Interventions salvatrices: Bien sûr mais lesquelles ?
Major incident triage: A consensus based definition of the essential life-saving interventions during the definitive care phase of a major incident
Vassallo J. et Al. Injury, Int. J. Care Injured 47 (2016) 1898–190
Plus le contexte d'intervention est difficile soit du fait de l'environnement soit du fait du danger tactique et plus le choix des nterventions médicales doit être réflechi et restreint et mis en oeuvre par uintervenant pas forcément médecin mas formé spécifiquement à la pratique d'une action nécessaire à la survie. Ce travail identiife ainsi une trentaine de conduites essentielles à un réseau de traumatisés graves. Lire aussi cet article
Introduction: Triage is a key principle in the effective management of major incidents. The process currently relies on algorithms assigning patients to specific triage categories; there is, however, little guidance as to what these categories represent. Previously, these algorithms were validated against injury severity scores, but it is accepted now that the need for life-saving intervention is a more important outcome. However, the definition of a life-saving intervention is unclear. The aim of this study was to define what constitutes a life-saving intervention, in order to facilitate the definition of an adult priority one patient during the definitive care phase of a major incident.
Methods: We conducted a modified Delphi study, using a panel of subject matter experts drawn from the United Kingdom and Republic of South Africa with a background in Emergency Care or Major Incident Management. The study was conducted using an online survey tool, over three rounds between July and December 2013. A four point Likert scale was used to seek consensus for 50 possible interventions, with a consensus level set at 70%.
Results: 24 participants completed all three rounds of the Delphi, with 32 life-saving interventions reaching consensus.
Conclusions: This study provides a consensus definition of what constitutes a life-saving intervention in the context of an adult, priority one patient during the definitive care phase of a major incident. The definition will contribute to further research into major incident triage, specifically in terms of validation of an adult major incident triage tool.
|Results of the Delphi Process – Life-Saving Interventions.|
|1||Intubation for actual airway obstruction|
|2||Intubation for impending airway obstruction|
|3||Surgical airway for airway obstruction|
|4||Surgical airway for impending airway obstruction|
|8||Application of a chest seal (commercial/improvised)|
|9||Positive Pressure Ventilation for ventilatory inadequacy|
|10||Application of a tourniquet for haemorrhage control|
|11||Use of haemostatic agents for haemorrhage control|
|12||Insertion of an intra-osseous device for resuscitation purposes|
|13||Receiving uncross-matched blood|
|14||Receiving≥4 units of blood/blood products|
|15||Administration of tranexamic acid|
|16||Laparotomy for trauma|
|17||Thoracotomy for trauma|
|18||Pericardial window for trauma|
|19||Surgery to gain proximal vascular control|
|20||Interventional radiology for haemorrhage control|
|21||Application of a pelvic binder|
|22||ALS/ACLS protocols for a patient in a peri-arrest situation|
|23||ALS/ACLS protocols for a patient in cardiac arrest|
|24||Neurosurgery for the evacuation of an intra-cranial haematoma|
|26||Burr Hole Insertion|
|27||Spinal nursing for a C1-3 fracture|
|28||Administration of a seizure-terminating medication|
|29||Active rewarming for initial core temp<32° celcius|
|30||Passive rewarming for initial core temp<32° celcius|
|31||Correction of low blood glucose|
|32||Administration of chemical antidotes|