Ghanbari Vahid, Ardalan Ali, Zareiyan Armin, Nejati Amir, Hanfling Dan, Bagheri Alireza
Health in Disaster and Emergencies Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Health in Disaster and Emergencies Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Harvard Humanitarian Initiative, Harvard University, Cambridge, USA.
Int Emerg Nurs. 2019 Mar;43:126-132. doi: 10.1016/j.ienj.2018.10.004. Epub 2019 Jan 3.
Triage is a dynamic and complex decision-making process in order to determine priority of access to medical care in a disaster situation. The elements which should govern an ethical decision-making in prioritizing of victims have been debated for a long time. This paper aims to identify ethical principles guiding patient prioritization during disaster triage.
Electronic databases were searched via structured search strategy from 1990 until July 2017. The studies investigating patients' prioritization in disaster situation were eligible for inclusion. All types of articles and guidelines were included.
Of 7167 titles identified in the search, 35 studies were included. The important factors identified in patient prioritization were grouped into two categories: medical measures (medical need, likelihood of benefit and survivability) and Nonmedical measures (saving the most lives, youngest first, preserving function of society, protecting vulnerable groups, required resources and unbiased selection). Demographic characteristics, health status of patients, social value of patient, and unbiased selection are discriminatory factors in disaster triage.
Various factors have been introduced to consider ethical patient prioritization in disaster triage. Providers' engagement, public education, and ongoing training are required to reach a fair decision.
在灾难情况下，分诊是一个动态且复杂的决策过程，旨在确定获得医疗救治的优先顺序。关于在确定受害者优先顺序时应指导伦理决策的要素，长期以来一直存在争议。本文旨在确定在灾难分诊期间指导患者优先排序的伦理原则。
通过结构化搜索策略检索了1990年至2017年7月的电子数据库。纳入了调查灾难情况下患者优先排序的研究。纳入了所有类型的文章和指南。
在检索到的7167个标题中，纳入了35项研究。在患者优先排序中确定的重要因素分为两类：医疗措施（医疗需求、受益可能性和生存能力）和非医疗措施（拯救最多生命、先救最年轻者、维护社会功能、保护弱势群体、所需资源和无偏选择）。人口统计学特征、患者的健康状况、患者的社会价值和无偏选择是灾难分诊中的歧视性因素。
已引入各种因素来考虑灾难分诊中符合伦理的患者优先排序。需要医疗服务提供者的参与、公众教育和持续培训才能做出公平的决策。
