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Featured Articles
Predictive models and severity measurements in the ICU
The fundamental role of severity measurements in the intensive care unit (ICU) is the comparative audit. Assessing the risk of each patient
Endoscopic imaging of the small intestine
Historically, endoscopic investigation of the small intestine was limited due to inferior or invasive techniques. However, the emergence of video capsule endoscopy and device-assisted enteroscopy has revolutionised the management of small bowel diseases over the last ten years. These new endoscopic techniques are complemented by advances in radiology, particularly small bowel enterography. Future goals for development include steerable capsules and devices that improve ease and depth of insertion of the enteroscope to improve diagnosis and therapy of small bowel disease.
by Dr Christina A. Tennyson and Dr Carol E. Semrad
The small intestine constitutes the largest surface area of the gastrointestinal tract. Until recently, endoscopic exploration has been limited to its most proximal and distal ends because of its length (3-6 meters in adults) and coiled anatomy in the abdominal cavity. This has resulted in delayed diagnosis of small bowel tumours and limited options when having to treat small bowel bleeding, typically invasive intra-operative enteroscopy. Over the last ten years, however, the emergence of new endoscopic technologies, such as video capsule endoscopy and device-assisted enteroscopy, has revolutionised diagnosing and managing small bowel diseases, e.g. obscure bleeding, Crohn
Book review: Cardiovascular Clinical Trials: Putting the Evidence into Practice
Edited by Marcus Flather, Deepak Bhatt and Tobias Geisler
BMJ Books, November 2012, 408 pp,
How the medical imaging and healthcare IT industries are contributing to a safer, more sustainable healthcare system
Medical imaging is a highly innovative, advanced technology serving the patient and contributing to increasing life expectancy while potentially helping to control healthcare costs. Diagnosis is the foundation of medicine and new diagnostics
Triage in mass casualty situations
More often than not major incidents and disasters result in a mass casualty situation, which places health services under added pressure. To deal with such situation it is imperative to have a Major Incident Plan both for the pre-hospital and hospital sector. The ability ‘do the most for the most’ is central to dealing with such incidents. Triage is the universally accepted tool that allows health professionals to achieve this goal in a mass casualty situation.
by Dr Wayne Smith and Prof. Lee Wallis
The incidence of major incidents and disasters has been noted to be on the increase over the last couple of decades. A recent Oxfam report highlights a four-fold increase in the occurrence of weather related disasters alone, in the last two decades [1]. Moreover, increasing urbanisation across the globe seems to contribute to an increase of major incidents [2].
Although the literature may vary on what is meant by the terms ‘major incident’ and ‘disaster’, there is no doubt as to the many challenges these pose to the delivery of healthcare.
The World Health Organization (WHO) defines a disaster as an event of such a magnitude that the normal conditions of existence are so badly disrupted and the subsequent level of suffering is of such a nature that the community is unable to respond to it.
While a disaster, by definition, overwhelms the response capacity of the community, a major incident occurs more commonly. It is defined [3] as a situation which places significant demand on the medical resources regarding the number, severity, or type of live casualties, or the location of the incident so as to warrant the response of extraordinary resources.
Many of the definitions describe an imbalance between the number of casualties and the number of resources available to treat them. Recent disasters such as the Haiti earthquake and the tsunami in Japan bear testament to the potential extent of this imbalance.
It is this imbalance – between the large number of casualties and the limited medical resources which may be available to treat them during the acute phase – that calls for extraordinary response. This could be in the form of adequate planning, testing of the plans, and education of all relevant staff that may need to respond to a major incident. Triage is one of the tools at the forefront of dealing with this large influx of casualties.
Triage
Triage is derived from the French trier, meaning ‘to sort or sieve’. In medicine, this refers to the process of sorting patients according to priority as to establish an order for treatment and evacuation. Triage can take many different forms, and operates at a number of different levels. However, the aim is to give the right patient the right care at the right time in the right place. In certain circumstances, this may also mean ‘doing the most for the most’.
Although originally developed for use in military conflicts, triage is equally applicable to civilian disasters and day-to-day emergency settings. Accurate triage allows correct identification of those patients who need the most urgent intervention, as well as identifying quickly and safely those who can wait longer for treatment. The latter is the majority at a typical major incident. Triage may also be used to identify those patients who are so severely injured that they will not survive, or whose treatment will tie up resources that would be best used with other patients.
Triage is dynamic: as the patient
A price to pay for health
In an era of austerity, which many believe will continue long into the future, the cost of healthcare is a serious concern for national governments, healthcare providers, industry and the general public. Not only that, but the demand for healthcare will also increase in the coming decades, due to growing health needs, demographic changes and expectations. Fortunately, technological advances are continuously being made.
If we are to believe the statistics, life expectancy in Europe1 is on the rise:
Welcome brave new world of healthcare?
Looking back at 2012, it seems that healthcare, public, private and industry, are still reeling from the consequences of the global economic crisis.
In addition, men and women worldwide have gained slightly more than ten years of life expectancy overall, but they spend more years living with injury and illness according to the recently published Global Burden of Disease Study 2010. This study is the largest ever systematic effort to describe the global distribution and causes of a wide array of major diseases, injuries and health risk factors.
The results show that infectious diseases, maternal and child illness, and malnutrition now cause fewer deaths and less illness than they did twenty years ago. As a result, fewer children are dying every year, but more young and middle-aged adults are dying and suffering from disease and injury, as non-communicable diseases, such as cancer and heart disease, become the dominant causes of death and disability worldwide. Armed with this knowledge, how are we to proceed considering the financial restraints but also technological advances in mind?
Hence, on the cusp of 2013, this study certainly meets the need for complete, valid and reliable information on which the global health community can base its research and policies.
That is one side of the precarious healthcare coin.
The other relates to responsibility. As populations become more technologically savvy, they have more access to healthcare information. This, in turn, could mean a shift in responsibility