Articles: emergency-medical-services.
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The triage process is a valid concept in the initial approach to multiple casualties. Triage tags are, in theory, a reasonable adjunct to the process, but have proved to be a failure in practice. Based on the historical perspective and on the authors' experience with approximately 180 mass casualty drills and incidents, it is recommended that the "daily routine doctrine" be applied and that conventional, color-coded triage tags be replaced by a process of "geographical triage." A valid model for disaster planning is needed, and organizers must conduct drills that are based on the actual threat to the community in order to determine the most efficacious way to manage medical response.
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This retrospective study is a review of patients referred from a network of eight freestanding emergency centers FECs to a hospital emergency department during January and February 1984. During that time, 17,387 patients were seen at the FECs. Sixty-three (0.36%) of these patients were referred to the base hospital, of which 28 (44%) were admitted and six (9.5%) were admitted to a critical care unit. ⋯ Of the patients discharged from the hospital 70% were satisfied with FEC and 97% with hospital treatment. Of admitted patients, 89% were satisfied with FEC and 100% were satisfied with hospital treatment. For a similar illness in the future, 23% of all patients would return to a FEC, 28% would go to a private practitioner, and 48% would go directly to a hospital.
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The Committee on Trauma of the American College of Surgeons published a report in 1976 charging hospitals to provide care for seriously injured patients. Implementing an effective emergency care/trauma system in a not-for-profit community hospital was a task that demanded leadership, substantial time, and commitment. The building process could not have begun without a strong commitment from the hospital's board, administration, medical staff, and nursing service. ⋯ Monthly in-service programs were begun for the intensive care unit (ICU) and ED nurses. In each of the past 3 years, a 2-day trauma update program has been provided to the regional Emergency Medical Services (EMS) and medical community. The dedication and commitment of many people during the past 5 years has resulted in a sound system of emergency/trauma care in a community hospital.
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The primary goal of triage is to identify the majority of field trauma victims at risk for life-threatening injuries. When triage criteria are made sufficiently sensitive to accomplish this goal, high rates of overtriage occur. Orange County's original physiologic criteria were associated with an overtriage rate of 18-40% depending on the definition of a major trauma victim. ⋯ Despite this apparent high rate of overtriage, only 5.5% of all paramedic transports were for patients judged to have met field triage criteria. Based on this experience, an approach is suggested for evaluating the balance between over- and undertriage that occurs for a given set of triage criteria. Once this balance has been defined, triage guidelines can be modified to meet regional triage objectives.