Triage and the Lost Art of Decoding Vital Signs: Restoring Physiologically Based Triage Skills in Complex Humanitarian Emergencies
Triage and the Lost Art of Decoding Vital Signs: Restoring Physiologically Based Triage Skills in Complex Humanitarian Emergencies
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DOI：
10.1017/dmp.2017.40
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发表时间：
2018-02-01
影响因子：
2.7
通讯作者：
Burkle, Frederick M., Jr.
中科院分区：
文献类型：
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作者：
Burkle, Frederick M., Jr.
分类管理仍然是一个重大挑战，特别是在资源贫乏的环境中，如战争、复杂的人道主义紧急情况和发展中国家的公共卫生紧急情况。在分诊中，通常是生理学的破坏，而不是解剖学，这是至关重要的，支持基于临床医生评估的生理参数以及解剖学和损伤机制的分诊方法。近年来，发达国家有太多的临床医生被部署到人道主义紧急情况中，他们没有评估患者所需的体格检查技能，也没有远程馈送的电子监测、实验室和成像研究的好处。在分诊中，包括曾经被广泛接受和集体教导的解码生命体征的艺术，注意它们的特征和意义，可以提供患者生理状态的线索，提高分诊的灵敏度。注意解码生命体征本身不是一种分类方法或评分系统，而是一种支持现有分类方法的技能。随着不断变化的各种人道主义危机提出了独特的分流管理挑战，这些曾经有用的技能需要重新审视，理解，教授，并由分流规划者，分流人员和团队作为必要的辅助生理分流决策。
Triage management remains a major challenge, especially in resource-poor settings such as war, complex humanitarian emergencies, and public health emergencies in developing countries. In triage it is often the disruption of physiology, not anatomy, that is critical, supporting triage methodology based on clinician-assessed physiological parameters as well as anatomy and mechanism of injury. In recent times, too many clinicians from developed countries have deployed to humanitarian emergencies without the physical exam skills needed to assess patients without the benefit of remotely fed electronic monitoring, laboratory, and imaging studies. In triage, inclusion of the once-widely accepted and collectively taught art of decoding vital signs with attention to their character and meaning may provide clues to a patient's physiological state, improving triage sensitivity. Attention to decoding vital signs is not a triage methodology of its own or a scoring system, but rather a skill set that supports existing triage methodologies. With unique triage management challenges being raised by an ever-changing variety of humanitarian crises, these once useful skill sets need to be revisited, understood, taught, and utilized by triage planners, triage officers, and teams as a necessary adjunct to physiologically based triage decision-making.