Triage Process in Emergency Departments: an Indonesian Study

Background: Triage process has rapidly developed in some countries in the last three decades in order to respond to the demand for emergency services by growing population and emergency health needs. However, this development does not appear to match in Indonesian hospitals. The triage process in Indonesia remains obscure.Purpose: This study aimed to describe triage process in Indonesia from a range of different perspectives.Methods: The research design of this study was descriptive qualitative using semistructured interviews of 12 policy makers or persons responsible from 5 different organizations which informed triage practice in Indonesia. The data were analyzed using a three step content analysis.Results: The result produced 3 themes. First, four steps of triage process ranging from receiving to prioritizing were reported as the triaging procedures in Indonesia which were almost similar to the International literature except for a re-triage step. Second,primary and secondary triage processes were also applied in all emergency departments in Indonesia. Last, no prolonged waiting time in Indonesia could be assumed whether the triage process was effective and efficient or it was only a quick process of sorting to rapidly increase the number of patients in the treatment rooms. Out of the themes, the result also indicated that the involvement of nurses in health policy development inIndonesia needed supportConclusion: Triage process in Indonesia still needs improvements. Patient\u27s re-triage and evaluating secondary triage should be given more frameworks in the future. An effective and efficient triage process in Indonesia will best manage the number of patients in the treatment rooms and therefore further observational researches on patterns and trends are needed. Moreover, including the role of nurses as policy makers in the curriculum of nursing undergraduate and post-graduate degrees would give nurses the evidence to seek out policy making positions in the futur

Logistical Resource Capability During a Mass Casualty Event in Washington State

The need for increasing efficiencies for medical resource delivery during a mass casualty incident/event is a paramount logistical planning factor that could mean life or death to the citizens affected by a disaster. As such, Washington State has prioritized emergency management and preparedness. Using the just-in-time system by way of Baghbanian\u27 s complex adaptive decision-making theory as the foundation, gave purpose to this qualitative study. This was accomplished by analysis of emergency management professional responses, and to what degree, improvements can be made to the medical resource delivery system during a mass casualty incident/event. Data were collected through semi structured interviews with a random sample of 12 experienced emergency professionals from the State of Washington. This study was guided by primary research questions that focused on emergency managers and their understanding and adaptability toward preparedness. Interview data were deductively coded and analyzed through a thematic analysis procedure. The key theme of this study is that participants perceived slight differences in logistical and operational approaches that vector into transportation and operational understanding as the main factors influencing medical resource delivery. The positive social change association of this study is that it provides emergency managers, first responders, and medical staff with recommendations for analysis and planning development for medical resource delivery, thereby mitigating the life and death implications for citizens in future disasters

Damage Control Interdisciplinarity: An Antidote to Death Despair in Military Medicine

“Diseases of despair” is a conceptually broad category used to describe the phenomenon of premature mortality caused by suicide, drug poisoning, and alcoholic liver disease. Central to this conceptualization of mortality is that death occurs too early in an entire population of individuals infected with social despair. Implicit in the diseases of despair construct is a powerful normative claim about the manner and time of death—that death is bad if it is contextualized in unwanted conditions and happens before reaching midlife. As such, diseases of despair ought to be reduced, if not eliminated. Interestingly, military medical research on combat casualties abides by a comparable normative understanding of mortality—that combat provides a less than optimal context in which to die and that those who die on the battlefield do so too young. In response to this implicit normative ideal, military medical research and practice have made major strides in developing effective life-saving interventions in the past twenty years. Service members’ lives are saved after catastrophic injury due to advances in the combat damage control medical paradigm. The achievements of this paradigm are enshrined in an overall ninety-two percent survival rate for service members injured in Iraq and Afghanistan and have initiated interest in achieving zero preventable deaths after catastrophic injury in both military and civilian medicine. While medical achievements in Iraq and Afghanistan are laudable, primarily focusing on achieving zero preventable combat deaths constructs a military-medical culture wherein the despair of death is implicitly woven into military health policy, training, and organizational culture. This article will explore the complex challenge of addressing death despair in combat casualty management. I develop a modest argument suggesting that to effectively shift expectations relative to death and dying in casualty management, the Defense Health Agency needs to support interdisciplinary research that focuses on strategic second-order organizational change before developing health policy and medical training in preparation for future large-scale combat operations. In specific, I suggest that this interdisciplinary team needs to be led by academic experts in anthropology, history, and political science in collaboration with military medical and strategic experts

Online Optimisation of Casualty Processing in Major Incident Response

Recent emergency response operations to Mass Casualty Incidents (MCIs) have been criticised for a lack of coordination, implying that there is clear potential for response operations to be improved and for corresponding benefits in terms of the health and well-being of those affected by such incidents. In this thesis, the use of mathematical modelling, and in particular optimisation, is considered as a means with which to help improve the coordination of MCI response. Upon reviewing the nature of decision making in MCIs and other disaster response operations in practice, this work demonstrates through an in-depth review of the available academic literature that an important problem has yet to be modelled and solved using an optimisation methodology. This thesis involves the development of such a model, identifying an appropriate task scheduling formulation of the decision problem and a number of objective functions corresponding to the goals of the MCI response decision makers. Efficient solution methodologies are developed to allow for solutions to the model, and therefore to the MCI response operation, to be found in a timely manner. Following on from the development of the optimisation model, the dynamic and uncertain nature of the MCI response environment is considered in detail. Highlighting the lack of relevant research considering this important aspect of the problem, the optimisation model is extended to allow for its use in real-time. In order to allow for the utility of the model to be thoroughly examined, a complementary simulation is developed and an interface allowing for its communication with the optimisation model specified. Extensive computational experiments are reported, demonstrating both the danger of developing and applying optimisation models under a set of unrealistic assumptions, and the potential for the model developed in this work to deliver improvements in MCI response operations

Justification for a Nuclear Global Health Workforce: multidisciplinary analysis of risk, survivability & preparedness, with emphasis on the triage management of thermal burns

An assessment of the risks of nuclear conflict and the global preparedness to deal with such a catastrophe. Includes a proposal for triage and management of burn injuries based on a model of what would happen if there was a nuclear attack on Washington DC. Summarises the need for a global nuclear workforce to establish guidelines and strategies to address a nuclear event, the risk of which would appear to be increasingly likely given current world geopolitics

Best-subset Selection for Complex Systems using Agent-based Simulation

It is difficult to analyze and determine strategies to control complex systems due to their inherent complexity. The complex interactions among elements make it difficult to develop and test decision makers' intuition of how the system will behave under different policies. Computer models are often used to simulate the system and to observe both direct and indirect effects of alternative interventions. However, many decision makers are unwilling to concede complete control to a computer model because of the abstractions in the model, and the other factors that cannot be modeled, such as physical, human, social and organizational relationship constraints. This dissertation develops an agent-based simulation (ABS) model to analyze a complex system and its policy alternatives, and contributes a best-subset selection (BSS) procedure that provides a group of good performing alternatives to which decision makers can then apply their subject and context knowledge in making a final decision for implementation. As a specific example of a complex system, a mass casualty incident (MCI) response system was simulated using an ABS model consisting of three interrelated sub-systems. The model was then validated by a series of sensitivity analysis experiments. The model provides a good test bed to evaluate various evacuation policies. In order to find the best policy that minimizes the overall mortality, two ranking-and-selection (R&S) procedures from the literature (Rinott (1978) and Kim and Nelson (2001)) were implemented and compared. Then a new best-subset selection (BSS) procedure was developed to efficiently select a statistically guaranteed best-subset containing all alternatives that are close enough to the best one for a pre-specified probability. Extensive numerical experiments were organized to prove the effectiveness and demonstrate the performance of the BSS procedure. The BSS procedure was then implemented in conjunction with the MCI ABS model to select the best evacuation policies. The experimental results demonstrate the feasibility and effectiveness of our agent-based optimization methodology for complex system policy evaluation and selection

Recommendations for burns care in mass casualty incidents: WHO Emergency Medical Teams Technical Working Group on Burns (WHO TWGB) 2017-2020

Health and logistical needs in emergencies have been well recognised. The last 7 years has witnessed improved professionalisation and standardisation of care for disaster affected communities – led in part by the World Health Organisation Emergency Medical Team (EMT) initiative. Mass casualty incidents (MCIs) resulting in burn injuries present unique challenges. Burn management benefits from specialist skills, expert knowledge, and timely availability of specialist resources. With burn MCIs occurring globally, and wide variance in existing burn care capacity, the need to strengthen burn care capability is evident. Although some high-income countries have well-established disaster management plans, including burn specific plans, many do not – the majority of countries where burn mass casualty events occur are without such established plans. Developing globally relevant recommendations is a first step in addressing this deficit and increasing preparedness to deal with such disasters. Global burn experts were invited to a succession of Technical Working Group on burns (TWGB) meetings to: 1) review literature on burn care in MCIs; and 2) define and agree on recommendations for burn care in MCIs. The resulting 22 recommendations provide a framework to guide national and international specialist burn teams and health facilities to support delivery of safe care and improved outcomes to burn patients in MCIs.publishedVersio