Validating Triage for Chemical Mass Casualty Incidents - A First Step

验证化学大规模伤亡事件的分类——第一步

• 批准号: 8919744
• 负责人: Joan Marie Culley
• 金额: $ 52.07万
• 依托单位: UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8919744
• 关键词: Accident and Emergency department; Accounting; Address; Advisory Committees; Algorithms; Ammonia; Breathing; Caring; Chemical Exposure; Chemicals; Chlorine; Cities; Communicable Diseases; Computers; Confusion; Data; Data Reporting; Development; Disasters; Disease Outbreaks; Early Diagnosis; Early identification; Effectiveness; Emergency Department patient; Emergency Situation; Evaluation; Event; Exercise; Feedback; Funding; Goals; Gold; Guidelines; Hazardous Substances; Health care facility; Hospital Personnel; Hospitals; Informatics; Information Systems; Injury; Lead; Liquid substance; Measures; Medical Records; Methods; Monitor; Outcome; Oxygen; Patient Triage; Patients; Pattern; Phase; Process; Pulse Oximetry; Randomized; Recommendation; Reporting; Research; Research Design; Science; Severities; Signs and Symptoms; Solutions; Staging; Symptoms; System; Technology; Testing; Triage; United States National Institutes of Health; Wireless Technology; abstracting; base; computerized tools; design; emergency service responder; experience; flexibility; foodborne; hazard; improved; indexing; injured; innovation; killings; mass casualty; standard measure; tool

DESCRIPTION (provided by applicant): To mitigate the "surge" of casualties into a healthcare facility after a mass casualty incident (MCI), emergency responders and hospital personnel use triage to rapidly assess patients and prioritize their care with the goal of saving as many lives a possible. Three main challenges are encountered in the treatment of victims of toxic inhalation hazard chemicals (TIH chemicals) MCIs: 1) quickly identifying that a MCI has occurred, 2) rapidly detecting the chemical involved, and 3) identifying, triaging and processing those exposed accurately, precisely and efficiently to improve patient outcomes. The US produces and transports nearly 1.7 million railcars of hazardous materials each year. A spill of such chemicals as they move through a city could injure or kill hundreds of thousands of people. However, the proposed national guideline for existing mass casualty triage does not fully account for events that include chemicals. Findings from the our previous NIH/NLM R21LM10833 funded study of the Graniteville, SC chlorine disaster, found that: 1) The Emergency Severity Index (ESI) hospital triage system had poor predictive quality for victims exposed to chlorine; 2) the surge of victims into the ED came before any chemical exposure information was available, leading to confusion and difficult victim processing; and there exists more sensitive triage assessments (e.g., oxygen saturation measured by pulse oximetry [SpO2]). Currently, there are no informatics tools to rapidly identify the early stages of a surge, process victims efficiently, nor make triage recommendations for TIH chemicals or any other MCIs. We propose a new ED Informatics Computational Tool (EDICT) that incorporates a new triage algorithm (TIH Chemical Triage Algorithm), and integrates the NLM Wireless Information System for Emergency Responders (WISER) system with real disaster data to more accurately, precisely and efficiently triage ED patients, using a chemical MCI as a first step. SpO2 monitoring will be used in the TIH Chemical Triage Algorithm to better assess injury latency common with TIH chemical exposures. Computer-based informatics solutions that improve early identification, processing, and triage for patients admitted to the ED following a MCI will enhance the science of disaster informatics. Using EDICT in routine ED practice could potentially lead to a breakthrough in the general use of informatics technology to dramatically improve the way patients are processed in EDs. A flexible, robust and scalable informatics computational solution has the potential for broader applications in other types of MCIs (e.g., foodborne and communicable disease outbreaks), as well as day-to-day use in EDs. This study is the first step to developing new ED informatics tools, which can change all ED patient processing.

描述（由申请人提供）：在发生大规模伤亡事件（MCI）之后，减轻伤亡人数的“激增”为医疗机构，紧急响应者和医院人员使用Triage快速评估患者并确定护理的优先级，以挽救尽可能多的生命。在治疗有毒吸入危害化学物质（TIH化学物质）的受害者中，遇到了三个主要挑战：1）迅速确定发生了MCI，2）迅速检测到所涉及的化学物质，3）确定，分解和处理这些化学物质，精确，有效地，有效地，有效地改善患者成果。美国每年生产和运输近170万辆危险材料。这些化学物质在城市中移动时可能会伤害或杀死数十万人。但是，拟议的《全国大规模伤亡分子指南》并未完全解释包括化学物质在内的事件。我们以前的NIH/NLM R21LM10833资助研究的研究结果，SC氯灾害的研究结果发现：1）紧急严重性指数（ESI）医院分类系统对暴露于氯的受害者的预测质量较差； 2）在获得任何化学暴露信息之前，受害者涌入ED，导致混乱和困难的受害者处理；并且存在更多灵敏的分诊评估（例如，通过脉搏血氧饱和度测量的氧饱和度[SPO2]）。当前，没有信息工具可以快速识别激增的早期阶段， 有效地处理受害者，也没有为TIH化学物质或任何其他MCI提出分类建议。我们提出了一种新的ED信息学计算工具（EDICT），该工具将新的分类算法（TIH Chemical Triage算法）结合在一起，并将NLM无线信息系统（WISER）系统（WISER）与实际灾难数据集成到更准确，精确，精确，有效地使用Chemical MCI，使用Chemical MCI作为第一步。 SPO2监测将用于TIH化学分类算法中，以更好地评估具有TIH化学暴露常见的损伤潜伏期。基于计算机的信息学解决方案，可以改善MCI后接受ED的患者的早期识别，处理和分流的解决方案，将增强灾难信息学的科学。在常规练习中使用法令可能会导致一般使用信息学技术的突破，以显着改善ED中的患者处理方式。一种灵活，健壮和可扩展的信息计算解决方案具有在其他类型的MCI（例如食源性和传染病暴发）中进行更广泛应用的潜力，以及在EDS中的日常使用。这项研究是开发新的ED信息学工具的第一步，可以改变所有ED患者的处理。