ابزارهاي ترياژكودكان در بحران

Title

Pediatric disaster triage tools

English Abstract

Introduction: The tools we use every day to make medical triage decisions in the prehospital and hospital settings are primarily based on observations of physiology .the physiology of children is different from that of adults .thus physiology- based triage tools must take into consideration the differences between adult and pediatric physiology. Therefore ,The aim of this study is to introduce pediatric triage tools. Subjects and Methods: This study is a systematic review article that obtained by searching in Web sites ,articles and books. Discussion: this study we point to tree Pediatric disaster triage tools that are used in pediatric triage. Two tools designed specifically for pediatric (jump START & Smart Tape) and one tool with a pediatric modification (Sacco) are in use internationally. Jump START pediatric MCI triage tool can be used for children from birth to adolescence .triage designations are based on an assessment of respirations, perfusion, and mentation (RPM) that should take up to 30 seconds to perform. AVPU is the gauge of mental status used by jump START .patients are triaged in to the conventional four color categories of red ( emergent), yellow ( delayed ), green( minor) and black (deceased or expectant). The advantages of Jump START include: Jump START provides a rapid triage system specifically designed for children, taking into consideration their unique physiology. The algorithm is modified from an existing system widely accepted for adult triage. For most patients, triage can be accomplished within the 15 second goal. Objective triage criteria will provide emotional support for triage personnel forced to make life or death decisions for children in the MCI setting. Smart tape (pediatric triage tape or PTT): The pediatric triage tape relates the child’s length to changes in normal physiological values. The information is presented on a waterproof non-tear tape and can be used in conjunction with any existing triage label system. this length-based tool defines the standard triage categories based on an MRP (mobility/motor, respiratory, perfusion/pulse) or RPM (respirations, perfusion, mentation) assessment, with age-adjusted parameters in four length/age groups. The four pediatric groups are : 50-80 cm/3-10 kg, 80-100cm/11-18kg, 100-140 cm/19-32kg, >140 cm/>32kg .each compartment length/age section has a triage algorithm with vital signs corrected for age .the triage approach is divided into three assessment : mental status &walking ;breathing; and circulation. Finally patient are triaged in four color categories of red (highest priority), yellow (middle level of priority), green ( low priority) and black (deceased). The pediatric triage tape will temper the subjective desire to treat all children as a high priority. Children will be given a triage priority appropriate to their injuries. The Sacco Triage Method (STM) is based on trauma patient outcome data. The Sacco Triage Method (STM) is an evidence based outcome driven triage and resource management system that maximizes expected survivors in consideration of the timing, availability and capability of transport and treatment resources. Based on a simple age adjusted physiological score (i.e. respiratory rate, pulse, best motor response) that is computed routinely on every trauma patient and that is correlated to survival probability, triage decisions are made in response to the specific type, size and location of incident, and the resources that can be brought to bear on its resolution. STM explicitly prioritizes and tracks resource utilization and expected patient outcome, creates a triage and regional resource plan, and provides real time situation and status reports. Scores derived from an RPM assessment range from 0-12, with the lower scores indicating the most critically injured. age adjustment are made after the RPM assessment ; infants and children gain 1-2 additional points and older patients lose 1-2 points. traditional triage category color designations are not used. the Benefits 0f STM include : Saves lives( Method maximizes expected survivors, producing optimal strategies during MCI. Simulations of large incidents show increases in expected survivors in excess of 600% compared to current protocols.),Saves money , Is used every day, on every trauma patient , Is outcome driven/measurable ,Balances patient loads across hospitals( Distributes patients across trauma treatment centers within a region, not allowing the disaster to be “moved to the hospital.”) , Is scalable, Manages/leverages resources.( Maximizes human, transport and treatment resource utilization.) , Improves information flow.

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