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Field triage

Henry Zhao, Lauren Pesavento, Skye Coote, Edrich Rodrigues, Patrick Salvaris, Karen Smith, Stephen Bernard, Michael Stephenson, Leonid Churilov, Nawaf Yassi, Stephen M Davis, Bruce C V Campbell
BACKGROUND AND PURPOSE: Clinical triage scales for prehospital recognition of large vessel occlusion (LVO) are limited by low specificity when applied by paramedics. We created the 3-step ambulance clinical triage for acute stroke treatment (ACT-FAST) as the first algorithmic LVO identification tool, designed to improve specificity by recognizing only severe clinical syndromes and optimizing paramedic usability and reliability. METHODS: The ACT-FAST algorithm consists of (1) unilateral arm drift to stretcher <10 seconds, (2) severe language deficit (if right arm is weak) or gaze deviation/hemineglect assessed by simple shoulder tap test (if left arm is weak), and (3) eligibility and stroke mimic screen...
March 14, 2018: Stroke; a Journal of Cerebral Circulation
Zhao-Wen Zong, Lian-Yang Zhang, Hao Qin, Si-Xu Chen, Lin Zhang, Lei Yang, Xiao-Xue Li, Quan-Wei Bao, Dao-Cheng Liu, Si-Hao He, Yue Shen, Rong Zhang, Yu-Feng Zhao, Xiao-Zheng Zhong
The accurate assessment and diagnosis of combat injuries are the basis for triage and treatment of combat casualties. A consensus on the assessment and diagnosis of combat injuries was made and discussed at the second annual meeting of the Professional Committee on Disaster Medicine of the Chinese People's Liberation Army (PLA). In this consensus agreement, the massive hemorrhage, airway, respiration, circulation and hypothermia (MARCH) algorithm, which is a simple triage and rapid treatment and field triage score, was recommended to assess combat casualties during the first-aid stage, whereas the abbreviated scoring method for combat casualty and the MARCH algorithm were recommended to assess combat casualties in level II facilities...
February 13, 2018: Military Medical Research
Christian Waydhas, Markus Baake, Lars Becker, Boris Buck, Helena Düsing, Björn Heindl, Kai Oliver Jensen, Rolf Lefering, Carsten Mand, T Paffrath, Uwe Schweigkofler, Kai Sprengel, Heiko Trentzsch, Bernd Wohlrath, Dan Bieler
BACKGROUND: Trauma team activation (TTA) represents a considerable expenditure of trauma centre resources. It is mainly triggered by field triage criteria. The overall quality of the criteria may be evaluated based on the rate of over- and undertriage. However, there is no gold standard that defines which adult patients truly require a trauma team. The objective of this study was to develop consensus-based criteria defining the necessity for a trauma team. METHODS: A consensus group was formed by trauma specialists experienced in emergency and trauma care with a specific interest in field triage and having previously participated in guideline development...
February 21, 2018: World Journal of Surgery
Sandra R DiBrito, Marcelo Cerullo, Seth D Goldstein, Susan Ziegfeld, Dylan Stewart, Isam W Nasr
BACKGROUND: Discordant assessments of Glasgow Coma Score (GCS) following trauma can result in inappropriate triage. This study sought to determine the reliability of prehospital GCS compared to emergency department (ED) GCS. METHODS: We conducted a retrospective review of traumas from 01/2000 to 12/2015 at a Level-1 pediatric trauma center. We evaluated reliability between field and ED GCS using Pearson's correlation. We ascertained the difference between prehospital and ED GCS (delta-GCS)...
January 31, 2018: Journal of Pediatric Surgery
Kevin Ryan, Douglas George, James Liu, Patricia Mitchell, Kerrie Nelson, Ricky Kue
BACKGROUND: Mass casualty incident (MCI) triage and the use of triage tags to assign treatment priorities are not fully implemented despite emergency medical services (EMS) personnel training during drills and exercises. OBJECTIVES: To compare current field triage practices during both training and actual MCIs and identify any potential barriers to use. METHODS: During training sessions from November 2015 through March 2016, an anonymous survey was distributed to personnel in 3 distinct types of paid full-time EMS systems: Boston EMS (2-tiered, municipal third-service); Portland Fire Department (fire department-based ALS); and Stokes County EMS (county-based ALS) combined with Forsyth County EMS (county-based ALS)...
February 9, 2018: Prehospital Emergency Care
J Herman Kan, Robert C Orth, Terry A Yen, Erica K Schallert, Wei Zhang, Lane F Donnelly
PURPOSE: The proliferation of pediatric urgent care centers has increased the need for diagnostic imaging support, but the impact of employing radiology technologists at these centers is not known. The purpose of this study was to evaluate radiographic impact and quality at urgent care centers with and without radiology technologists. METHODS: A retrospective case-control study was conducted comparing 235 radiographic examinations (study) performed without and 83 examinations (control) performed with a radiology technologist at the authors' pediatric urgent care centers...
February 2, 2018: Journal of the American College of Radiology: JACR
Vivek Sharma, C M Sreedhar, J Debnath
Radiology services in a combat situation are essentially centred on assisting the battle field physicians/surgeons to save/salvage life and limb. Timely and accurate detection of type and mapping of extent of injury can aid in making imaging based triage which can be of immense help to the treating physicians/trauma surgeons. With the availability of rapid assessment (clinical as well as imaging based) and quick transport facility, the focus has gradually been shifting from merely limb-saving to life-saving strategies...
October 2017: Medical Journal, Armed Forces India
Min Woo Kim, Sang Do Shin, Kyoung Jun Song, Young Sun Ro, Yu Jin Kim, Ki Jeong Hong, Joo Jeong, Tae Han Kim, Jeong Ho Park, So Yeon Kong
BACKGROUND: It is unclear whether effect size of the hypoxia is different on in-hospital mortality and disability according to hypotension status in the field. METHODS: Adult severe trauma (ST) patients during 2012-13 who were treated by emergency medical services (EMS) and had abnormal revised trauma scores in the field or who had positive trauma triage criteria were analyzed. Exposure was hypoxia (<94%) measured by EMS. End points were hospital mortality and disability defined as a Glasgow Outcome Scale that decreased by 2 points or more...
January 26, 2018: Prehospital Emergency Care
R A Yingst, J Berger, B A Cohen, B Hynek, M E Schmidt
We tested science operations strategies developed for use in remote mobile spacecraft missions, to determine whether reconnoitering a site of potential habitability prior to in-depth study (a walkabout-first strategy) can be a more efficient use of time and resources than the linear approach commonly used by planetary rover missions. Two field teams studied a sedimentary sequence in Utah to assess habitability potential. At each site one team commanded a human "rover" to execute observations and conducted data analysis and made follow-on decisions based solely on those observations...
March 2017: Acta Astronautica
Julie Bensimon Etzol, Marco Valente, Sandrine Altmeyer, Caroline Bettencourt, Samuel Bouvet, Guillaume Cosler, François Desangles, Michel Drouet, Fabrice Entine, Francis Hérodin, Flora Jourquin, Yannick Lecompte, Patrick Martigne, Xavier Michel, Jérôme Pateux, Nicolas Ugolin, Sylvie Chevillard
DosiKit is a new field-radiation biodosimetry immunoassay for rapid triage of individuals exposed to external total-body radiation. Here, we report on the validation of this immunoassay in human blood cell extracts 0.5 h after in vitro exposure to137 Cs gamma rays, using γ-H2AX analysis. First, calibration curves were established for five donors at doses ranging from 0 to 10 Gy and dose rates ranging from ∼0.8 to ∼3 Gy/min. The calibration curves, together with a γ-H2AX peptide scale, enabled the definition of inter-experimental correction factors...
December 7, 2017: Radiation Research
Tobias Neidel, Nicolas Salvador, Axel R Heller
BACKGROUND: Major incidents are characterized by a lack of resources compared to an overwhelming number of casualties, requiring a prioritization of medical treatment. Triage algorithms are an essential tool for prioritizing the urgency of treatment for patients, but the evidence to support one over another is very limited. We determined the influence of blood pressure limits on the diagnostic value of triage algorithms, considering if pulse should be palpated centrally or peripherally...
December 4, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Priti P Parikh, Pratik Parikh, Bradley Guthrie, Logan Mamer, Melissa Whitmill, Timothy Erskine, Randy Woods, Jonathan Saxe
BACKGROUND: The American College of Surgeons developed the National Field Triage Decision Scheme (NFTDS) that has been adapted by many trauma centers in the nation, but quantitative evidence of its efficacy is unclear. We compare the NFTDS and state of Ohio guidelines to the "observed" rates and with rates derived using a statistical model. METHODS: We used 4757 trauma records from 2008-2012 available from the state and calculated undertriage (UT) and overtriage (OT) rates...
December 2017: Journal of Surgical Research
Toby I Gropen, Amelia Boehme, Sheryl Martin-Schild, Karen Albright, Alyana Samai, Sammy Pishanidar, Nazli Janjua, Ethan S Brandler, Steven R Levine
BACKGROUND: This study aims to develop a simple scale to identify patients with prehospital stroke with large vessel occlusion (LVO), without losing sensitivity for other stroke types. METHODS: The Emergency Medical Stroke Assessment (EMSA) was derived from the National Institutes of Health Stroke Scale (NIHSS) items and validated for prediction of LVO in a separate cohort. We compared the EMSA with the 3-item stroke scale (3I-SS), Cincinnati Prehospital Stroke Severity Scale (C-STAT), Rapid Arterial oCclusion Evaluation (RACE) scale, and Field Assessment Stroke Triage for Emergency Destination (FAST-ED) for prediction of LVO and stroke...
March 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Y Mayasi, R P Goddeau, M Moonis, B Silver, A H Jun-O'Connell, A S Puri, N Henninger
BACKGROUND AND PURPOSE: Prehospital stroke scales may help identify patients likely to have large-vessel occlusion to facilitate rapid triage to thrombectomy-capable stroke centers. Scale misclassification may result in inaccurate decisions and possible harm. Pre-existing leukoaraiosis has been shown to attenuate the association between deficit type and stroke severity. We sought to determine whether leukoaraiosis affects the predictive ability of 5 commonly used large-vessel occlusion scales...
February 2018: AJNR. American Journal of Neuroradiology
Govindan Subramanian, Gennady Poda
Alzheimer's disease is a chronic neurodegenerative disease affecting more than 30 million people worldwide. Development of small molecule inhibitors of human β-secretase 1 (hBACE-1) is being the focus of pharmaceutical industry for the past 15-20 years. Here, we successfully applied multiple ligand-based in silico modeling techniques to understand the inhibitory activities of a diverse set of small molecule hBACE-1 inhibitors reported in the scientific literature. Strikingly, the use of only a small subset of 230 (13%) molecules allowed us to develop quality models that performed reasonably well on the validation set of 1,476 (87%) inhibitors...
March 2018: Chemical Biology & Drug Design
S Magnone, A Ghirardi, M Ceresoli, L Ansaloni
INTRODUCTION: Centralization of trauma patients has become the standard of care. Unfortunately, overtriage can overcome the capability of Trauma Centres. This study aims to analyse the association of different mechanisms of injury with severe or major trauma defined as Injury Severity Score (ISS) greater than 15 and an estimation of overtriage upon our Trauma Centre. METHODS: A retrospective review of our prospective database was undertaken from March 2014 to August 2016...
November 10, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Daniel Kiden Nishijima, Samuel D Gaona, Trent Waechter, Ric Maloney, Adam Blitz, Andrew R Elms, Roel D Farrales, James Montoya, Troy Bair, Calvin Howard, Megan Gilbert, Renee Trajano, Kaela Hatchel, Mark Faul, Jeneita M Bell, Victor Coronado, David R Vinson, Dustin W Ballard, Daniel J Tancredi, Hernando Garzon, Kevin E Mackey, Kiarash Shahlaie, James F Holmes
Field triage guidelines recommend transport of head-injured patients on anticoagulants or antiplatelets to a higher-level trauma center based on studies suggesting a high incidence of traumatic intracranial hemorrhage (tICH). We compared the incidence of tICH in older adults transported by EMS with and without anticoagulation or antiplatelet use and evaluated the accuracies of different sets of field triage criteria to identify tICH. This was a prospective, observational study at 5 EMS agencies and 11 hospitals...
November 6, 2017: Journal of Neurotrauma
Craig D Newgard, Tarsicio Uribe-Leitz, Adil H Haider
No abstract text is available yet for this article.
November 1, 2017: JAMA Surgery
Frank J Voskens, Eveline A J van Rein, Rogier van der Sluijs, Roderick M Houwert, Robert Anton Lichtveld, Egbert J Verleisdonk, Michiel Segers, Ger van Olden, Marcel Dijkgraaf, Luke P H Leenen, Mark van Heijl
Importance: A major component of trauma care is adequate prehospital triage. To optimize the prehospital triage system, it is essential to gain insight in the quality of prehospital triage of the entire trauma system. Objective: To prospectively evaluate the quality of the field triage system to identify severely injured adult trauma patients. Design, Setting, and Participants: Prehospital and hospital data of all adult trauma patients during 2012 to 2014 transported with the highest priority by emergency medical services professionals to 10 hospitals in Central Netherlands were prospectively collected...
November 1, 2017: JAMA Surgery
J Harrison, B Moreno, O Van Hoey, L-C Mihailescu, F Vanhavere, M Million, V Fomenko, M Akselrod
Fluorescent nuclear track detectors (FNTDs) as criticality dosimeters for both neutrons and gamma are further characterized in terms of angular dependence and quick dose assessment. The power spectrum integral depth profiles obtained from stacks of fluorescent images acquired within FNTDs exposed to a broad spectrum neutron field at various angles are analyzed to determine a calibration curve for angular dependence. MCNPX simulations were shown to be in good agreement with experimental results. A prototype triage reader was also designed and tested for quick assessment of dose...
October 21, 2017: Radiation Protection Dosimetry
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