Triage Systems in Mass Casualty Incidents and Disasters: A Review Study with A Worldwide Approach

BACKGROUND: Injuries caused by emergencies and accidents are increasing in the world. To prioritise patients to provide them with proper services and to optimally use the resources and facilities of the medical centres during accidents, the use of triage systems, which are one of the key principles of accident management, seems essential. AIM: This study is an attempt to identify available triage systems and compare the differences and similarities of the standards of these systems during emergencies and disasters through a review study. METHODS: This study was conducted through a review of the triage systems used in emergencies and disasters throughout the world. Accordingly, all articles published between 1990 and 2018 in both English and Persian journals were searched based on several keywords including Triage, Disaster, Mass Casualty Incidents, in the Medlib, Scopus, Web of Science, Pubmed, Cochrane Library, Science Direct, Google scholar, Irandoc, Magiran, Iranmedex, and SID databases in isolation and in combination using both and/ or conjunctions. RESULTS: Based on the search done in these databases, twenty different systems were identified in the primary adult triage field including START, Homebush triage Standard, Sieve, Care Flight, STM, Military, CESIRA Protocol, MASS, Revers, CBRN Triage, Burn Triage, META Triage, Mass Gathering Triage, SwiFT Triage, MPTT, TEWS Triage, Medical Triage, SALT, mSTART and ASAV. There were two primary triage systems including Jump START and PTT for children, and also two secondary triage systems encompassing SAVE and Sort identified in this respect. ESI and CRAMS were two other cases distinguished for hospital triage systems. CONCLUSION: There are divergent triage systems in the world, but there is no general and universal agreement on how patients and injured people should be triaged. Accordingly, these systems may be designed based on such criteria as vital signs, patient's major problems, or the resources and facilities needed to respond to patients’ needs. To date, no triage system has been known as superior, specifically about the patients’ clinical outcomes, improvement of the scene management or allocation of the resources compared to other systems. Thus, it is recommended that different countries such as Iran design their triage model for emergencies and disasters by their native conditions, resources and relief forces

Effect of Nanographene on Physical, Mechanical, and Thermal Properties and Morphology of Nanocomposite Made of Recycled High Density Polyethylene and Wood Flour

The effects of the amount of nanographene on physical, mechanical, and thermal properties and morphology of the wood-plastic composites were investigated. This wood-plastic was made using recycled high density polyethylene (HDPE), nanographene, and wood flour. Four weight levels, 0, 0.5, 1.5, or 2.5 wt.% of nanographene, were combined with 70% polymeric matrix and 30% lignocellulosic material with an internal mixer. The results showed that by increasing the amount of nanographene up to 0.5% by weight, the flexural strength, flexural modulus, and notched impact strength of the composite increased. After adding 2.5 wt.% nanographene, these properties were reduced. By increasing the amount of nanographene, both the amount of residual ash and the thermal stability increased. Study of the images from scanning electron microscope (SEM) showed that the samples containing 0.5% of nanographene had less pores and were smoother than other samples

The Estimation of Survival and Associated Factors in Self-Immolation Attempters in Ilam Province of Iran (2011-2015)

BACKGROUND: Self-immolation is the most common method of suicide in Ilam province. AIM: This study aimed to estimate the survival rate in self-immolation attempters in Ilam and identify the associated factors. METHODS: A descriptive-analytic study was conducted based on data collected at Taleghani Hospital in Ilam, Iran. All persons passed away due to self-immolation or those hospitalised in the centre of the self-burned patients located in Ilam during 2011 to 2015 were assessed. Survival rate was calculated based on Kaplan-Meier. To compare the survival rate between groups, Univariate Log Rank and for multivariate analysis, the Cox test of STATA12 software was used. RESULTS: During 2011 to 2015, 236 persons including 168 females and 69 males committed self-immolation. The mean and median of survival time in attempters were 32.2 ± 4.7 and 3 ± 0.33 days, respectively. In Univariate Log-Rank test, the following variables including age, sex, burn degree, Total Body Surface Area (TBSA), and burns in neck and head and lower limbs had a significantly meaningful relation with survival, while in multivariate Cox Regression test only two variables including Total Body Surface Area and age remained in the model. CONCLUSION: The mean and median survival rate in self-attempters are very low. Quickly hospitalisation without waste of time should be considered. Providing prompt treatments and compensating dehydration in early hours especially within the first 24 hours of self-immolation are very vital. Younger persons and those with lower burn surface have more chance for longer survival and recuperation