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Triage in emergency departments is performed by nurses. In recent years, hospital triage has developed in Iran, and few studies have addressed nurses' competency in triage. Objective: The objective of this study was to assess the knowledge of nurses about triage in hospitals of Sistan-va-Balouchestan state in Iran.
Methods:
A survey was conducted among nurses in emergency departments (n = 10). The questionnaire was composed of factual knowledge questions about triage (n = 15) and triage decision-making questions (n = 10). Seventy nurses working in hospitals in Sistan-va-Balouchestan state participated. The questionnaire reliability was 0.60 using the test-re-test method. Content validity was considered based on Canadian Triage and Acuity Scale.
Results:
The response rate was 68% (70/102). Nurses proved to be unfamiliar with triage. Only 28% of their responses were correct. Only three emergency departments have specified special nurses to perform triage. Inter-rater agreement between nurses for all was r = 0.56 and for each nurse was r = 0.12.
Conclusions:
Emergency departments were not committed to a valid, reliable triage scale. Specialized education about hospital triage with a new approach is recommended. Further research on emergency department triage scales, standards, and guidelines is recommended.
The use of a common template for observer studies is a way of structuring the experiences gained (lessons observed and learned) from such studies. This facilitates the comparison of reports within one's own field as well as between different sectors. It also facilitates the implementation of joint observer activities and joint observer reports, promoting more comprehensive and holistic learning from the events.
Methods:
Using the Utstein method for studying disasters and the Swedish Disaster Medicine study organization (KAMEDO) as an inspiration, a number of Swedish governmental authorities and organizations compiled a template for presenting standardized observer reports. The following tides have been identified to be included: (1) Tide; (2) Preface; (3) Observers and Authors; (4) Summary and Experiences; (5) Introduction/Material and Methods; (6) Hazard; (7) Background (including pre-event status and preparedness); (8) Event; (9) Damage; (10) Disturbances; (11) Responses; (12) Recovery and Development; (13) Discussion; (14) References; (15) Appendices; (16) Keywords; (17) Index; and (18) Abbreviations.
Results:
This template has been used successfully for observer studies within the health sector (evacuation of Swedes from the war in Lebanon, 2006, a power supply failure at a major university hospital in Stockholm, 2007), within the food sector (Cryptosporidium contamination of water supply in Ireland, 2007, consequences for water supply from floods in the UK, 2007, sewage contamination of water supply in Finland, 2007) and within crisis management and rescue services sectors (floods in the UK, 2007, sewage contamination of water supply in Finland, 2007, wild fires in California, 2007)
Conclusions:
The use of a common, standardized template for the documentation of lessons observed and learned from major disasters/crises has proven useful. In addition to enhancing the completeness and learning value of the reports, it also has proven to be a useful tool for stimulating intra-sectoral cooperation and learning.
Disaster medicine is an increasingly important part of medicine. Training in the practical aspects of disaster medicine often is impossible, and simulation may offer an educational opportunity superior to traditional didactic methods.
Methods:
Twenty-two medical students at the Università degli studi del Piemonte Orientale were block-randomized into two groups of 11 students stratified by year of education. All participants received an eight-hour course of lectures and problem-based learning in disaster medicine. The intervention group received additional disaster medicine training on the disastermed.ca patient simulator, while the control group spent equal time on the simulator in a non-disaster setting. The ability of the two groups to manage a simulated disaster was compared.
Results:
Students in the intervention group were able to triage their patients more quickly than the control group (mean difference = 43 seconds, 95% CI 0.34–1.09 minutes, p <0.0003). Patients in the intervention group also were assessed more quickly (mean difference = 6.3 minutes, 95% CI = 0.4–12.1 minutes, p <0.04). Scores of performance indicators on a standardized scale was significantly higher in the intervention group (18/18) compared to the control group (8/18; p <0.0004). All students stated that they preferred the simulation-based curriculum to a lecture-based curriculum. When asked to rate the exercise overall, the median score was 8 on a 10-point modified Likert scale with no difference between the control and intervention groups.
Conclusions:
Simulation of a mass-casualty incident increased the speed at which medical students were able to triage and assess simulated patients. Exposure to the disaster simulation also increased the scores on a structured command-and-control performance indicator instrument. Overall student satisfaction with the simulation-based curriculum was high, and all students felt that the simulation was a valuable learning experience.
The role of ultrasound in disaster medicine has not been not well established. This report describes the transport and use of point-of-care ultrasound by Disaster Medical Assistance Team (DMAT) responding to a mass-casualty incident due to a cyclone. Ultrasound-competent physicians on the team were able to use portable ultrasound on cyclone casualties to exclude intra-abdominal hemorrhage, peri cardial fluid, pneumothoraces, and hemothoraces Information obtained using ultrasound made initial patient management, and subsequent decisions regarding triage for transport safer and based on more detailed clinical information.