Because neuromuscular abnormalities seem to develop earlier than previously reported, electroneuromyography should be used more frequently as a diagnostic test.
Reviewed by Nancy M. Gillium PURPOSE: To develop a triage protocol to ensure that there is equitable and efficient use of critical resources such as ventilators and antiviral medications, in a time of an influenza pandemic in humans. METHODS: An expert panel with critical care experience was brought together to use best practice evidence in developing a triage protocol for prioritizing access to critical care resources. The group consisted of specialized clinicians in infectious disease, medical ethics, military medicine, triage and disaster management. The group began an in-depth review of research using medical literature through MEDLINE from 1966 through to 2004, which included disaster literature, military protocols and published pandemic plans. A final report was distributed to 150 critical care leaders for comments. The responses were incorporated into a document for use in critical care triage protocols. RESULTS: There were many triage protocols identified for trauma, chemical, biological and nuclear events, but the research failed to identify any general research protocols specifically for critical care. The working group began to develop a critical care triage protocol with features from other protocols that appeared useful, such as use of a color-coded triage tool, inclusion and exclusion criteria, and minimum qualifications for survival. It was determined that the most appropriate scoring system was the Sequential Organ Failure Assessment (SOFA) because it covers a wide variety of conditions requiring critical care. The protocol that was developed has four main components: (1) inclusion criteria; (2) exclusion criteria; (3) minimum qualifications for survival; and (4) prioritization. It was designed to function as a guideline for decision-making during the initial time period of an influenza pandemic if the critical care system was overwhelmed. The goal of the protocol was to maximize the treatment benefits for the largest number of patients pre-Reviewed by James Cotton PURPOSE: To determine the state of medical preparedness and emergency care, as well as to examine the charac-Nursing Insight http://wadem.medicine.wisc.edu Vol. 3, No. 2 Irvin CB, Atas JG Prehospital Disast Med 2007;22(3):220-223 Reviewed by Ronald A. Langlotz PURPOSE: The purpose of this paper was to identify acceptable alternatives to emergency department visits by people with non-emergent medical conditions post-disaster and to describe operations of a Hurricane Katrina evacuation center established in Michigan to address the critical needs of evacuees.METHODS: This is a brief, non-research based, descriptive report. During a five week period, data were recorded on non-urgent evacuees as a result of Hurricane Katrina who required medical screening, referrals and/or prescriptions. The numbers of evacuees coming to the center and those receiving medical evaulations were tracked using a running tally system. RESULTS:Seven hundred sixteen individuals presented to the Evacuee Center. Of that number, 631 (88%) people
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