scholarly journals Triaged Treatment-Based Conventional Weapon Combat Wound Classification Code Design and Injury Spectrum Statistical Analysis

2020 ◽  
Vol 185 (11-12) ◽  
pp. e2032-e2038
Author(s):  
Bo Peng ◽  
Shuo Liu ◽  
Lei Xu ◽  
Zhen He
Keyword(s):  
Emergency Treatment ◽  
Hospital Staff ◽  
First Aid ◽  
Mass Casualty ◽  
Classification Systems ◽  
Coding System ◽  
Traditional Methods ◽  
Vast Number ◽  
High Incidence ◽  
Wound Classification

Abstract Introduction We create an expandable combat wound classification coding system and a stratified standardized combat wound injury spectrum to support triage according to the treatment echelon and to provide the basis for the rapid and efficient classification of combat casualties. The coding system simultaneously assists in identifying injuries with a high incidence of fatality that require emergency treatment, and provides a framework for the triage of combat wounds in mass casualty situations. Materials and Methods The three-tiered treatment echelon consisting of battlefield on-site first aid, emergency treatment, and early treatment was used to design an expanded combat wound classification coding system according to the differential needs of combat wound treatment. The Herfindahl−Hirschman Index (HHI) index was used as the key indicator for injury spectrum ranking and was applied to select the key anatomical structures that require the highest priority treatment in the three treatment echelons. The combat wound classification codes were based on the results of consultations with selected experts and results from the HHI index calculations. The use of the classification codes at the battlefield on-site first aid stage and emergency treatment stage was evaluated in exercises to test and compare the effectiveness of the classification codes against current classification systems. Results We obtained exhaustive combinations from the vast number of combat wound factors in combat wound classification codes, constructed injury spectrum frameworks within the different treatment echelons, and identified injuries with a high-incidence of fatality in each of the treatment echelons. Compared with traditional methods, the time spent on coding was reduced and classification accuracy was improved when using the new classification codes, which led to improved efficiency of classification and a reduced workload for hospital staff. Conclusions The combat wound classification codes that were established through the HHI index and expert consultations achieved good results in terms of having higher classification speed and accuracy than traditional methods. This means they could be used to identify injuries with a high-incidence of fatality and provide guidance to improve the efficiency of treatment among all treatment echelons in the army.

scholarly journals Triaged treatment-based conventional weapon combat wound classification code design and injury spectrum statistical analysis

2020 ◽  
Author(s):  
BO PENG ◽  
Shuo Liu ◽  
Fei Pan ◽  
Zhen He ◽  
Tan-shi Li
Keyword(s):  
Emergency Treatment ◽  
Mass Casualty ◽  
Three Dimensions ◽  
Code Design ◽  
Classification Code ◽  
Treatment Techniques ◽  
High Incidence ◽  
Wound Classification ◽  
Combat Casualties ◽  
Fatal Injuries

Abstract Purpose To provide evidence for the rapid and efficient classification of combat casualties while simultaneously determining the types of high-incidence fatal injuries that require emergency treatment to support the triage of combat wounds in mass casualty situations. Methods The three-tiered treatment echelon consisting of battlefield on-site first aid, emergency treatment, and early treatment was used to design an expanded combat wound classification code system according to the differential needs of combat wound treatment. Three dimensions of evaluation indicators consisting of likelihood, importance, and suitability were established and an optimized quasi-HHI index was used for the normalization and ranking of expert survey results. Results We obtained exhaustive combinations from the massive number of combat wound factors in combat wound classification codes, constructed injury spectrum frameworks within the different treatment echelons, and identified high-incidence fatal injuries in different treatment echelons. Conclusions Our combat wound classification codes achieved good results in terms of having higher classification speed and accuracy than traditional methods. The high incidence fatal injuries identified by the constructed combat wound spectrum can provide guidance and support when used for the improvement of treatment techniques and upgrading equipment in the Chinese People’s Liberation Army.

scholarly journals Simple Emergency Triage (SET) – the new perspective on mass casualty incident triage

2020 ◽  
Vol 7 (2) ◽  
pp. 120-123
Author(s):  
Jerzy Jaskuła ◽  
Marek Siuta
Keyword(s):  
Personal Experience ◽  
Emergency Services ◽  
Statistical Data ◽  
First Aid ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Starting Point ◽  
Analysis And Synthesis ◽  
The Subject ◽  
New Perspective

The aim: Incidents with large number of casualties present a major challenge for the emergency services. Incident witnesses are always the first on scene. Authors aim at giving them an algorithm arranging the widely known first aid rules in such way, that the number of potential fatalities before the services’ arrival may be decreased. Material and methods: The authors’ main aim was creating an algorithm for mass casualty incident action, comprising elements not exceeding first aid skill level. Proceedings have been systematized, which led to creation of mass casualty incident algorithm. The analysis was based on the subject matter literature, legal acts and regulations, statistical data and author’s personal experience. Results: The analysis and synthesis of data from various sources allowed for the creation of Simple Emergency Triage (SET) algorithm. It has been proven – on theoretical level – that introducing an organized way of proceeding in mass casualty incident on the first aid level is justified. Conclusions: The SET algorithm presented in the article is of an implemental character. It may be a supplement to basic first aid skills. Algorithm may also be the starting point for further empirical research aimed at verifying its effectiveness.

scholarly journals (P1-46) A Model of Mass Casualty Management Education: The Prehospital Mass Casualty Exercise and Trauma Management Course

2011 ◽  
Vol 26 (S1) ◽  
pp. s113-s114
Author(s):  
M. Eryilmaz ◽  
M. Durusu ◽  
S.K. Tuncer ◽  
A. Bayir ◽  
I. Arziman ◽  
...  
Keyword(s):  
Emergency Surgery ◽  
Medical Management ◽  
Management Education ◽  
Panel Discussion ◽  
First Aid ◽  
Mass Casualty ◽  
Trauma Management ◽  
The Third ◽  
European Congress ◽  
Scene Management

IntroductionIn this article, we aimed to share “the prehospital mass casualty exercise and trauma management course” which is performed at the 10th European Congress of Trauma & Emergency Surgery as a model.Methods and MaterialsThe preparation, format, participant properties and the discussion of the course were evaluated.ResultsThe course performed in 4 parts. On the first part, a panel discussion including opening, targets of course and a conference was performed. On the second part, the prehospital mass casualty exercise was performed. On the third part, the participants discussed in different 4 workshops. On the last part, basic discussion results were declared. At the mass casualty exercise, the scenario was adapted from bus bombing which was in Diyarbakir on 03.01.2010, 6 deaths, 96 wounded. Field and injury simulations were performed. We trained 15 paramedic volunteers to act as wounded patients. Moulage and make-ups were made due to previously defined injuries as in Diyarbakir. The victims were placed in simulated maneuvers field. Participants were accepted in five each groups to the maneuvers field and they were requested to manage the scene, triage, first aid. After the exercise, 4 workshops themed as Scene Medical Management, Ground and Air Evacuations, Preparedness of the E D's and Preparedness of the OR's, and ICU's were performed. The results of the workshops were presented at the last part.Discussion and ConclusionThe participants expressed that observing and experiencing the chaos circumstances during the maneuvers are the most important things in scene management and these must be considered in preparedness and planning phases.

scholarly journals (A219) Development of a Hospital Disaster Plan for Countries with Limited Resources

2011 ◽  
Vol 26 (S1) ◽  
pp. s60-s60 ◽  
Author(s):  
F. Plani
Keyword(s):  
Hospital Staff ◽  
Mass Casualty ◽  
World Cup ◽  
Private Funding ◽  
Disaster Plan ◽  
Staff Members ◽  
Resource Limited ◽  
The World ◽  
Critical Issues ◽  
Disaster Training

The Chris Hani Baragwanath Hospital (CHBH) in South Africa is the largest in the world, with 2,900 beds. Its trauma unit boasts 15 resuscitation bays, while the triage area has space for 40 stretchers. There are 5,000 trauma resuscitations performed yearly, out of 50,000 patients seen in the Trauma Emergency Department. There is an eight-bed Trauma Intensive Care Unit (ICU) and a 56-bed Trauma Ward. There also are 25 stepdown beds, 70 outlying beds, a six-bed Burn ICU, 20-bed ward, and a 24-bed shortstay ward. There are about 80 resuscitations and 70 trauma emergency operations weekly. However, the hospital is severely limited in financial and human resources, with only 2–3 interns, two registrars, and one trauma consultant on-call. The hospital is at > 130% bed occupancy. The CHBH was designated as the main disaster hospital for the 2010 FIFA World Cup, due to its proximity to the 96,000-seat Soccer City. Nominal disaster plans existed, but there were no resources, preparations, or knowledge, as was the case with most other government hospitals. The Trauma Directorate developed a new plan for the World Cup, future mass-casualty incidents at CHBH, and for other resource limited hospitals. The plans are centered on four critical issues: (1) preparedness of hospital structure and staff; (2) dissemination of the plan; (3) disaster training; and (4) the development of “Disaster Bags” for 350 casualties A free disaster course trained > 400 staff members on in-hospital triage and trauma management. All hospital staff were allocated specific functions in case of disasters. This is the first time the CHBH has had an integrated disaster plan, with separate equipment allocation, through private funding, and involving all disciplines.

(A285) Hospital Preparation for Mass Casualty Events

2011 ◽  
Vol 26 (S1) ◽  
pp. s79-s79
Author(s):  
G. Margalit
Keyword(s):  
National Level ◽  
Task Assignment ◽  
Emergency Situation ◽  
Hospital Staff ◽  
Mass Casualty ◽  
Mass Casualties ◽  
Trauma Patients ◽  
Industrial Accidents ◽  
Car Accidents ◽  
Mass Casualty Events

BackgroundHospitals handle numerous tasks whose fundamental purpose is to provide medical treatment. Amongst these, the hospital prepares for the treatment of trauma patients who have been involved in car accidents, injuries at work and industrial accidents. These preparations, although part of the operative conventions of the hospital, do not guarantee the ability to handle Mass Casualty Events which require unique and dedicated preparation and a different operational approach. This paper presents the hospital approach of handling Emergency Mass Casualty Events.The ApproachThe preparations require involvement of a national level that must participate in the definition of the activities, task assignment and preparation of an annual plan. The peak of the preparations is a multidisciplinary drill, implemented as part of the annual activity of the hospital.The ImplementationIn an emergency situation, the aim is for the hospital staff to be capable of providing its patients (and family members) the best professional care in any given scenario. To achieve the above, the hospital is required to perform the following tasks: Defining procedures, personnel training, logistics infrastructure, control, drills and lesson learned implementation. The tasks should be performed under a multi-annual plan that covers various Mass Casualties Events scenarios including: a train accident, an event involving dangerous industrial materials (e.g. ammonia spill), biological scenarios (e.g. bird-flu) and radiation events (e.g. nuclear reaction).ConclusionsOnly precise preparations, disconnected completely from the on-going hospital routine can answer the need to handle Mass Casualties Events.

scholarly journals Using DIRECT Wound Assessment to Predict Limb Salvage and Provide Prognosis of Diabetic Foot Ulcers

2021 ◽  
Vol 17 (1) ◽  
pp. 9-18
Author(s):  
Dongkeun Jun ◽  
Yongseok Kwon ◽  
Jaehyun Bae ◽  
Myungchul Lee ◽  
Jeenam Kim ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Diabetic Foot ◽  
Complete Healing ◽  
Classification Systems ◽  
Assessment System ◽  
Foot Ulcers ◽  
Grading System ◽  
Diabetic Foot Ulcers ◽  
Coding System ◽  
Wound Assessment

Background: Many wound assessment systems including the Wagner classification and University of Texas (UT) grading system have been previously described. The authors of this study applied the DIRECT (Debridement of necrosis, Infection control, Revascularization, Exudate control, Chronicity, and Top surface) wound coding system for initial assessment of diabetic foot ulcers (DFUs) to predict limb salvage and prognosis.<br/>Methods: From January 2016 to February 2020, a total of 169 first-time DFU patients were retrospectively evaluated using the DIRECT wound coding assessment system. DFUs were followed up for at least 6 months, and scores in each component of the coding system according to final limb status were statistically evaluated. The coding assessment’s ability to predict major amputation was compared to those of the Wagner classification and the UT grading system.<br/>Results: Subjects were divided into complete healing (n=80, 47.3%), not healed (n=71, 42%), and amputation (n=18, 10.7%) groups. The mean values of each component of DIRECT assessment for the complete healing/amputation groups were D 0.86/1.56 (P<0.001), I 0.46/0.89 (P=0.001), R 0.65/0.94 (P=0.014), E 1.15/1.56 (P=0.049), C 0.69/0.89 (P=0.086), T 0.53/0.72 (P=0.13) and the sum was 3.140/4.741 (P<0.001). The area under the receiver operating characteristic curve of the DIRECT, Wagner, and UT grading systems was 0.722, 0.603, and 0.663, respectively.<br/>Conclusion: The DIRECT coding system shows a greater association with prediction of amputation or complete healing, compared with the Wagner and UT wound classification systems. This more accurate wound assessment system will be helpful in predicting prognosis and planning treatments.

Basic Principles and Benefits of Various Classification Systems in Health

2011 ◽  
pp. 51-58
Author(s):  
Dimitra Petroudi ◽  
Athanasios Zekios
Keyword(s):  
Information Systems ◽  
Health Professionals ◽  
International Classification Of Diseases ◽  
Classification Systems ◽  
Coding System ◽  
Basic Principles ◽  
Medical Coding ◽  
Coding Systems ◽  
Classification Of Diseases

The introduction of information systems in health progressively led tï coding systems. The purposes of these systems are: recording causes of death, coding diseases and procedures, etc. The most important medical coding system in our days is ICD (International Classification of Diseases). Other coding systems that health professionals use are: SNOMED, LOINC, MeSH, UMLS, DSM, DRG and HCPCS. There are also many Nursing Classification Systems, such as: NANDA, NIC, NOC, ICNP, Omaha and HHCC. This chapter describes these coding systems and their advantages.

COOLING IN THE EMERGENCY TREATMENT OF BURNS

PEDIATRICS ◽  
1973 ◽  
Vol 52 (3) ◽  
pp. 430-432
Author(s):  
Michael F. Epstein ◽  
John D. Crawford
Keyword(s):  
Health Professional ◽  
Simple Form ◽  
Emergency Treatment ◽  
First Aid ◽  
Hot Water ◽  
Coagulation Necrosis ◽  
Thermal Stimulus ◽  
Thermal Injuries ◽  
The Difference

Recent correspondence in the Lancet1-3 has called attention to the benefit of immediate cooling in the treatment of thermal injuries. This simple form of first aid can be provided as well by the layman as by the health professional and, more importantly, sooner. Given the same thermal stimulus, prompt cooling can mean the difference between extensive deep burns and more limited superficial injuries. What is the evidence to back this claim? The studies of Henriques and Moritz4 and Ofeigsson5 indicate that after hot water or flame exposure the temperature of skin and of the deeper tissue layers remains high enough to result in a period of extension of coagulation necrosis.

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