Abstract:
STUDY OBJECTIVE:Efficient management and allocation of scarce medical resources can improve outcomes for victims of mass casualty events. However, the effectiveness of specific strategies has never been systematically reviewed. We analyze published evidence on strategies to optimize the management and allocation of scarce resources across a wide range of mass casualty event contexts and study designs. METHODS:Our literature search included MEDLINE, Scopus, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Global Health, Web of Science, and the Cochrane Database of Systematic Reviews, from 1990 through late 2011. We also searched the gray literature, using the New York Academy of Medicine's Grey Literature Report and key Web sites. We included both English- and foreign-language articles. We included studies that evaluated strategies used in actual mass casualty events or tested through drills, exercises, or computer simulations. We excluded studies that lacked a comparison group or did not report quantitative outcomes. Data extraction, quality assessment, and strength of evidence ratings were conducted by a single researcher and reviewed by a second; discrepancies were reconciled by the 2 reviewers. Because of heterogeneity in outcome measures, we qualitatively synthesized findings within categories of strategies. RESULTS:From 5,716 potentially relevant citations, 74 studies met inclusion criteria. Strategies included reducing demand for health care services (18 studies), optimizing use of existing resources (50), augmenting existing resources (5), implementing crisis standards of care (5), and multiple categories (4). The evidence was sufficient to form conclusions on 2 strategies, although the strength of evidence was rated as low. First, as a strategy to reduce demand for health care services, points of dispensing can be used to efficiently distribute biological countermeasures after a bioterrorism attack or influenza pandemic, and their organization influences speed of distribution. Second, as a strategy to optimize use of existing resources, commonly used field triage systems do not perform consistently during actual mass casualty events. The number of high-quality studies addressing other strategies was insufficient to support conclusions about their effectiveness because of differences in study context, comparison groups, and outcome measures. Our literature search may have missed key resource management and allocation strategies because of their extreme heterogeneity. Interrater reliability was not assessed for quality assessments or strength of evidence ratings. Publication bias is likely, given the large number of studies reporting positive findings. CONCLUSION:The current evidence base is inadequate to inform providers and policymakers about the most effective strategies for managing or allocating scarce resources during mass casualty events. Consensus on methodological standards that encompass a range of study designs is needed to guide future research and strengthen the evidence base. Evidentiary standards should be developed to promote consensus interpretations of the evidence supporting individual strategies.
journal_name
Ann Emerg Medjournal_title
Annals of emergency medicineauthors
Timbie JW,Ringel JS,Fox DS,Pillemer F,Waxman DA,Moore M,Hansen CK,Knebel AR,Ricciardi R,Kellermann ALdoi
10.1016/j.annemergmed.2013.02.005subject
Has Abstractpub_date
2013-06-01 00:00:00pages
677-689.e101issue
6eissn
0196-0644issn
1097-6760pii
S0196-0644(13)00109-1journal_volume
61pub_type
杂志文章,评审abstract::To define a subset of injured children for whom emergency cervical spine radiography may be unnecessary, we performed a retrospective chart and radiologic review. Two entry methods were used: All injured children, from birth through 16 years, who had received cervical spine radiographs at The Children's Memorial Hospi...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(87)80171-3
更新日期:1987-03-01 00:00:00
abstract::Acute ischemic stroke is the third leading cause of death in the United States and the leading cause of adult disability. The direct and indirect costs of stroke care exceed $51 billion annually. In 1996, the US Food and Drug Administration approved the first treatment for acute ischemic stroke, intravenous tissue pla...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1067/mem.2001.111573
更新日期:2001-02-01 00:00:00
abstract::Increasing numbers of patients with diagnosed HIV infection are presenting to inner-city emergency departments. Unfortunately, there is little information available on the characteristics and emergency clinical problems of HIV-infected patients to guide physicians in patient care and strategies for resource use. Preli...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)82555-7
更新日期:1990-09-01 00:00:00
abstract::A young woman presented with acute abdominal pain, anemia, and a positive pregnancy test. At surgery a large retroperitoneal hematoma secondary to a ruptured right kidney was found. Pathological examination revealed a hematogenic necrosis of a choriocarcinoma of the kidney. The patient tolerated subsequent chemotherap...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(87)80432-8
更新日期:1987-12-01 00:00:00
abstract::Acute asthma exacerbations are common complaints in patients who present to the emergency department. A prospective, double-blinded study was designed to evaluate how frequency of dosing of an inhaled beta-agonist, metaproterenol (Alupent inhalation solution) would affect patient response, length of stay in the ED, an...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章
doi:10.1016/s0196-0644(05)82134-1
更新日期:1990-01-01 00:00:00
abstract::One hundred twenty-five pediatric emergency department patients were studied prospectively to determine whether any findings on the physical examination were predictive of abnormalities seen on chest radiograph. We attempted to find possible correlations between such clinical examination findings, recorded prior to ra...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(86)80374-2
更新日期:1986-07-01 00:00:00
abstract::Traumatic dislocation of the hip joint is relatively uncommon in children. The trauma required to produce a dislocation can vary from minimal to severe, high-energy force. We report a case of posterior hip dislocation in a 9-year-old boy who received relatively minor trauma to his leg but who did not seek medical atte...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(87)80298-6
更新日期:1987-01-01 00:00:00
abstract::Prothrombin complex concentrates are frequently used to rapidly reverse anticoagulation with vitamin K antagonists associated with life-threatening bleeding. We report a patient receiving warfarin who presented to the emergency department with an international normalization ratio greater than 12.8 in cardiac tamponade...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2008.12.027
更新日期:2009-06-01 00:00:00
abstract:STUDY OBJECTIVES:To examine trends in legal handgun purchases from federally licensed dealers and specifically to describe recent changes in age and gender of purchaser and caliber of handguns purchased. METHODS:A cohort study was performed of the adult population of Washington state from 1950 through 1992 using a sta...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(98)70100-3
更新日期:1998-07-01 00:00:00
abstract::Patients frequently arrive in the emergency department under the influence of alcohol after exposure to extreme conditions of heat or cold. While ethanol ingestion and ambient heat are recognized to have vasodilatory action, previous studies of their interactive effect are limited and guidelines for patient care are v...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章
doi:10.1016/s0196-0644(84)80282-6
更新日期:1984-08-01 00:00:00
abstract:STUDY OBJECTIVE:Measurement of interval data is important in the accurate recording of events that occur in an emergency medical services system. Measurement of intervals should be a simple task. However, when two separate clocks are needed to record the beginning and end of an interval, accurate measurement may be dif...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(97)70222-1
更新日期:1997-04-01 00:00:00
abstract:STUDY OBJECTIVE:Factors associated with intraosseous (IO) catheterization are not well described. Our objective is to identify factors associated with the attempt and timing of IO catheterization in a pediatric emergency department (ED) resuscitation setting. METHODS:We completed a video-based, case-control study (1:3...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2019.09.005
更新日期:2020-06-01 00:00:00
abstract:STUDY OBJECTIVE:Newer combination HIV antigen-antibody tests allow detection of HIV sooner after infection than previous antibody-only immunoassays because, in addition to HIV-1 and -2 antibodies, they detect the HIV-1 p24 antigen, which appears before antibodies develop. We determine the yield of screening with HIV an...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,多中心研究
doi:10.1016/j.annemergmed.2017.11.027
更新日期:2018-07-01 00:00:00
abstract::TSS is a recently described acute febrile illness characterized by hypotension, rash, desquamation, and multisystemic involvement. While most common in menstruating women, TSS also occurs in men and non-menstruating women. It is now known that the disease is caused by one or more toxins produced by the S aureus organi...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/s0196-0644(88)80121-5
更新日期:1988-03-01 00:00:00
abstract::The American Board of Emergency Medicine gathers extensive background information on emergency medicine residents and the programs in which they train. We present the third annual report on the status of US emergency medicine residency programs. [American Board of Emergency Medicine. Report of the Task Force on Reside...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1067/mem.2000.106388
更新日期:2000-05-01 00:00:00
abstract:STUDY OBJECTIVES:To develop a practical procedure for producing a nomogram describing the relationship between the osmolality gap and serum ethanol concentrations that is appropriate for the formulas and analytical methodologies in use at any laboratory. DESIGN:Retrospective review of serum sodium, glucose, urea nitro...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)81899-2
更新日期:1992-11-01 00:00:00
abstract::Since September 11, 2001, concern about potential terrorist attacks has increased in the United States. To reduce morbidity and mortality from outbreaks of illness from the intentional release of chemical agents, we examine data from the Toxic Exposure Surveillance System (TESS). TESS, a national system for timely col...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2005.09.016
更新日期:2006-02-01 00:00:00
abstract:STUDY OBJECTIVE:In patients presenting to the emergency department (ED) with an initial diagnostic impression of noncardiac chest pain, we determine the 30-day incidence of adverse cardiac events and characteristics associated with those events. METHODS:The multicenter, prospectively collected Internet Tracking Regist...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2004.03.021
更新日期:2004-12-01 00:00:00
abstract:STUDY OBJECTIVE:We evaluate the effectiveness and safety of an outpatient clinical care pathway for the initial treatment of acute proximal lower-extremity deep venous thrombosis (DVT) with low molecular weight heparin (LMWH) managed by the emergency department of 2 affiliated community hospitals. METHODS:This observa...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章
doi:10.1067/mem.2001.113703
更新日期:2001-03-01 00:00:00
abstract:STUDY OBJECTIVE:We compare utilization, price per visit, and the types of care delivered across freestanding emergency departments (EDs), hospital-based EDs, and urgent care centers in Texas. METHODS:We analyzed insurance claims processed by Blue Cross Blue Shield of Texas from 2012 to 2015 for patient visits to frees...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2016.12.006
更新日期:2017-12-01 00:00:00
abstract:STUDY OBJECTIVE:The accurate diagnosis of influenza remains a diagnostic dilemma. We examine the performance of various strategies for diagnosing influenza infection in an unselected sample of adults during influenza season. METHODS:Consecutive adults presenting to a university emergency department or urgent care clin...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2005.05.020
更新日期:2005-11-01 00:00:00
abstract:STUDY OBJECTIVE:To determine the effect of the institution of out-of-hospital albuterol treatments for acute asthma on out-of-hospital time intervals emergency department (ED) morbidity. DESIGN:Retrospective chart and ambulance run report review. PARTICIPANTS:All patients who presented with a diagnosis of asthma on t...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章
doi:10.1016/s0196-0644(94)70205-5
更新日期:1994-11-01 00:00:00
abstract:STUDY OBJECTIVE:The Utstein guidelines recommend that emergency medical services (EMS)-witnessed cardiac arrests be considered separately from other out-of-hospital cardiac arrest cases. The objective of this study was to assess EMS-witnessed cardiac arrest and to determine predictors of survival in this group. METHOD...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/S0196-0644(00)70133-8
更新日期:2000-02-01 00:00:00
abstract:STUDY OBJECTIVE:We determine the sensitivity, specificity, and clinical utility of the Gram's stain of peritoneal fluid in patients undergoing paracentesis. METHODS:We conducted a retrospective chart review of all peritoneal fluid analyses in a 3-year period in an urban 3-hospital system. Peritoneal dialysis and diagn...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2008.12.020
更新日期:2009-07-01 00:00:00
abstract:STUDY OBJECTIVES:The objectives of this study were to assess the efficacy of parenteral magnesium sulfate (MgSO4), digoxin, and combined MgSO4-digoxin therapies in acutely lowering ventricular rates in patients with newly recognized atrial fibrillation. DESIGN:A randomized, double-blinded, placebo-controlled clinical ...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0196-0644(94)70163-6
更新日期:1994-07-01 00:00:00
abstract:STUDY OBJECTIVE:Previous studies have suggested that the initial emergency department (ED) lactate concentration may be an important prognostic indicator for inhospital mortality from acute drug poisoning. We conduct this cohort study to formally validate the prognostic utility of the initial lactate concentration in a...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2018.02.022
更新日期:2018-07-01 00:00:00
abstract::Neurologic injury is a significant source of morbidity and mortality in pediatric patients. In order to clarify the factors influencing outcome in pediatric patients with severe head injury, we studied 200 consecutive patients with Glasgow Coma Scale (GCS) scores of 8 or less. The following data were collected: age, G...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(85)81025-8
更新日期:1985-12-01 00:00:00
abstract::We developed a cardiopulmonary resuscitation (CPR) message that can be given via telephone by emergency dispatchers directly to an individual reporting a cardiac arrest. The message was developed and evaluated on the basis of empirical observation of CPR performance of 203 community volunteers during simulated cardiac...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(84)80730-1
更新日期:1984-09-01 00:00:00
abstract:STUDY OBJECTIVE:Pleuritic chest pain is a common presenting complaint in the emergency department (ED) and a symptom of pulmonary embolism. Patients with pleuritic chest pain would benefit from a simple and rapid way of screening for pulmonary embolism. The aim of this study is to assess the utility of Simplify D-dimer...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章
doi:10.1016/j.annemergmed.2005.03.018
更新日期:2005-10-01 00:00:00
abstract::Acoustic otoscopy detects middle ear pathology by measuring the ability of the tympanic membrane to reflect sound. Fluid or thickening of the tympanic membrane increases sound reflection. We conducted a study to compare acoustic otoscopy with pneumatic otoscopy in identifying middle ear pathology in 80 children (160 e...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章
doi:10.1016/s0196-0644(89)80578-5
更新日期:1989-04-01 00:00:00