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

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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

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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
5	Needle thoracocentesis
6	Finger thoracostomy
7	Tube thoracostomy
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
25	Craniotomy
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