Maternal and Child Healthcare Service by Portable Health Clinic System Using a Triage Protocol
Rafiqul IslamKimiyo KikuchiYoko SatoRieko IzukuraNusrat JahanNazneen SultanaMeherun NessaFumihiko YokotaMariko NishikitaniAshir AhmedNaoki Nakashima
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Abstract:
The number of deaths of a mother and child caused by maternal and child healthcare (MCH) issues has been greatly decreased recently, but still, the number is extremely high especially in developing countries. Although the governments have been given a priority in this issue, the lack of financial and human resources brings a limit. Thus, the use of low-cost but appropriate technology is required. Portable Health Clinic (PHC), a telemedicine system developed for providing primary healthcare, is such a technology. This study aimed to address this MCH issue with the aid of a low-cost PHC service involving a continuum-of-care protocol to the rural communities of Bangladesh. Moreover, this study introduces a triage protocol to distinguish high-risk patients from the early stage of the continuum of care who need special care and refer to specialized physicians to prevent unwanted deaths.Keywords:
Triage
Continuum of care
Triage
Disaster Response
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Traditional triage could not meet the needs of battlefield casualties’ care in modern warfare. This paper designs of triage and medical evacuation system for casualties at sea that can quickly address mass-casualty triage, and store and transmit medical information during battlefield treatment and medical evacuation. This system consists of a high-capacity medical information card, a simulated patient generator, a triage classifier and a multifunctional airbag triage vest.
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Battlefield
Medical evacuation
Mass Casualty
Modern warfare
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Military medicine
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Objective To study the role of triage in medical transport of critically wounded persons after earthquake and tsunami disaster.Methods In the medical relief of earthquake and tsunami disaster occurred in Aceh of Indonesia,triage was carried out to screen the critically wounded persons.After the critical wounded persons were transported to the Aceh Airport with helicopters,medical workers from Multi-national Joint Transport Center provided emergency medical service and decided the transport priority according to the triage in Aceh Airport.Results A total of 217 wounded persons were evacuated to the respective medical institutions after brief triage and rapid treatment.Conclusion Triage can make full use of limited medical resources in treatment of critically wounded persons.
Triage
Disaster Medicine
Medical evacuation
Medical treatment
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A key aim in any mass disaster event is to avoid diverting resources by overwhelming specialized tertiary centers with minor casualties. The most crucial aspect of an effective disaster response is pre-hospital triage at the scene. Unfortunately, many triage systems have serious shortcomings in their methodologies and no existing triage system has enough scientific evidence to justify its universal adoption. Moreover, it is observed that the optimal approach to planning is by no means clear-cut and that each new incident involving burns appears to produce its own unique problems not all of which were predictable. In most major burns disasters, victims mostly have combined trauma burn injuries and form a heterogeneous group with a broad range of devastating injuries. Are these victims primarily burn patients or trauma patients? Should they be taken care of in a burn center or in a trauma center or only in a combined burns-trauma center? Who makes the decision? The present review is aimed at answering some of these questions. Un objectif clé après les désastres de masse de tous les types est d’éviter le détournement des ressources submergeant les centres tertiaires spécialisés de patients atteints de lésions mineures. L’aspect le plus crucial d’une réponse efficace aux catastrophes est le triage préhospitalier à la scène de l’accident. Malheureusement, de nombreux systèmes de triage présentent de sérieuses lacunes dans leurs méthodologies et aucun système de triage actuellement utilisé ne démontre de posséder les qualités scientifiques suffisantes pour justifier son adoption universelle. Par ailleurs, on observe que l’approche optimale pour la planification n’est pas nullement claire et que tous les cas de désastre par feu présentent des aspects particuliers non tous prévisibles. Dans la plupart des grands désastres par feu, la majorité des victimes présentent une association de brûlures et d’autres traumatismes et constituent un groupe hétérogène atteint d’une large gamme de lésions dévastatrices. Ces victimes sont-elles principalement des patients brûlés ou des patients traumatisés? Faut-il les prendre en charge dans un centre des brûlés ou un centre des traumatisés ou seulement dans un centre dédié aux soins des deux catégories de patients? Qui prend la décision? Les Auteurs de cette étude mirent à répondre à certaines de ces questions.
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Mass-casualty incident
Mass Casualty
Trauma Center
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Major trauma
Tertiary care
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Not everyone who uses the prehospital system needs ambulance transportation, but triaging patients is fraught with pitfalls. These authors evaluated whether emergency medical technicians in Portland, Oregon could apply prehospital triage protocols appropriately.
Emergency medicine experts developed a set of triage protocols to stratify patients into 1 of …
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Abstract Purpose: This study is an evaluation of the ability of medically trained and controlled emergency medical dispatchers to use telephone triage techniques to direct the appropriate prehospital unit to an emergency scene. Methods: Emergency dispatchers, educated in a formal emergency medical dispatch program, were assigned one of four triage priorities to incoming 9-1-1 calls. The actual field management delivered for each patient was compared with the dispatcher's triage to determine the appropriateness of triage. Results: A total of 1,045 consecutive calls were reviewed with 74.4% sorted as needing advanced life support (ALS) units on scene; 65.3% (95% CI, 61.9 to 68.6%) of these calls required ALS intervention. A total of 3.4% of the runs sorted to the non-ALS response groups were identified to have required ALS intervention. Comparing the need for ALS intervention, a significant difference was found between the triage groups. Conclusion: Emergency medical dispatchers, using a formal system for telephone triage, are able to direct appropriate prehospital resources to the emergency scene.
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Early efforts to incorporate telemedicine into Emergency Medicine focused on connecting remote treatment clinics to larger emergency departments (EDs) and providing remote consultation services to EDs with limited resources. Owing to continued ED overcrowding, some EDs have used telemedicine to increase the number of providers during surges of patient visits and offer scheduled "home" face-to-face, on-screen encounters. In this study, we used remote on-screen telemedicine providers in the "screening-in-triage" role.This study aimed to compare the efficiency and patient safety of in-person screening and telescreening.This cohort study, matched for days and proximate hours, compared the performance of real-time remote telescreening and in-person screening at a single urban academic ED over 22 weeks in the spring and summer of 2016. The study involved 337 standard screening hours and 315 telescreening hours. The primary outcome measure was patients screened per hour. Additional outcomes were rates of patients who left without being seen, rates of analgesia ordered by the screener, and proportion of patients with chest pain receiving or prescribed a standard set of tests and medications.In-person screeners evaluated 1933 patients over 337 hours (5.7 patients per hour), whereas telescreeners evaluated 1497 patients over 315 hours (4.9 patients per hour; difference=0.8; 95% CI 0.5-1.2). Split analysis revealed that for the final 3 weeks of the evaluation, the patient-per-hour rate differential was neither clinically relevant nor statistically discernable (difference=0.2; 95% CI -0.7 to 1.2). There were fewer patients who left without being seen during in-person screening than during telescreening (2.6% vs 3.8%; difference=-1.2; 95% CI -2.4 to 0.0). However, compared to prior year-, date-, and time-matched data on weekdays from 1 am to 3 am, a period previously void of provider screening, telescreening decreased the rate of patients LWBS from 25.1% to 4.5% (difference=20.7%; 95% CI 10.1-31.2). Analgesia was ordered more frequently by telescreeners than by in-person screeners (51.2% vs 31.6%; difference=19.6%; 95% CI 12.1-27.1). There was no difference in standard care received by patients with chest pain between telescreening and in-person screening (29.4% vs 22.4%; difference=7.0%; 95% CI -3.4 to 17.4).Although the efficiency of telescreening, as measured by the rate of patients seen per hour, was lower early in the study period, telescreening achieved the same level of efficiency as in-person screening by the end of the pilot study. Adding telescreening during 1-3 am on weekdays dramatically decreased the number of patients who left without being seen compared to historic data. Telescreening was an effective and safe way for this ED to expand the hours in which patients were screened by a health care provider in triage.
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This article discusses the use of triage by the emergency medical technician when responding to a multiple casualty incident. It describes the START system, a commonly used system of triage, and notes difficulties EMS technicians frequently have when first using triage. It also relates the troubling emotions that one can experience while executing triage systems.
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The objective of this study was to design a triage system for emergency patients in the pre-hospital EMS phase without special knowledge related to the triage system. For this, we selected the Manchester system considering the pre-hospital emergency situation. Through this study, without the special knowledge about the complex triage system, the paramedics were able to produce the triage result by recording information through a newly designed ambulance report.
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When there are a lot of injured people at a large-scale disaster site, medical staff first do triage. Triage is to decide the priority for treatment depending on the degree of severity or urgency of injured people. Paper triage tags are used now to show their condition and to record information on injuries. We do research that collect information of injured people by using electronic triage tags which replace the current paper tags. To do prompt and accurate emergency medical services with electronic tags at a disaster site, it is important for medical staff to engage in a disaster-relief training using them on a daily basis. So we propose the disaster-relief training system using the electronic triage tag. This system supports to develop the scenarios of injured people information and transport information. We let the electronic triage tag generate vital signs of injured people constantly. By collecting and monitoring those data at regular intervals, we aim to conduct a more practical disaster-relief training considering the change in symptoms of injured people.
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