Surgery News - February 2009 - (Page 7) FEBRUARY 2009 • SURGERY NEWS TRAUMA 7 Surgeons Help Craft Mass Casualty Triage Model BY CHRISTINE KILGORE Else vier Global Medical Ne ws urgeons have played an integral role in developing a proposed national guideline on mass casualty triage designed to improve the consistency of disaster triage practices. The guideline, titled SALT (Sort, Assess, Life-Saving Interventions, Treatment and/or Transport), establishes a standardized set of priority categories and color designations for primary field triage and formalizes processes for sorting patients and applying lifesaving interventions (Disaster Med. Public Health Prep. 2008;2 [suppl.1]:S25-34). Surgery’s participation reflects a growing recognition that disaster preparedness—including field triage—is not just an emergency medicine issue, said the two surgeons who helped write the guideline. “Our argument has always been that we have something to contribute to the science and the thought process, and that we need to be involved because we’re going to be the recipients [of the victims],” said Dr. Jeffrey Hammond, an ACS Fellow who is a trauma and critical care surgeon at the Robert Wood Johnson Medical School, New Brunswick, N.J. Dr. Jeffrey Salomone, an ACS Fellow who is associate professor of surgery at Emory University, Atlanta, and deputy chief of surgery at Grady Memorial Hospital in that city, concurred: “Trauma surgeons need to be involved in trauma care, from the prehospital phase to the hospital phase to rehab.” Dr. Hammond, Dr. Salomone, Dr. Eileen Bulger, also an ACS Fellow, Dr. Sharon Henry, and Dr. Howard Taekman participated in the multidisciplinary guideline development work group, which was established and supported by the Department of Health and Human Services; the Centers for Disease Control and Prevention; and the Terrorism Injuries Information, Dissemination, and Exchange (TIDE) Project, a cooperative partnership led by the American College of Emergency Physicians. The 20-plus members of the work group used bits of published evidence supporting various components of nine main mass triage systems—along with consensus opinion—to formulate a guideline that they emphasize is a “beginning rather than a final product.” “The guideline picks the best [aspects] of all the systems and pulls them together,” said Dr. Salomone. SALT’s first step calls for a global sorting process in which patients are prioritized for individual assessment through simple voice commands. Since patients who can walk may have injuries that need immediate or delayed treatment, they should be individually assessed before being designated as “minimally injured.” The wave command is recommended for further distinguishing patients who cannot follow a command, and thus need assessment first, from those who cannot walk but can still follow a command and make purposeful movements. S (This latter group should be assessed first.) The first priority in individual assessment, the document says, is to provide rapid lifesaving interventions that likely will have a profound impact on survival: controlling major hemorrhage, opening the airway (and two rescue breaths for children), decompressing the chest of patients with tension pneumothorax, and providing anecdotes for chemical exposures. Next, patients should be prioritized for treatment based on assignment to one of five color-coded categories: red, for patients in need of immediate care; yellow, for patients who need care but not immediately; green, for patients who can tolerate a delay in care without an increased risk for mortality; black, for patients who are dead; and gray, for patients who are likely to die given the available resources. The gray category is intended to be flexible and dynamic, with patients reevaluated frequently— and their triage category changed as appropriate. The American Medical Association is integrating the proposed triage methodology into its disaster medicine courses. Other organizations, including the ACS, are calling for substantive field trials. “SALT is a good approach, but before [the ACS] jumps fully behind it, they want to have some evidence,” said Dr. Salomone. http://www.surgitel.com http://www.surgitel.com
Table of Contents Feed for the Digital Edition of Surgery News - February 2009 Surgery News - February 2009 Contents The 20/20 Vision ICD-10 Looms News From the College: MedPAC Flak Oncology: Best for Breast General Surgery: Weighty Problem Surgery News - February 2009 Surgery News - February 2009 - Contents (Page 1) Surgery News - February 2009 - Contents (Page 2) Surgery News - February 2009 - Contents (Page 3) Surgery News - February 2009 - Contents (Page 4) Surgery News - February 2009 - The 20/20 Vision ICD-10 Looms (Page 5) Surgery News - February 2009 - The 20/20 Vision ICD-10 Looms (Page 6) Surgery News - February 2009 - The 20/20 Vision ICD-10 Looms (Page 7) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 8) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 9) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 10) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 11) Surgery News - February 2009 - Oncology: Best for Breast (Page 12) Surgery News - February 2009 - Oncology: Best for Breast (Page 13) Surgery News - February 2009 - Oncology: Best for Breast (Page 14) Surgery News - February 2009 - Oncology: Best for Breast (Page 15) Surgery News - February 2009 - Oncology: Best for Breast (Page 16) Surgery News - February 2009 - Oncology: Best for Breast (Page 17) Surgery News - February 2009 - Oncology: Best for Breast (Page 18) Surgery News - February 2009 - General Surgery: Weighty Problem (Page 19) Surgery News - February 2009 - General Surgery: Weighty Problem (Page 20)
For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.