Biomedical Engineering Reference
In-Depth Information
epidemiological approach such as SEIRV uses five
categories for triage categorization [2:p. 422]:
number of lives. This might include a system
that refuses medical assistance to those unlikely
to recover. In 1998, under the direction of
the Department of Defense (DOD) Preparedness
Program (DPP), the Biological Weapons Improved
Resource Program conducted a series of work-
shops designed to identify improved strategies to
managing a large-scale biological terrorism attack
[6]. From this project, a template was obtained for
an interagency response that included the efficient
utilization of a community's combined medical
resources.
The modular emergency medical system
(MEMS) is one component of the response and
is designed to assess the need to rapidly enhance
the community's medical capacity. In a large-
scale biological weapon incident, it focuses on
managing the large number of casualties, which
overwhelms the existing medical capabilities and
involves an outbreak of a disaster. MEMS provides
systematic, coordinated and effective medical care
to casualties. The response is based on the inci-
dent command system (ICS), which is a nation-
ally recognized emergency response system. The
MEMS plan also establishes a framework for
which outside medical resources can assist local
response efforts.
The MEMS response divides into two types of
expandable patient care modules: The acute care
center (ACC) and the neighborhood emergency
help centers (NEHCs). These modules enable non-
hospital facilities to become mass care centers. The
ACC and NEHC are linked to a local hospital
that oversees patient care, medical resources, and
communication. The modules and hospitals can
provide a vast array of care and services to victims
of biological incidents as well as to the local normal
patient population. The casualties and “worried
well” would be triaged through the MEMS.
If hospitals reach full capacity, an ACC can
be established in a nearby building to transfer
and redirect patients who need non-critical, agent-
specific supportive care. Transportation units
would coordinate the transfer of all patients
between the ACCs the NEHC and the hospitals.
In addition, they would also transfer patients not
(S) Susceptible individuals (including those with
incomplete or unsuccessful vaccinations)
(E) Exposed individuals (who are symptomatic
and contagious)
(I) Infectious individuals (who are symptomatic
and contagious)
(R) Removed individuals who are no longer
sources of infection
(V) Vaccinated (who are successfully vaccinated)
Difficulty in triage comes form distinguishing
those individuals actually exposed, those poten-
tially exposed, those “psychologically” exposed,
and those with multiple unexplained symptoms.
Overtriage may also occur and accuracy will
improve as more data are obtained.
Triage tags will be helpful in identifying victims
and in determining priorities for treatment. They
may also include basic medical information that
follows the victim through the treatment. To be
effective, triage tags must be simple, easy to under-
stand, and should allow for a brief documentation.
If a victim improves or deteriorates necessitating
a new category, a new tag should be added on top
with a brief description of the management deci-
sion recorded along with the date and time.
Triage management provides the “best
opportunity” to survive but does not necessarily
guarantee treatment or survival. Triage and
resource allocation can be measured as “life saved”
(L) per unit “effort” (E) or resources required
[2:p. 425]. Critically ill or injured patients would
have a low L/E value due to the high amount of
resources needed. Victims who can be saved with
a moderate amount of resources needed but would
die without it them have a high L/E value. Triage
categories should be disaster-specific and should
help set thresholds for initiating care.
14.3 Hospital Expansion
A large-scale disaster requiring triage for a
prolonged period would result in an effective
medical response that would save the maximum
