The Ethical Triage and Management Guidelines of the Entrapped and Mangled Extremity in Resource Scarce Environments: A Systematic Literature Review

Weinstein, Eric S.; Gosney, James E.; Ragazzoni, Luca; Franc, Jeffrey Michael; Herbert, Teri Lynn; Weinstein, Brielle; Verde, Manuela; Zeller, Johannes; Wolfson, Nikolaj; Boyce, William; Cramer, Jordan

doi:10.1017/dmp.2020.49

Cited by 7 publications

(1 citation statement)

References 62 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, some research suggests that such systems impose unnecessarily rigid rules on triage decision-making; furthermore, these systems are essentially invalid because they are a product of "subjective" expert opinion [54]. Some authors suggest that the majority of these systems have a weak scientific base [55][56][57], lack studies with high-quality evidence supporting triage and treatment [58,59].…”

Section: Assessment Criteria and Slippery Slopesmentioning

confidence: 99%

Herding cats: ethics in prehospital triage

2021

View full text Add to dashboard Cite

Objective: Triage can create an ethical slippery slope when providing prehospital emergency health care. In triage decisions, emergency management is like the idiom of “herding cats”, which refers to managing or controlling the chaos and organizing people toward common goals. The purpose of this literature review is to explore the ethical framework of prehospital triage and to provide a critical view of the subject. Methods: Published materials related to “triage”, “ethics”, and “prehospital emergency medicine” were extracted from online databases and books from 1985 until February 2021. The papers were handled in seven themes including the historical basis, the importance of the triage, ethical considerations in prehospital triage, justice, assessment and decision-making, the variability of triage assessment criteria, and the reliability of triage decisions. Except for the historical basis and the importance of triage, the other five groups were discussed with an ethical critique of the content. The methodology in this article is based on a critical interpretation of discussions on triage through ethical approaches. Results: There are three basic ethical approaches to triage: utilitarianism, beneficence, and justice. Due to the historical military basis of triage, results-focused approaches have become more prominent. Ethical values in prehospital triage include the issues of human rights, moral rights, social justice, and beneficence. Ethical difficulties in triage decision-making involve vulnerability, limited resources, the concern of safety, the urgency of the situation, and instability. Triage decisions may be affected by subjective approaches such as the personal values and beliefs of the decision-makers. Conclusions: Three predominant ethical concepts in triage are utilitarianism, beneficence, and justice. The unique dynamics of the field influence triage decision-making in a variety of ways. The way triage is structured makes it more amenable to subjective influences. Considering the differences in prehospital triage models and approaches, there is an important need for an ethical framework that expresses clear values and principles that will guide prehospital emergency caregivers. In this paper, it is suggested that an ethical framework should include the following six headings: basic bioethical principles, distributing scarce resources, decision-making process, community support, assessment criteria, and promote the common good.

show abstract

Section: Assessment Criteria and Slippery Slopesmentioning

confidence: 99%

Herding cats: ethics in prehospital triage

2021

View full text Add to dashboard Cite

show abstract

Characteristics of COVID-19 Community Practice Declines in Noninvasive Diagnostic Imaging Professional Work

Duszak

Maze²,

Sessa

et al. 2020

Journal of the American College of Radiology

View full text Add to dashboard Cite

Purpose: The operational and financial impact of the widespread coronavirus disease 2019 (COVID-19) curtailment of imaging services on radiology practices is unknown. We aimed to characterize recent COVID-19-related community practice noninvasive diagnostic imaging professional work declines.Methods: Using imaging metadata from nine community radiology practices across the United States between January 2019 and May 2020, we mapped work relative value unit (wRVU)-weighted stand-alone noninvasive diagnostic imaging service codes to both modality and body region. Weekly 2020 versus 2019 wRVU changes were analyzed by modality, body region, and site of service. Practice share c 2 testing was performed.Results: Aggregate weekly wRVUs ranged from a high of 120,450 (February 2020) to a low of 55,188 (April 2020). During that À52% wRVU nadir, outpatient declines were greatest (À66%). All practices followed similar aggregate trends in the distribution of wRVUs between each 2020 versus 2019 week (P ¼ .96-.98). As a percentage of total all-practice wRVUs, declines in CT (20,046 of 63,992; 31%) and radiography and fluoroscopy (19,196; 30%) were greatest. By body region, declines in abdomen and pelvis (16,203; 25%) and breast (12,032; 19%) imaging were greatest. Mammography (À17%) and abdominal and pelvic CT (À14%) accounted for the largest shares of total all-practice wRVU reductions. Across modality-region groups, declines were far greatest for mammography (À92%).Conclusions: Substantial COVID-19-related diagnostic imaging work declines were similar across community practices and disproportionately impacted mammography. Decline patterns could facilitate pandemic second wave planning. Overall implications for practice workflows, practice finances, patient access, and payment policy are manifold.

show abstract

Modelo de evaluación del plan de respuesta frente a la pandemia de COVID-19 en un hospital de tercer nivel

Llorente-Parrado

Mejon-Berges

Cossio-Gil

et al. 2020

Journal of Healthcare Quality Research

View full text Add to dashboard Cite

Background and purpose. During the first wave of the epidemic caused by SARS-CoV-2, hospitals have come under significant pressure. This scenario of uncertainty, low scientific evidence, and insufficient resources, has generated significant variability in practice between different health organisations. In this context, it is proposed to develop a standards-based model for the evaluation of the preparedness and response system against COVID-19 in a tertiary hospital. Materials and methods. The study, carried out at the University Hospital of Vall d'Hebron in Barcelona (Spain), was designed in two phases: 1) development of the standards-based model, by means of a narrative review of the literature, analysis of plans and protocols implemented in the hospital, a review process by expert professionals from the centre, and plan of action, and 2) validation of usability and usefulness of the model through self-assessment and hospital audit. Results. The model contains 208 standards distributed into 9 criteria: leadership and strategy; prevention and infection control; management of professionals and skills; public areas; healthcare areas; areas of support for diagnosis and treatment; logistics, technology and works; communication and patient care; and information and research systems. The evaluation achieved 85.2% compliance, with 42 areas for improvement and 96 good practices identified. Conclusions. Implementing a standards-based model is a useful tool to identify areas for improvement and good practices in COVID-19 preparedness and response plans in a hospital. In the current context, it is recommended to repeat this methodology in other non-hospital and public health settings.

show abstract

The Ethical Triage and Management Guidelines of the Entrapped and Mangled Extremity in Resource Scarce Environments: A Systematic Literature Review

Cited by 7 publications

References 62 publications

Herding cats: ethics in prehospital triage

Herding cats: ethics in prehospital triage

Characteristics of COVID-19 Community Practice Declines in Noninvasive Diagnostic Imaging Professional Work

Modelo de evaluación del plan de respuesta frente a la pandemia de COVID-19 en un hospital de tercer nivel

Contact Info

Product

Resources

About