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[PMID]:29197316
[Au] Autor:Shartar SE; Moore BL; Wood LM
[Ad] Endereço:From Emory University Office of Critical Event Preparedness and Response, the Department of Emergency Medicine, Emory University School of Medicine, and Grady Health System, Atlanta, Georgia.
[Ti] Título:Developing a Mass Casualty Surge Capacity Protocol for Emergency Medical Services to Use for Patient Distribution.
[So] Source:South Med J;110(12):792-795, 2017 Dec.
[Is] ISSN:1541-8243
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Metropolitan areas must be prepared to manage large numbers of casualties related to a major incident. Most US cities do not have adequate trauma center capacity to manage large-scale mass casualty incidents (MCIs). Creating surge capacity requires the distribution of casualties to hospitals that are not designated as trauma centers. Our objectives were to extrapolate MCI response research into operational objectives for MCI distribution plan development; formulate a patient distribution model based on research, hospital capacities, and resource availability; and design and disseminate a casualty distribution tool for use by emergency medical services (EMS) personnel to distribute patients to the appropriate level of care. METHODS: Working with hospitals within the region, we refined emergency department surge capacity for MCIs and developed a prepopulated tool for EMS providers to use to distribute higher-acuity casualties to trauma centers and lower-acuity casualties to nontrauma hospitals. A mechanism to remove a hospital from the list of available resources, if it is overwhelmed with patients who self-transport to the location, also was put into place. RESULTS: The number of critically injured survivors from an MCI has proven to be consistent, averaging 7% to 10%. Moving critically injured patients to level 1 trauma centers can result in a 25% reduction in mortality, when compared with care at nontrauma hospitals. US cities face major gaps in the surge capacity needed to manage an MCI. Sixty percent of "walking wounded" casualties self-transport to the closest hospital(s) to the incident. CONCLUSIONS: Directing critically ill patients to designated trauma centers has the potential to reduce mortality associated with the event. When applied to MCI responses, damage-control principles reduce resource utilization and optimize surge capacity. A universal system for mass casualty triage was identified and incorporated into the region's EMS. Flagship regional coordinating hospitals were designated to coordinate the logistics of the disaster response of both trauma-designated and undesignated hospitals. Finally, a distribution tool was created to direct the flow of critically injured patients to trauma centers and redirect patients with lesser injuries to centers without trauma designation. The tool was distributed to local EMS personnel and validated in a series of tabletop and functional drills. These efforts demonstrate that a regional response to MCIs can be implemented in metropolitan areas under-resourced for trauma care.
[Mh] Termos MeSH primário: Planejamento em Desastres/métodos
Serviços Médicos de Emergência/métodos
Incidentes com Feridos em Massa
Capacidade de Resposta ante Emergências
Triagem/métodos
[Mh] Termos MeSH secundário: Georgia
Seres Humanos
Centros de Traumatologia/organização & administração
Índices de Gravidade do Trauma
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171207
[Lr] Data última revisão:
171207
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171203
[St] Status:MEDLINE
[do] DOI:10.14423/SMJ.0000000000000740


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[PMID]:28557770
[Au] Autor:Barfield WD; Krug SE; COMMITTEE ON FETUS AND NEWBORN; DISASTER PREPAREDNESS ADVISORY COUNCIL
[Ti] Título:Disaster Preparedness in Neonatal Intensive Care Units.
[So] Source:Pediatrics;139(5), 2017 May.
[Is] ISSN:1098-4275
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Disasters disproportionally affect vulnerable, technology-dependent people, including preterm and critically ill newborn infants. It is important for health care providers to be aware of and prepared for the potential consequences of disasters for the NICU. Neonatal intensive care personnel can provide specialized expertise for their hospital, community, and regional emergency preparedness plans and can help develop institutional surge capacity for mass critical care, including equipment, medications, personnel, and facility resources.
[Mh] Termos MeSH primário: Planejamento em Desastres/organização & administração
Unidades de Terapia Intensiva Neonatal/organização & administração
[Mh] Termos MeSH secundário: Cuidados Críticos/ética
Cuidados Críticos/organização & administração
Serviço Hospitalar de Emergência/organização & administração
Família/psicologia
Seres Humanos
Admissão e Escalonamento de Pessoal
Apoio Social
Capacidade de Resposta ante Emergências/ética
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170810
[Lr] Data última revisão:
170810
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170531
[St] Status:MEDLINE


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[PMID]:28260411
[Au] Autor:Therrien MC; Normandin JM; Denis JL
[Ad] Endereço:Ecole nationale d'administration publique a Montreal, Montreal, Canada.
[Ti] Título:Bridging complexity theory and resilience to develop surge capacity in health systems.
[So] Source:J Health Organ Manag;31(1):96-109, 2017 Mar 20.
[Is] ISSN:1758-7247
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Purpose Health systems are periodically confronted by crises - think of Severe Acute Respiratory Syndrome, H1N1, and Ebola - during which they are called upon to manage exceptional situations without interrupting essential services to the population. The ability to accomplish this dual mandate is at the heart of resilience strategies, which in healthcare systems involve developing surge capacity to manage a sudden influx of patients. The paper aims to discuss these issues. Design/methodology/approach This paper relates insights from resilience research to the four "S" of surge capacity (staff, stuff, structures and systems) and proposes a framework based on complexity theory to better understand and assess resilience factors that enable the development of surge capacity in complex health systems. Findings Detailed and dynamic complexities manifest in different challenges during a crisis. Resilience factors are classified according to these types of complexity and along their temporal dimensions: proactive factors that improve preparedness to confront both usual and exceptional requirements, and passive factors that enable response to unexpected demands as they arise during a crisis. The framework is completed by further categorizing resilience factors according to their stabilizing or destabilizing impact, drawing on feedback processes described in complexity theory. Favorable order resilience factors create consistency and act as stabilizing forces in systems, while favorable disorder factors such as diversity and complementarity act as destabilizing forces. Originality/value The framework suggests a balanced and innovative process to integrate these factors in a pragmatic approach built around the fours "S" of surge capacity to increase health system resilience.
[Mh] Termos MeSH primário: Assistência à Saúde/organização & administração
Capacidade de Resposta ante Emergências/organização & administração
[Mh] Termos MeSH secundário: Continuidade da Assistência ao Paciente/organização & administração
Continuidade da Assistência ao Paciente/normas
Assistência à Saúde/normas
Seres Humanos
Modelos Organizacionais
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171006
[Lr] Data última revisão:
171006
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:170307
[St] Status:MEDLINE
[do] DOI:10.1108/JHOM-04-2016-0067


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[PMID]:28152138
[Au] Autor:Kelen GD; Troncoso R; Trebach J; Levin S; Cole G; Delaney CM; Jenkins JL; Fackler J; Sauer L
[Ad] Endereço:Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland2Johns Hopkins Office of Critical Event Preparedness and Response, Johns Hopkins Institutions, Baltimore, Maryland.
[Ti] Título:Effect of Reverse Triage on Creation of Surge Capacity in a Pediatric Hospital.
[So] Source:JAMA Pediatr;171(4):e164829, 2017 Apr 03.
[Is] ISSN:2168-6211
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: The capacity of pediatric hospitals to provide treatment to large numbers of patients during a large-scale disaster remains a concern. Hospitals are expected to function independently for as long as 96 hours. Reverse triage (early discharge), a strategy that creates surge bed capacity while conserving resources, has been modeled for adults but not pediatric patients. Objective: To estimate the potential of reverse triage for surge capacity in an academic pediatric hospital. Design, Setting, and Participants: In this retrospective cohort study, a blocked, randomized sampling scheme was used including inpatients from 7 units during 196 mock disaster days distributed across the 1-year period from December 21, 2012, through December 20, 2013. Patients not requiring any critical interventions for 4 successive days were considered to be suitable for low-risk immediate reverse triage. Data were analyzed from November 1, 2014, through November 21, 2016. Main Outcomes and Measures: Proportionate contribution of reverse triage to the creation of surge capacity measured as a percentage of beds newly available in each unit and in aggregate. Results: Of 3996 inpatients, 501 were sampled (268 boys [53.5%] and 233 girls [46.5%]; mean [SD] age, 7.8 [6.6] years), with 10.8% eligible for immediate low-risk reverse triage and 13.2% for discharge by 96 hours. The psychiatry unit had the most patients eligible for immediate reverse triage (72.7%; 95% CI, 59.6%-85.9%), accounting for more than half of the reverse triage effect. The oncology (1.3%; 95% CI, 0.0%-3.9%) and pediatric intensive care (0%) units had the least effect. Gross surge capacity using all strategies (routine patient discharges, full use of staffed and unstaffed licensed beds, and cancellation of elective and transfer admissions) was estimated at 57.7% (95% CI, 38.2%-80.2%) within 24 hours and 84.1% (95% CI, 63.9%-100%) by day 4. Net surge capacity, estimated by adjusting for routine emergency department admissions, was about 50% (range, 49.1%-52.6%) throughout the 96-hour period. By accepting higher-risk patients only (considering only major critical interventions as limiting), reverse triage would increase surge capacity by nearly 50%. Conclusions and Relevance: Our estimates indicate considerable potential pediatric surge capacity by using combined strategic initiatives. Reverse triage adds a meaningful but modest contribution and may depend on psychiatric space. Large volumes of pediatric patients discharged early to the community during disasters could challenge pediatricians owing to the close follow-up likely to be required.
[Mh] Termos MeSH primário: Hospitais Pediátricos/estatística & dados numéricos
Alta do Paciente/estatística & dados numéricos
Capacidade de Resposta ante Emergências/estatística & dados numéricos
Triagem/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adolescente
Criança
Pré-Escolar
Estudos de Coortes
Feminino
Seres Humanos
Lactente
Masculino
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170705
[Lr] Data última revisão:
170705
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170203
[St] Status:MEDLINE
[do] DOI:10.1001/jamapediatrics.2016.4829


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[PMID]:27365321
[Au] Autor:Collins TA; Robertson MP; Sicoutris CP; Pisa MA; Holena DN; Reilly PM; Kohl BA
[Ad] Endereço:1 Department of Advanced Practice, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
[Ti] Título:Telemedicine coverage for post-operative ICU patients.
[So] Source:J Telemed Telecare;23(2):360-364, 2017 Feb.
[Is] ISSN:1758-1109
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Introduction There is an increased demand for intensive care unit (ICU) beds. We sought to determine if we could create a safe surge capacity model to increase ICU capacity by treating ICU patients in the post-anaesthesia care unit (PACU) utilizing a collaborative model between an ICU service and a telemedicine service during peak ICU bed demand. Methods We evaluated patients managed by the surgical critical care service in the surgical intensive care unit (SICU) compared to patients managed in the virtual intensive care unit (VICU) located within the PACU. A retrospective review of all patients seen by the surgical critical care service from January 1st 2008 to July 31st 2011 was conducted at an urban, academic, tertiary centre and level 1 trauma centre. Results Compared to the SICU group ( n = 6652), patients in the VICU group ( n = 1037) were slightly older (median age 60 (IQR 47-69) versus 58 (IQR 44-70) years, p = 0.002) and had lower acute physiology and chronic health evaluation (APACHE) II scores (median 10 (IQR 7-14) versus 15 (IQR 11-21), p < 0.001). The average amount of time patients spent in the VICU was 13.7 + /-9.6 hours. In the VICU group, 750 (72%) of patients were able to be transferred directly to the floor; 287 (28%) required subsequent admission to the surgical intensive care unit. All patients in the VICU group were alive upon transfer out of the PACU while mortality in the surgical intensive unit cohort was 5.5%. Discussion A collaborative care model between a surgical critical care service and a telemedicine ICU service may safely provide surge capacity during peak periods of ICU bed demand. The specific patient populations for which this approach is most appropriate merits further investigation.
[Mh] Termos MeSH primário: Unidades de Terapia Intensiva
Cuidados Pós-Operatórios/métodos
Telemedicina/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Cuidados Críticos/métodos
Feminino
Seres Humanos
Tempo de Internação
Masculino
Meia-Idade
Capacidade de Resposta ante Emergências
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170721
[Lr] Data última revisão:
170721
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160702
[St] Status:MEDLINE
[do] DOI:10.1177/1357633X16631846


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[PMID]:27447336
[Au] Autor:Subhash SS; Baracco G; Miller SL; Eagan A; Radonovich LJ
[Ti] Título:Estimation of Needed Isolation Capacity for an Airborne Influenza Pandemic.
[So] Source:Health Secur;14(4):258-63, 2016 Jul-Aug.
[Is] ISSN:2326-5108
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We estimated the number of isolation beds needed to care for a surge in patients during an airborne-transmissible influenza pandemic. Based on US health system data, the amount of available airborne isolation beds needed for ill patients will be exceeded early in the course of a moderate or severe influenza pandemic, requiring medical facilities to find ways to further expand isolation bed capacity. Rather than building large numbers of permanent airborne infection isolation rooms to increase surge capacity, an investment that would come at great financial cost, it may be more prudent to prepare for wide-scale creation of just-in-time temporary negative-pressure wards.
[Mh] Termos MeSH primário: Planejamento em Desastres
Número de Leitos em Hospital
Influenza Humana/epidemiologia
Pandemias
[Mh] Termos MeSH secundário: Planejamento Hospitalar
Seres Humanos
Influenza Humana/transmissão
Determinação de Necessidades de Cuidados de Saúde
Isolamento de Pacientes/métodos
Capacidade de Resposta ante Emergências
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170607
[Lr] Data última revisão:
170607
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160723
[St] Status:MEDLINE
[do] DOI:10.1089/hs.2016.0015


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[PMID]:27120326
[Au] Autor:Glasgow S; Vasilakis C; Perkins Z; Brundage S; Tai N; Brohi K
[Ad] Endereço:From the Centre for Trauma Sciences (S.G., Z.P., S.B., N.T., K.B.), Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, UK; and Centre for Healthcare Innovation and Improvement (C.V.), School of Management, University of Bath, Somerset, United Kingdom.
[Ti] Título:Managing the surge in demand for blood following mass casualty events: Early automatic restocking may preserve red cell supply.
[So] Source:J Trauma Acute Care Surg;81(1):50-7, 2016 Jul.
[Is] ISSN:2163-0763
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Traumatic hemorrhage is a leading preventable cause of mortality following mass casualty events (MCEs). Improving outcomes requires adequate in-hospital provision of high-volume red blood cell (RBC) transfusions. This study investigated strategies for optimizing RBC provision to casualties in MCEs using simulation modeling. METHODS: A computerized simulation model of a UK major trauma center (TC) transfusion system was developed. The model used input data from past MCEs and civilian and military trauma registries. We simulated the effect of varying on-shelf RBC stock hold and the timing of externally restocking RBC supplies on TC treatment capacity across increasing loads of priority one (P1) and two (P2) casualties from an event. RESULTS: Thirty-five thousand simulations were performed. A casualty load of 20 P1s and P2s under standard TC RBC stock conditions left 35% (95% confidence interval, 32-38%) of P1s and 7% (4-10%) of P2s inadequately treated for hemorrhage. Additionally, exhaustion of type O emergency RBC stocks (a surrogate for reaching surge capacity) occurred in a median of 10 hours (IQR, 5 to >12 hours). Doubling casualty load increased this to 60% (57-63%) and 30% (26-34%), respectively, with capacity reached in 2 hours (1-3 hours). The model identified a minimum requirement of 12 U of on-shelf RBCs per P1/P2 casualty received to prevent surge capacity being reached. Restocking supplies in an MCE versus greater permanent on-shelf RBC stock holds was considered at increasing hourly intervals. T-test analysis showed no difference between stock hold versus supply restocking with regard to overall outcomes for MCEs up to 80 P1s and P2s in size (p < 0.05), provided the restock occurred within 6 hours. CONCLUSION: Even limited-sized MCEs threaten to overwhelm TC transfusion systems. An early-automated push approach to restocking RBCs initiated by central suppliers can produce equivocal outcomes compared with holding excess stock permanently at TCs. LEVEL OF EVIDENCE: Therapeutic/care management study, level IV.
[Mh] Termos MeSH primário: Simulação por Computador
Transfusão de Eritrócitos/estatística & dados numéricos
Necessidades e Demandas de Serviços de Saúde
Hemorragia/terapia
Incidentes com Feridos em Massa
Capacidade de Resposta ante Emergências/organização & administração
Centros de Traumatologia
[Mh] Termos MeSH secundário: Hemorragia/mortalidade
Seres Humanos
Centros de Traumatologia/organização & administração
Reino Unido
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170629
[Lr] Data última revisão:
170629
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:160428
[St] Status:MEDLINE
[do] DOI:10.1097/TA.0000000000001101


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[PMID]:27084112
[Au] Autor:Haverkort JJ; Biesheuvel TH; Bloemers FW; de Jong MB; Hietbrink F; van Spengler LL; Leenen LP
[Ad] Endereço:Major Incident Hospital, University Medical Center Utrecht, the Netherlands. Electronic address: jjm.haverkort@outlook.com.
[Ti] Título:Hospital evacuation: Exercise versus reality.
[So] Source:Injury;47(9):2012-7, 2016 Sep.
[Is] ISSN:1879-0267
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: The Dutch Major Incident Hospital (MIH) is a standby, highly prepared, 200-bed hospital strictly reserved to provide immediate, large-scale, and emergency care for victims of disasters and major incidents. It has long-standing experience training for various major incident scenarios, including functioning as a back-up facility for the Netherlands. In 1995, the MIH had experience with overtaking an evacuated hospital when that hospital was threatened by flooding. In November 2014, an exercise was performed to transfer an evacuating hospital to the MIH. The scenario again became reality when a neighbouring hospital had to evacuate in September 2015. This article evaluates the events and compares the exercise to the real events in order to further optimise future training. METHODS: All three events were analysed using the Protocol for Reports from Major Accidents and Disasters, a standardised protocol to evaluate medical responses to a major incident. RESULTS: During the 2014 exercise, 72 patients were received, compared with 143 and 70, respectively, in the real events in 1995 and 2015. Personnel from the evacuating hospitals accompanied the patients and continued working in the MIH. The patient surge differed on all three occasions. The information technology (IT) systems proved to be more prone to fail during the real event, and legal implications to have staff from another hospital work in the MIH had to be put in protocol during the deployment. The acute phase was comparable in all three events, and performance was good. However, the exercise did not last long enough to analyse the implications on multiday care, as experienced during a multiday deployment. CONCLUSION: Large-scale major incident exercises are a great benchmark for the medical response in the acute phase of relief. The MIH was shown to be highly prepared to admit an entire evacuating hospital or large groups of patients in such a scenario. Experiences from the past, combined with regular training that closely resembles reality, guarantee the level of preparedness. Key differences between a true deployment and an exercise are the inability to train multiple days, and in our experience, a successful operation of IT systems in test environments does not guarantee their successful use during live events.
[Mh] Termos MeSH primário: Planejamento em Desastres/organização & administração
Eficiência Organizacional/normas
Serviço Hospitalar de Emergência
Incidentes com Feridos em Massa
Transferência de Pacientes/organização & administração
Transporte de Pacientes/organização & administração
Triagem
[Mh] Termos MeSH secundário: Idoso
Protocolos Clínicos
Comportamento Cooperativo
Planejamento em Desastres/métodos
Planejamento em Desastres/normas
Feminino
Administração Hospitalar
Seres Humanos
Masculino
Meia-Idade
Países Baixos/epidemiologia
Transferência de Pacientes/normas
Avaliação de Programas e Projetos de Saúde
Trabalho de Resgate
Capacidade de Resposta ante Emergências/normas
Transporte de Pacientes/normas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170918
[Lr] Data última revisão:
170918
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160417
[St] Status:MEDLINE


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[PMID]:26912379
[Au] Autor:Yehualashet YG; Mkanda P; Gasasira A; Erbeto T; Onimisi A; Horton J; Banda R; Tegegn SG; Ahmed H; Afolabi O; Wadda A; Vaz RG; Nsubuga P
[Ad] Endereço:World Health Organization, Country Representative Office, Abuja, Nigeria.
[Ti] Título:Strategic Engagement of Technical Surge Capacity for Intensified Polio Eradication Initiative in Nigeria, 2012-2015.
[So] Source:J Infect Dis;213 Suppl 3:S116-23, 2016 May 01.
[Is] ISSN:1537-6613
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Following the 65th World Health Assembly (WHA) resolution on intensification of the Global Poliomyelitis Eradication Initiative (GPEI), the Nigerian government, with support from the World Health Organization (WHO) and other partners, implemented a number of innovative strategies to curb the transmission of wild poliovirus (WPV) in the country. One of the innovations successfully implemented since mid 2012 is the WHO's engagement of surge capacity personnel. METHODS: The WHO reorganized its functional structure, adopted a transparent recruitment and deployment process, provided focused technical and management training, and applied systematic accountability framework to successfully manage the surge capacity project in close collaboration with the national counterparts and partners. The deployment of the surge capacity personnel was guided by operational and technical requirement analysis. RESULTS: Over 2200 personnel were engaged, of whom 92% were strategically deployed in 11 states classified as high risk on the basis of epidemiological risk analysis and compromised security. These additional personnel were directly engaged in efforts aimed at improving the performance of polio surveillance, vaccination campaigns, increased routine immunization outreach sessions, and strengthening partnership with key stakeholders at the operational level, including community-based organizations. DISCUSSION: Programmatic interventions were sustained in states in which security was compromised and the risk of polio was high, partly owing to the presence of the surge capacity personnel, who are engaged from the local community. Since mid-2012, significant programmatic progress was registered in the areas of polio supplementary immunization activities, acute flaccid paralysis surveillance, and routine immunization with the support of the surge capacity personnel. As of 19 June 2015, the last case of WPV was reported on 24 July 2014. The surge infrastructure has also been instrumental in building local capacity; supporting other public health emergencies, such as the Ebola outbreak response and measles and meningitis outbreaks; and strengthening the integrated disease surveillance and response. Due to weak health systems in the country, it is vital to maintain a reasonable level of the surge capacity for successful implementation of the 2013-2018 global polio endgame strategy and beyond.
[Mh] Termos MeSH primário: Erradicação de Doenças
Programas de Imunização
Poliomielite/prevenção & controle
Capacidade de Resposta ante Emergências
[Mh] Termos MeSH secundário: Implementação de Plano de Saúde
História do Século XXI
Seres Humanos
Nigéria/epidemiologia
Poliomielite/epidemiologia
Poliomielite/história
Vigilância da População
Estudos Retrospectivos
Vacinação
Organização Mundial da Saúde
[Pt] Tipo de publicação:HISTORICAL ARTICLE; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1608
[Cu] Atualização por classe:170220
[Lr] Data última revisão:
170220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:160226
[St] Status:MEDLINE
[do] DOI:10.1093/infdis/jiv494


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[PMID]:26479736
[Au] Autor:Pollaris G; Sabbe M
[Ad] Endereço:Department of Emergency Medicine, University Hospitals Leuven, Leuven, Belgium.
[Ti] Título:Reverse triage: more than just another method.
[So] Source:Eur J Emerg Med;23(4):240-247, 2016 Aug.
[Is] ISSN:1473-5695
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Reverse triage is a way to rapidly create inpatient surge capacity by identifying hospitalized patients who do not require major medical assistance for at least 96 h and who only have a small risk for serious complications resulting from early discharge. Electronic searches were conducted in the MEDLINE, TRIP, Cochrane Library, CINAHL, EMBASE, Web of Science, and SCOPUS databases to identify relevant publications published from 2004 to 2014. The reference lists of all relevant articles were screened for additional relevant studies that might have been missed in the primary searches. There will always be small individual differences in the reverse triage decision process, influencing the potential effect on surge capacity, but at most, 10-20% of hospital total bed capacity can be made available within a few hours. Reverse triage could be a response to Emergency Department (ED) crowding, as it gives priority to ED patients with urgent needs over inpatients who can be discharged with little to no health risks. The early discharge of inpatients entails negative consequences. They often return to the ED for further assessment, treatment, and even readmission. When time to a medical referral or bed is less than 4-6 h, 100 additional lives per annum are predicted to be potentially saved. The results of our systematic review identified only a small number of publications addressing reverse triage, indicating that reverse triage and surge capacity are relatively new subjects of research within the medical field. Not all research questions could be fully answered.
[Mh] Termos MeSH primário: Capacidade de Resposta ante Emergências
Triagem
[Mh] Termos MeSH secundário: Aglomeração
Serviço Hospitalar de Emergência
Hospitalização
Seres Humanos
Incidentes com Feridos em Massa
Triagem/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:151020
[St] Status:MEDLINE



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