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）后医疗机构的“激增”伤亡人数，紧急救援人员和医院人员使用分诊来快速评估患者并优先考虑他们的护理，目标是挽救尽可能多的生命。在有毒吸入有害化学品（TIH化学品）MCI受害者的治疗中遇到了三个主要挑战：1)快速识别已经发生的MCI， 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、分类和处理暴露者，以改善患者的预后。美国每年生产和运输近170万辆火车的危险物质。当这些化学物质在城市中扩散时，可能会造成数十万人受伤或死亡。然而，拟议的针对现有大规模伤亡分类的国家指导方针并没有充分考虑到包括化学品在内的事件。我们之前由NIH/NLM R21LM10833资助的对南卡罗来纳州Graniteville氯气灾难的研究发现：1)紧急严重性指数（ESI）医院分诊系统对暴露于氯的受害者的预测质量较差；2)在没有任何化学品暴露信息的情况下，受害者涌入急诊科，导致混乱和难以处理受害者；并且存在更敏感的分诊评估（例如，通过脉搏血氧仪测量血氧饱和度[SpO2]）。目前，还没有信息学工具来快速识别激增的早期阶段，

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.