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Triaging plays an important role in providing suitable care to the largest number of casualties in a disaster setting. We developed the Pediatric Physiological and Anatomical Triage score (PPATS) as a new secondary triage method.
This study was performed to validate the accuracy of the PPATS in pediatric patients with burn injuries.
A retrospective review of pediatric patients with burn injuries younger than 15 years old registered in the Japan Trauma Databank from 2004 to 2016 was conducted. The PPATS, which was assigned scores from 0 to 22, was calculated based on vital signs, anatomical abnormalities, and need for life-saving intervention. The PPATS categorized the patients by their priority and defined the intensive care unit (ICU)-indicated patients as those with PPARSs more than 6. This study compared the accuracy of prediction of ICU-indicated patients between the PPATS and Triage Revised Trauma Score (TRTS).
Among 87 pediatric patients, 62 (71%) were admitted to the ICU. The median age was 3 years (interquartile range: 1 to 9 years old). The sensitivity and specificity of the PPATS were 74% and 36%, respectively. The area under the receiver-operating characteristic curve was not different between the PPTAS [0.51 (95% confidence interval: -0.51–1.48) and the TRTS [0.51 (-1.17–1.62), p=0.57]. Regression analysis showed a significant association between the PPATS and the Injury Severity Score (ISS) (r2=0.39, p<0.01). On the other hand, there is no association between the TRTS and the ISS (r2=0.00, p=0.79).
The accuracy of the PPATS was not superior to that of current secondary-triage methods. However, the PPATS had the advantage of objectively determining the triage priority ranking based on the severity of the pediatric patients with burn injuries.
HMIMMS (Major Incident Medical Management and Support: The Practical Approach in the Hospital) has been introduced by ALSG (Advanced Life Support Group, Manchester, UK) and developed for many countries for preparing to accept huge numbers of casualties at a hospital during major incidents. The original HMIMMS course has been held in Japan since 2007, produced over 1,200 providers. Japan has a crucial history of natural disasters, earthquakes, tsunamis, and typhoons often resulting in extensive damages to infrastructure and communications.
The MIMMS-JAPAN and the Japanese Association for Disaster Medicine have joined to plan to revise the original HMIMMS course from the point of view of the difference of the type of disaster.
By the permission of ALSG, two subjects were added “Hospital Evacuation” and “Business Continuity Plan” as lectures, workshops, and tabletops to the original HMIMMS course. Before attending the course, students were required to watch e-learning for deeper understanding and time-saving. Total program was organized into two days.
Main points of modification are to:
1.Replace a system peculiar to the UK with a Japanese system.
2.Add unique contents of a Japanese disaster.
3.Add the important subjects especially in Japan.
4.Modify the presentation slides to understand easily for Japanese students. But the fundamental concept that hospital functions upon ‘CSCATTT’ is strictly preserved.
Newly revised HMIMMS course will start in 2019 for Japanese learners. Many reflections must be accumulated and further revisions will continue.
A large number of visitors to Tokyo during the Tokyo Olympic and Paralympic Games in 2020 resulted in an increase of injury/illness and burden to the routine emergency medical services system. Furthermore, extremely hot and humid weather, terrorism, and outbreaks of infectious diseases are marked risks.
We introduce the present status of an academic consortium (AC2020) to fulfill our mission as academic organizations. The Japanese Association for Acute Medicine (JAAM) and six academic associations have initially established the AC2020 since 2016, which consists of the 23 associations at this time. The role of the AC2020 is to provide knowledgeable evidence, intelligence, and support for constructing response plans for medical problems via the website (http://2020ac.com/).
The joint committee of the AC2020 (JC-AC2020) has been launched to accomplish consortium activities; make statements and recommendations, compile manuals, conduct seminars, and coordinate the training program of on-site medical teams. The JC-AC2020 organizes nine working groups of heat stroke, lightning strike, nursing, athletes, first responders, foreigners, pre and in-hospital response of MCI, and data collection for audit.
As of December in 2018, AC2020 has released 30 documents and 10 event-news on the website including seven statements, two recommendations of a prerequisite of the on-site medical team, and two manuals concerning the treatment of gunshot and explosive injuries. Based on some of these statements, the Tokyo government has already enhanced the previous plan.
The AC2020 will propose the web site as a portal site and platform, disseminate the activities widely to society, and ask for the cooperation of other related organizations and academic societies. The AC2020 will aim to provide the landmark project of mass-gathering medical care in Japan as well as the transition to the Olympic Games in Paris in 2024.
We quantified an absolute imbalance of the medical risks and the support needs for children at each disaster-based hospital in Kanagawa immediately following the occurrence of a large earthquake by using the risk resource ratio (RRR) and need for medical resources (NMR).
The RRR and NMR of 33 disaster-based hospitals were estimated through dividing the estimated number of pediatric victims by the number of critically patients. We calculated the ratio of the NMR of each hospital.
The total number of pediatric victims in Kanagawa was estimated at 8,391. The total number of vacant beds for pediatric victims was 352. The median RRR and NMR of the total number of pediatric victims were 27 and 224. The median RRR and NMR of the number of critically ill pediatric patients were 27 and 12.
The absolute imbalance of the RRR and NMR for children in Kanagawa was quantified. This suggests that we might embark on preparedness strategies for children in advance. (Disaster Med Public Health Preparedness. 2018;13:672–676)
Triage has an important role in providing suitable care to the largest number of casualties in a disaster setting, but there are no secondary triage methods suitable for children. This study developed a new secondary triage method named the Pediatric Physiological and Anatomical Triage Score (PPATS) and compared its accuracy with current triage methods.
A retrospective chart review of pediatric patients under 16 years old transferred to an emergency center from 2014 to 2016 was performed. The PPATS categorized the patients, defined the intensive care unit (ICU)-indicated patients if the category was highest, and compared the accuracy of prediction of ICU-indicated patients among PPATS, Physiological and Anatomical Triage (PAT), and Triage Revised Trauma Score (TRTS).
Among 137 patients, 24 (17.5%) were admitted to ICU. The median PPATS score of these patients was significantly higher than that of patients not admitted to ICU (11 [IQR: 9-13] versus three [IQR: 2-4]; P<.001). The optimal cut-off value of the PPTAS was six, yielding a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 95.8%, 86.7%, 60.5%, and 99.0%. The area under the receiver-operating characteristic curve (AUC) was larger for PPTAS than for PAT or TRTS (0.95 [95% CI, 0.87-1.00] versus 0.65 [95% CI, 0.58-0.72]; P<.001 and 0.79 [95% CI, 0.69-0.89]; P=.003, respectively). Regression analysis showed a significant association between the PPATS and the predicted mortality rate (r2=0.139; P<.001), ventilation time (r2=0.320; P<.001), ICU stay (r2=0.362; P<.001), and hospital stay (r2=0.308; P<.001).
The accuracy of PPATS was superior to other methods for secondary triage of children.
ToidaC, MugurumaT, AbeT, ShinoharaM, GakumazawaM, YogoN, ShirasawaA, MorimuraN. Introduction of Pediatric Physiological and Anatomical Triage Score in Mass-Casualty Incident. Prehosp Disaster Med. 2018;33(2):147–152.
Past history of mass casualties related to international football games brought the importance of practical planning, preparedness, simulation training, and analysis of potential patient presentations to the forefront of emergency research.
The Japanese Ministry of Health, Labor, and Welfare established the Health Research Team (HRT-MHLW) for the 2002 FIFA World Cup game (FIFAWC). The HRT-MHLW collected patient data related to the games and analyzed the related factors regarding patient presentations.
A total of 1,661 patients presented for evaluation and care from all 32 games in Japan. The patient presentation rate per 1,000 spectators per game was 1.21 and the transport-to-hospital rate was 0.05. The step-wise regression analysis identified that the patient presentations rate increased where access was difficult. As the number of total spectators increased, the patient presentation rate decreased. (p <0.0001, r = 0.823, r2 = 0.677).
In order to develop mass-gathering medical-care plans in accordance with the types and sizes of mass gatherings, it is necessary to collect data and examine risk factors for patient presentations for a variety of events.
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