IT-Supported Management of Mass Casualty Incidents: The e-Triage Project

Voice, analogue mobile radio, and paper have been successfully used for decades for coordination of emergencies and disasters, but although being simple and robust this approach cannot keep pace with today’s requirements any more. Emerging and established digital communication standards open the door to new applications and services, but the expected benefit needs to be carefully evaluated against robustness, interoperability, and user-friendliness. This paper describes a framework for IT-supported management of mass casualty incidents, which is currently under implementation and study. The four pillars of the concept are handheld devices for use both in daily rescue operations and in disasters, autonomous satellite-based communication infrastructure, a distributed database concept for maximal availability, and psychological acceptance research

IT-Supported Management of Mass Casualty Incidents: The e-Triage Project

Emergencies arise out of disasters and are characterized by limited resources in terms of medical personnel and infrastructure, underlining the importance of mobilizing regional, supra-regional and/or international help to the affected regions. Effective deployment of this help is crucial, but only possible if a common operational picture among authorities, coordination centers, and staff working in the field is developed as quickly as possible. Since mass casualty incidents (MCIs) normally overwhelm the regularly available rescue resources (rescue personnel, transport vehicles, hospital capacity, etc.), a particularly effective crisis management has to be applied. In general, for co-ordination centers it is a challenge to get an immediate and accurate situation overview (i.e. number of victims, injury categories and their location). Indeed, triage and registration performed at different places by different teams maintaining different lists are indubitably an error-prone approach. Furthermore, it can happen that all later attempts to track the way of single patient, their attendants and transport vehicles are not very successful, although this could be of key interest in scenarios with nuclear, biological or chemical hazards. Within the e-Triage project, which is sponsored by the German Federal Ministry of Education and Research, an integrated concept for electronic registration of affected persons is under development

Digital Orthopaedics: A Glimpse Into the Future in the Midst of a Pandemic.

BackgroundThe response to COVID-19 catalyzed the adoption and integration of digital health tools into the health care delivery model for musculoskeletal patients. The change, suspension, or relaxation of Medicare and federal guidelines enabled the rapid implementation of these technologies. The expansion of payment models for virtual care facilitated its rapid adoption. The authors aim to provide several examples of digital health solutions utilized to manage orthopedic patients during the pandemic and discuss what features of these technologies are likely to continue to provide value to patients and clinicians following its resolution.ConclusionThe widespread adoption of new technologies enabling providers to care for patients remotely has the potential to permanently change the expectations of all stakeholders about the way care is provided in orthopedics. The new era of Digital Orthopaedics will see a gradual and nondisruptive integration of technologies that support the patient's journey through the successful management of their musculoskeletal disease

Equivalent Mid-Term Results of Open vs Endoscopic Gluteal Tendon Tear Repair Using Suture Anchors in Forty-Five Patients.

BackgroundLittle is known about the relative efficacy of open (OGR) vs endoscopic (EGR) gluteal tendon repair of gluteal tendon tears in minimizing pain and restoring function. Our aim is to compare these 2 surgical techniques and quantify their impact on clinical outcomes.MethodsAll patients undergoing gluteal tendon tear repair at our institution between 2015 and 2018 were retrospectively reviewed. Pain scores, limp, hip abduction strength, and the use of analgesics were recorded preoperatively and at last follow-up. The Hip disability and Osteoarthritis Outcome Score Junior and Harris Hip Score Section1 were obtained at last follow-up. Fatty degeneration was quantified using the Goutallier-Fuchs Classification (GFC). Statistical analysis was conducted using one-way analysis of variance and t-tests.ResultsForty-five patients (mean age 66, 87% females) met inclusion criteria. Average follow-up was 20.3 months. None of the 10 patients (22%) undergoing EGR had prior surgery. Of 35 patients (78%) undergoing OGR, 12 (27%) had prior hip replacement (75% via lateral approach). The OGRs had more patients with GFC ≥2 (50% vs 11%, P = .02) and used more anchors (P = .03). Both groups showed statistical improvement (P ≤ .01) for all outcomes measured. GFC >2 was independently associated with a worst limp and Harris Hip Score Section 1 score (P = .05). EGR had a statistically higher opioid use reduction (P < .05) than OGR. Other comparisons between EGR and OGR did not reach statistical significance.ConclusionIn this series, open vs endoscopic operative approach did not impact clinical outcomes. More complex tears were treated open and with more anchors. Fatty degeneration adversely impacted outcomes. Although further evaluation of the efficacy of EGR in complex tears is indicated, both approaches can be used successfully

Clinical decision support system for point of care use--ontology-driven design and software implementation

OBJECTIVES: The objective of this research was to design a clinical decision support system (CDSS) that supports heterogeneous clinical decision problems and runs on multiple computing platforms. Meeting this objective required a novel design to create an extendable and easy to maintain clinical CDSS for point of care support. The proposed solution was evaluated in a proof of concept implementation. METHODS: Based on our earlier research with the design of a mobile CDSS for emergency triage we used ontology-driven design to represent essential components of a CDSS. Models of clinical decision problems were derived from the ontology and they were processed into executable applications during runtime. This allowed scaling applications' functionality to the capabilities of computing platforms. A prototype of the system was implemented using the extended client-server architecture and Web services to distribute the functions of the system and to make it operational in limited connectivity conditions. RESULTS: The proposed design provided a common framework that facilitated development of diversified clinical applications running seamlessly on a variety of computing platforms. It was prototyped for two clinical decision problems and settings (triage of acute pain in the emergency department and postoperative management of radical prostatectomy on the hospital ward) and implemented on two computing platforms--desktop and handheld computers. CONCLUSIONS: The requirement of the CDSS heterogeneity was satisfied with ontology-driven design. Processing of application models described with the help of ontological models allowed having a complex system running on multiple computing platforms with different capabilities. Finally, separation of models and runtime components contributed to improved extensibility and maintainability of the system

MOSAIC vision and scenarios for mobile collaborative work related to health and wellbeing

The main objective of the MOSAIC project is to accelerate innovation in Mobile Worker Support Environments by shaping future research and innovation activities in Europe. The modus operandi of MOSAIC is to develop visions and illustrative scenarios for future collaborative workspaces involving mobile and location-aware working. Analysis of the scenarios is input to the process of road mapping with the purpose of developing strategies for R&D leading to deployment of innovative mobile work technologies and applications across different domains. This paper relates to one specific domain, that of Health and Wellbeing. The focus is therefore is on mobile working environments which enable mobile collaborative working related to the domain of healthcare and wellbeing services for citizens. This paper reports the work of MOSAIC T2.2 on the vision and scenarios for mobile collaborative work related to this domain. This work was also an input to the activity of developing the MOSAIC roadmap for future research and development targeted at realization of the future Health and Wellbeing vision. The MOSAIC validation process for the Health and Wellbeing scenarios is described and one scenario – the Major Incident Scenario - is presented in detail

Mistriaged Advanced Life Support Patients in a Two-Tiered, Suburban Emergency Medical Services System

Introduction: Emergency medical services (EMS) systems exist to provide prehospital care in diverse environments throughout the world. Advanced Life Support (ALS) services can provide advanced care including 12-lead electrocardiogram (ECG), endotracheal intubation and parenteral medication administration. Basic Life Support (BLS) can provide basic care such as splinting, wound care and cardiopulmonary resuscitation. ALS can release patients to BLS for transport to the hospital, and this is an area of high risk. Our study examines patients who were triaged and admitted to a critical care location, including an intensive care unit (ICU), cardiac catheterization laboratory, or operating room (OR).Methods: The analysis included data from 2007–2015 of all patients who were triaged. We evaluated demographics, admission diagnoses, and dispositions using descriptive statistics. Diagnoses were grouped into categories based on the system.Results: We found that 372/17,639 (2%) of patients were mistriaged to BLS and admitted to a critical care location. The average age was 64. The most common diagnosis categories were neurological (24%), gastrointestinal (GI)/abdominal pain (15%), respiratory (12%), and cardiac (12%).Conclusion: It is uncommon for patients triaged from ALS to BLS to be admitted to an ICU, catheterization lab or OR, with a rate of 2%. Neurological, GI, sepsis, and trauma diagnoses were the most frequent categories of patient complaints that were mistriaged. This study should lead to further studies to examine this patient population