- Email: [email protected]
Difficulties of triage in mass casualties incident
Injury, Int. J. Care Injured 44 (2013) 1965–1966
Contents lists available at ScienceDirect
Injury journal homepage: www.elsevier.com/locate/injury
[(5483)TD.SARIEM]Letter to the Editor Comments on Mahaluxmivala et al. ‘‘Ilizarov external fixator: Acute shortening and lengthening versus bone transport in the management of tibial non-unions’’
[(5480)TD.SARIEM]Letter to the Editor
Dear Editor,
We would like to congratulate Postma et al. [1] for their study assessing the performance of prehospital triage after the Turkish Airlines crash near Amsterdam in 2009. First, it was found that 7 of 18 patients with spinal injury were transported to hospital without spinal immobilisation or only with spine board. A more systematic approach of spinal immobilisation after plane crashes seems necessary. Second, the authors reported that triage tags were used only in 12% of casualties, and they wrote that ‘‘This asks for a casualty/ triage tag with enough space for identification information, medical information and triage category which can be altered during the process. The goal should be to create a tag/card (maybe digital) that has use during day to day casualty management and is also applicable in MCIs.’’ We had the opportunity to develop such a tool in the fire brigade of Paris. Our standardised digital information system (SINUS) is a digital system for victim counting, identification and triage in mass casualty incident. SINUS is used in our department since 2009 in daily practice (when 5 victims or more are involved). Every casualty receives on the field a bar-coded bracelet with unique identifying number, as well as a decontaminable medical card. The nature of the wound, the triage category, the identity and the hospital destination are gradually completed by paramedics and doctors in the rescue chain. These data are then transferred in real time towards a computer application in order to inform all the partners (rescue teams, hospitals, authorities). Third, overtriage appeared high (when considering the modified Baxt criteria: 80–89%). Effective trauma system relies on accurate prehospital triage to correctly identify trauma patients for transfer to an appropriate facility. And Frykberg and Tepas assessed 220 bombings and found (multiple linear regression analysis) a direct linear relationship between prehospital overtriage and mortality in hospitalised patients [2]. After London bombing in 2004, such high rate of overtriage was reported in mass casualty triage by rescuers or paramedics, but it contrasts with data concerning in the field triage by specialised practicians [3]. Whatever, only few real-life experiences of prehospital paediatric triage are reported in medical literature. Two studies found difficulties in predicting injury severity, with major overtriage in paediatric trauma patients [4,5]. On the basis of their exceptional experience, we would like to know whether the authors had the opportunity to explore specifically the overtriage rate associated with prehospital paediatric triage protocol used after Turkish Airlinescrash.
We read with deep interest the article by Mahaluxmivala [1]. We appreciate the work of the authors on the article. However, the data about infection of Table 1 are inconsistent with that in Results. From Table 1, infection was recorded in 2 patients in group 1, 5 patients in group 2 and 6 patients in group 3. But from Results, infection was noted in 4 patients in group 1, 5 patients in group 2 and 1 patient in group 3. This makes us confused. We do not know clearly about patient demographics. In brief, we think a corrigendum should be made; otherwise the inconsistency about the data of infection makes readers more difficult to extract the data. Nonetheless, the flaw cannot lessen this article’s complete value and we thoroughly enjoyed reading the paper with respect. Conflict of interest statement Authors declare that there is no conflict of interest. Reference [1] Mahaluxmivala J, Nadarajah R, Allen PW, Hill RA. Ilizarov external fixator: acute shortening and lengthening versus bone transport in the management of tibial non-unions. Injury 2005;36:662–8.
Peng Yina, b Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, PR China b Medical College, Nankai University, No. 94 Weijin Road, Tianjin 300071, PR China a
Lihai Zhang Zhi Mao Peifu Tang* Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, PR China *Corresponding author. Tel.: +86 10 6693 8101; fax: +86 10 6816 1218 E-mail address: [email protected] (L. Zhang) 3 August 2013 1 September 2013[(5483)TD.ENIM][
Difficulties of triage in mass casualties incident
Conflicts of interest
http://dx.doi.org/10.1016/j.injury.2013.09.005
No authors have any conflicts of interest. 0020–1383/$ – see front matter . Crown Copyright ß 2013 Published by Elsevier Ltd. All rights reserved.
1966
Letters to the Editor / Injury, Int. J. Care Injured 44 (2013) 1965–1966
References [1] Postma IL, Weel H, Heetveld MJ, van der Zande I, Bijlsma TS, Bloemers FW, et al. Mass casualty triage after an airplane crash near Amsterdam. Injury 2013. http://dx.doi.org/10.1016/j.injury.2013.03.038. pii: S0020-1383(13)00178-2. [2] Frykberg ER, Tepas III JJ. Terrorist bombings, lessons learned from Belfast to Beirut. Ann Surg 1988;208:569–76. [3] Aylwin CJ, Ko¨nig TC, Brennan NW, Shirley PJ, Davies G, Walsh MS, et al. Reduction in critical mortality in urban mass casualty incidents: analysis of triage surge, and resource use after the London bombings on July 7, 2005. Lancet 2006;368(9554):2219–25. [4] Engum S, Mitchell M, Scherer LR, Gomez G, Jacobson L, Solotkin K, et al. Prehospital triage in the injured pediatric patient. J Pediatr Surg 2000;35(1):82–7. [5] Qazi K, Kempf J, Christopher N, Gerson L. Paramedic judgement of the need for trauma team activation for paediatric patients. Acad Emerg Med 1998; 5(10):1002–7.
Ste´phane Travers* Michel Bignand Ste´phane Raclot Laurent Domanski Jean Pierre Tourtier Emergency Medical Service, Fire Brigade of Paris, 1 place Jules Renard, 75017 Paris, France *Corresponding author. Tel.: +33 6 22 24 64 34 E-mail address: [email protected] (S. Travers) [(5480)TD.ENIM] http://dx.doi.org/10.1016/j.injury.2013.09.002
Contents lists available at ScienceDirect
Injury journal homepage: www.elsevier.com/locate/injury
[(5483)TD.SARIEM]Letter to the Editor Comments on Mahaluxmivala et al. ‘‘Ilizarov external fixator: Acute shortening and lengthening versus bone transport in the management of tibial non-unions’’
[(5480)TD.SARIEM]Letter to the Editor
Dear Editor,
We would like to congratulate Postma et al. [1] for their study assessing the performance of prehospital triage after the Turkish Airlines crash near Amsterdam in 2009. First, it was found that 7 of 18 patients with spinal injury were transported to hospital without spinal immobilisation or only with spine board. A more systematic approach of spinal immobilisation after plane crashes seems necessary. Second, the authors reported that triage tags were used only in 12% of casualties, and they wrote that ‘‘This asks for a casualty/ triage tag with enough space for identification information, medical information and triage category which can be altered during the process. The goal should be to create a tag/card (maybe digital) that has use during day to day casualty management and is also applicable in MCIs.’’ We had the opportunity to develop such a tool in the fire brigade of Paris. Our standardised digital information system (SINUS) is a digital system for victim counting, identification and triage in mass casualty incident. SINUS is used in our department since 2009 in daily practice (when 5 victims or more are involved). Every casualty receives on the field a bar-coded bracelet with unique identifying number, as well as a decontaminable medical card. The nature of the wound, the triage category, the identity and the hospital destination are gradually completed by paramedics and doctors in the rescue chain. These data are then transferred in real time towards a computer application in order to inform all the partners (rescue teams, hospitals, authorities). Third, overtriage appeared high (when considering the modified Baxt criteria: 80–89%). Effective trauma system relies on accurate prehospital triage to correctly identify trauma patients for transfer to an appropriate facility. And Frykberg and Tepas assessed 220 bombings and found (multiple linear regression analysis) a direct linear relationship between prehospital overtriage and mortality in hospitalised patients [2]. After London bombing in 2004, such high rate of overtriage was reported in mass casualty triage by rescuers or paramedics, but it contrasts with data concerning in the field triage by specialised practicians [3]. Whatever, only few real-life experiences of prehospital paediatric triage are reported in medical literature. Two studies found difficulties in predicting injury severity, with major overtriage in paediatric trauma patients [4,5]. On the basis of their exceptional experience, we would like to know whether the authors had the opportunity to explore specifically the overtriage rate associated with prehospital paediatric triage protocol used after Turkish Airlinescrash.
We read with deep interest the article by Mahaluxmivala [1]. We appreciate the work of the authors on the article. However, the data about infection of Table 1 are inconsistent with that in Results. From Table 1, infection was recorded in 2 patients in group 1, 5 patients in group 2 and 6 patients in group 3. But from Results, infection was noted in 4 patients in group 1, 5 patients in group 2 and 1 patient in group 3. This makes us confused. We do not know clearly about patient demographics. In brief, we think a corrigendum should be made; otherwise the inconsistency about the data of infection makes readers more difficult to extract the data. Nonetheless, the flaw cannot lessen this article’s complete value and we thoroughly enjoyed reading the paper with respect. Conflict of interest statement Authors declare that there is no conflict of interest. Reference [1] Mahaluxmivala J, Nadarajah R, Allen PW, Hill RA. Ilizarov external fixator: acute shortening and lengthening versus bone transport in the management of tibial non-unions. Injury 2005;36:662–8.
Peng Yina, b Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, PR China b Medical College, Nankai University, No. 94 Weijin Road, Tianjin 300071, PR China a
Lihai Zhang Zhi Mao Peifu Tang* Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, PR China *Corresponding author. Tel.: +86 10 6693 8101; fax: +86 10 6816 1218 E-mail address: [email protected] (L. Zhang) 3 August 2013 1 September 2013[(5483)TD.ENIM][
Difficulties of triage in mass casualties incident
Conflicts of interest
http://dx.doi.org/10.1016/j.injury.2013.09.005
No authors have any conflicts of interest. 0020–1383/$ – see front matter . Crown Copyright ß 2013 Published by Elsevier Ltd. All rights reserved.
1966
Letters to the Editor / Injury, Int. J. Care Injured 44 (2013) 1965–1966
References [1] Postma IL, Weel H, Heetveld MJ, van der Zande I, Bijlsma TS, Bloemers FW, et al. Mass casualty triage after an airplane crash near Amsterdam. Injury 2013. http://dx.doi.org/10.1016/j.injury.2013.03.038. pii: S0020-1383(13)00178-2. [2] Frykberg ER, Tepas III JJ. Terrorist bombings, lessons learned from Belfast to Beirut. Ann Surg 1988;208:569–76. [3] Aylwin CJ, Ko¨nig TC, Brennan NW, Shirley PJ, Davies G, Walsh MS, et al. Reduction in critical mortality in urban mass casualty incidents: analysis of triage surge, and resource use after the London bombings on July 7, 2005. Lancet 2006;368(9554):2219–25. [4] Engum S, Mitchell M, Scherer LR, Gomez G, Jacobson L, Solotkin K, et al. Prehospital triage in the injured pediatric patient. J Pediatr Surg 2000;35(1):82–7. [5] Qazi K, Kempf J, Christopher N, Gerson L. Paramedic judgement of the need for trauma team activation for paediatric patients. Acad Emerg Med 1998; 5(10):1002–7.
Ste´phane Travers* Michel Bignand Ste´phane Raclot Laurent Domanski Jean Pierre Tourtier Emergency Medical Service, Fire Brigade of Paris, 1 place Jules Renard, 75017 Paris, France *Corresponding author. Tel.: +33 6 22 24 64 34 E-mail address: [email protected] (S. Travers) [(5480)TD.ENIM] http://dx.doi.org/10.1016/j.injury.2013.09.002