Disaster medicine and public health preparedness
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Disaster Med Public Health Prep · Jun 2015
Pediatric Disposition Classification (Reverse Triage) System to Create Surge Capacity.
Critically insufficient pediatric hospital capacity may develop during a disaster or surge event. Research is lacking on the creation of pediatric surge capacity. A system of "reverse triage," with early discharge of hospitalized patients, has been developed for adults and shows great potential but is unexplored in pediatrics. ⋯ The classification system has potential for an ethically acceptable risk-based taxonomy for pediatric inpatient reverse triage, including identification of those deemed safe for early discharge during surge events.
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Disaster Med Public Health Prep · Feb 2015
Triage management, survival, and the law in the age of Ebola.
Liberia, Sierra Leone, and Guinea lack the public health infrastructure, economic stability, and overall governance to stem the spread of Ebola. Even with robust outside assistance, the epidemiological data have not improved. Vital resource management is haphazard and left to the discretion of individual Ebola treatment units. ⋯ In particular, the WHO has been severely compromised by post-2003 severe acute respiratory syndrome (SARS) staffing, budget cuts, a weakened IHR treaty, and no unambiguous legal mandate. Population-based triage management under a central authority is indicated to control the transmission and ensure fair and decisive resource allocation across all triage categories. The shared responsibilities critical to global health solutions must be realized and the rightful attention, sustained resources, and properly placed legal authority be assured within the WHO, the IHR, and the vulnerable nations.
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Disaster Med Public Health Prep · Feb 2015
Ebola triage screening and public health: the new "vital sign zero".
During public health emergencies of international concern such as the 2014 Ebola event, health care leaders need to educate clinicians on the front lines to make uncomfortable, but real triage decisions that focus on optimization of population health outcomes over individual care. Health care workers must consider their own protection first before direct contact with potentially contagious patients. In an era of globalization and emerging infectious disease, routine triage including evaluation of the standard vital signs must shift to include public health considerations with immediate consequences. A new "vital sign zero" should be taken at the time of initial patient evaluation to assess for risk and exposure to potentially contagious infectious diseases.
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The size of the world's largest Ebola outbreak now ongoing in West Africa makes clear that further exportation of Ebola virus disease to other parts of the world will remain a real possibility for the indefinite future. Clinicians outside of West Africa, particularly those who work in emergency medicine, critical care, infectious diseases, and infection control, should be familiar with the fundamentals of Ebola virus disease, including its diagnosis, treatment, and control. ⋯ We review the pathophysiology and clinical features of the disease, highlighting diagnosis, treatment, and hospital infection control issues that are relevant to practicing clinicians. We reference official guidance and point out where important uncertainty or controversy exists.