Validating Triage for Chemical Mass Casualty Incidents - A First Step

描述（由申请人提供）：为了减轻大规模伤亡事件（MCI）后进入医疗机构的伤亡人员的“激增”，紧急救援人员和医院工作人员使用分类来快速评估患者并优先考虑他们的护理，目标是尽可能多地挽救生命。在治疗有毒吸入危险化学品（TIH化学品）MCI的受害者时遇到三个主要挑战：1）快速识别MCI已经发生，2）快速检测所涉及的化学品，以及3）准确，精确和有效地识别，分类和处理那些暴露的人，以改善患者的结果。美国每年生产和运输近170万辆危险材料的轨道车。这些化学品在城市中流动时的泄漏可能会伤害或杀死数十万人。然而，拟议的现有大规模伤亡分类国家准则没有充分考虑到包括化学品在内的事件。我们之前的NIH/NLM R21 LM 10833资助的南卡罗来纳州Graniteville氯气灾难研究发现：1）紧急情况严重程度指数（ESI）医院分流系统对暴露于氯气的受害者的预测质量较差; 2）在任何化学品暴露信息可用之前，受害者涌入艾德，导致混乱和困难的受害者处理;并且存在更敏感的分类评估（例如，通过脉搏血氧仪[SpO 2]测量的氧饱和度）。目前，还没有信息学工具来迅速确定激增的早期阶段， 有效地处理受害者，也不对TIH化学品或任何其他MCI提出分类建议。我们提出了一种新的艾德信息学计算工具（EDICT），它采用了一种新的分诊算法（TIH化学分诊算法），并将NLM无线应急信息系统（WISER）系统与真实的灾难数据相结合，以更准确，精确和有效地分诊艾德患者，使用化学MCI作为第一步。将在TIH化学品分类算法中使用SpO 2监测，以更好地评估TIH化学品暴露常见的损伤潜伏期。以计算机为基础的信息学解决方案，改善早期识别，处理和分流的病人承认艾德以下MCI将加强灾害信息学的科学。在常规艾德实践中使用EDICT可能会导致信息学技术的普遍使用的突破，以显着改善患者在ED中的处理方式。一个灵活的、鲁棒的和可扩展的信息学计算解决方案具有在其他类型的MCI中更广泛应用的潜力（例如，食源性和传染性疾病爆发），以及ED的日常使用。这项研究是开发新的艾德信息学工具的第一步，这可以改变所有艾德患者的处理。

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.