大规模伤亡事件和灾难中的分诊系统:一项全球视角的综述研究

Triage Systems in Mass Casualty Incidents and Disasters: A Review Study with A Worldwide Approach.

作者信息

Bazyar Jafar, Farrokhi Mehrdad, Khankeh Hamidreza

机构信息

Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

出版信息

Open Access Maced J Med Sci. 2019 Feb 12;7(3):482-494. doi: 10.3889/oamjms.2019.119. eCollection 2019 Feb 15.

Abstract

BACKGROUND

Injuries caused by emergencies and accidents are increasing in the world. To prioritise patients to provide them with proper services and to optimally use the resources and facilities of the medical centres during accidents, the use of triage systems, which are one of the key principles of accident management, seems essential.

AIM

This study is an attempt to identify available triage systems and compare the differences and similarities of the standards of these systems during emergencies and disasters through a review study.

METHODS

This study was conducted through a review of the triage systems used in emergencies and disasters throughout the world. Accordingly, all articles published between 1990 and 2018 in both English and Persian journals were searched based on several keywords including Triage, Disaster, Mass Casualty Incidents, in the Medlib, Scopus, Web of Science, PubMed, Cochrane Library, Science Direct, Google scholar, Irandoc, Magiran, Iranmedex, and SID databases in isolation and in combination using both and/ or conjunctions.

RESULTS

Based on the search done in these databases, twenty different systems were identified in the primary adult triage field including START, Homebush triage Standard, Sieve, CareFlight, STM, Military, CESIRA Protocol, MASS, Revers, CBRN Triage, Burn Triage, META Triage, Mass Gathering Triage, SwiFT Triage, MPTT, TEWS Triage, Medical Triage, SALT, mSTART and ASAV. There were two primary triage systems including Jump START and PTT for children, and also two secondary triage systems encompassing SAVE and Sort identified in this respect. ESI and CRAMS were two other cases distinguished for hospital triage systems.

CONCLUSION

There are divergent triage systems in the world, but there is no general and universal agreement on how patients and injured people should be triaged. Accordingly, these systems may be designed based on such criteria as vital signs, patient's major problems, or the resources and facilities needed to respond to patients' needs. To date, no triage system has been known as superior, specifically about the patients' clinical outcomes, improvement of the scene management or allocation of the resources compared to other systems. Thus, it is recommended that different countries such as Iran design their triage model for emergencies and disasters by their native conditions, resources and relief forces.

摘要

背景

在全球范围内,由紧急情况和事故导致的伤害正在增加。为了对患者进行优先级排序,以便为他们提供适当的服务,并在事故发生时优化利用医疗中心的资源和设施,使用分诊系统似乎至关重要,分诊系统是事故管理的关键原则之一。

目的

本研究旨在通过一项综述研究,识别现有的分诊系统,并比较这些系统在紧急情况和灾难期间标准的异同。

方法

本研究通过对全球紧急情况和灾难中使用的分诊系统进行综述来开展。因此,基于包括“分诊”“灾难”“大规模伤亡事件”等几个关键词,在1990年至2018年期间发表在英文和波斯文期刊上的所有文章,在Medlib、Scopus、科学网、PubMed、考克兰图书馆、科学Direct、谷歌学术、伊朗文献数据库、Magiran、Iranmedex和SID数据库中单独及结合使用“和”或“或”连词进行搜索。

结果

基于在这些数据库中的搜索,在成人初级分诊领域确定了20种不同的系统,包括START、霍姆布什分诊标准、筛检法、CareFlight、STM、军事分诊、CESIRA协议、MASS、Revers、CBRN分诊、烧伤分诊、META分诊、大规模集会分诊、SwiFT分诊、MPTT、TEWS分诊、医疗分诊、SALT、mSTART和ASAV。有两种儿童初级分诊系统,即Jump START和PTT,在这方面还确定了两种二级分诊系统,即SAVE和Sort。ESI和CRAMS是另外两种用于医院分诊系统的情况。

结论

世界上存在不同的分诊系统,但对于如何对患者和伤者进行分诊并没有普遍的共识。因此,这些系统可以根据生命体征、患者的主要问题或满足患者需求所需的资源和设施等标准来设计。迄今为止,没有一种分诊系统被认为优于其他系统,特别是在患者的临床结局、现场管理的改善或资源分配方面。因此,建议伊朗等不同国家根据本国的条件、资源和救援力量,设计适合本国紧急情况和灾难的分诊模式。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1606/6390156/f0db6bf099d1/OAMJMS-7-482-g001.jpg

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