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Surgeons Advised To Give Up On Worst Injured In Case Of Nuclear Detonation

Researchers concluded that surgical triage following a nuclear detonation should treat moderately injured patients first, then severely and mildly injured people, because of the limited medical personnel and material resources that would be available.

The model of time and resource-based triage (MORTT) tests different hospital-based triage approaches in the first 48 hours after a nuclear detonation of an improvised nuclear device. It’s not a tool in and of itself, but it examines the effect of various prioritizations and focuses primarily on the surgical needs of trauma victims.

The report appears in Disaster Medicine and Public Health Preparedness. The entire issue, devoted to nuclear preparedness, is open access.

According to the study, the focus of triage in a mass casualty incident changes from the needs of an individual victim to the goal of saving the most lives possible.

MORTT found that in poorly resourced settings, prioritizing victims with moderate life-threatening injuries over victims with severe life-threatening injuries saves more lives and reduces demand for intensive care, which is likely to outstrip local and national capacity, the authors found. More lives would be saved if victims with combined injury (trauma plus radiation more than 2 Gy) are prioritized after nonirradiated victims with similar trauma.

Also, the authors wrote, as the victim loading increases up to 10 times the available personnel or resources, triage by moderate-severe-mild saves three times as many people than other systems. This could translate into thousands of lives saved.

“The results differ significantly from conventional triage schemes, in which the salvageable victim most likely to die next is prioritized, but these results are logical in the aftermath of a nuclear detonation for multiple reasons,” the authors wrote. “First, severely injured people have a lower probability of survival even if treated. Second, severely injured people require more resources. Finally, medical resources may be unavailable to stabilize moderately injured victims while severely injured people are treated, and therefore people with moderate injuries will progress to a more severe category.”

ACP Hospitalist has previously covered emergency response issues, surge response and how hospitalists responded after the Haitian earthquake.

*This blog post was originally published at ACP Hospitalist*


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