British journal of anaesthesia
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The identification, triage, and extrication of casualties followed by on-scene management and transport to an appropriate hospital after mass casualty incidents can be complicated, delivered to variable standards, and add significant delays to care. An effective pre-hospital pathway can both increase the chances of survival of individual patients and significantly influence the effectiveness of the entire emergency response.
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With healthcare systems rapidly becoming overwhelmed and occupied by patients during a pandemic, effective and safe care for patients is easily compromised. During the course of the current pandemic, numerous treatment guidelines have been developed and published that have improved care for patients with COVID-19. Certain lessons have only been learned during the course of the outbreak, from which we can learn for future pandemics. This editorial aims to raise awareness about the importance of timely stockpiling of sufficient amounts of personal protection equipment and medications, adequate oxygen supplies, uninterrupted electricity, and fair locally adapted triage strategies.
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Editorial Comment
Is artificial intelligence ready to solve mechanical ventilation? Computer says blow.
Artificial intelligence (AI) has the potential to identify treatable phenotypes, optimise ventilation strategies, and provide clinical decision support for patients who require mechanical ventilation. Gallifant and colleagues performed a systematic review to identify studies using AI to solve a diverse range of clinical problems in the ventilated patient. They identify 95 studies, the majority of which were reported in the last 5 yr. Their findings indicate that the majority of studies have significant methodological bias and are a long way from deployment.
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Editorial Comment
Meta-analyses of clinical trials: are we getting lemonade from lemons?
Meta-analyses guide planning of clinical trials and clinical care, but are subject to all the methodologic problems and potential biases present in the underlying trials. Furthermore, publication bias often contributes to overestimated benefit in meta-analyses of small trials, which are often 'corrected' by subsequent large trials. Meta-analyses are no substitute for large robust trials.
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Efficiency is an essential part of sustainable healthcare, especially in emergency and acute care (including surgical) settings. Waste minimisation, streamlined processes, and lean principles are all important for responsible stewardship of finite health resources. However, the promotion of efficiency above all else has effectively subordinated preparedness as a form of waste. ⋯ The ongoing COVID-19 pandemic has exposed the gap between efficient processes and resilient systems in many health settings. In anticipation of future pandemics, natural disasters, and mass casualty incidents, health systems, and individual healthcare workers, must prioritise preparedness to be ready for the unexpected or for crises. This requires a reframing of priorities to view preparedness as crucial insurance against system failure during disasters, by taking advantage of lessons learnt preparing for war and mass casualty incidents.