons of Disaster Medical Assistance Team and Medical Association relief teams that perform treatment during the acute phase of disaster. They must understand and have skills for triage of different mental health cases.