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المؤلفون: Jean-Francois Légaré, John Colin Boyd, Ansar Hassan, Sohrab Lutchmedial, Jafna L. Cox, Alexandra M. Yip
المصدر: Canadian Journal of Cardiology. 34:202-208
مصطلحات موضوعية: Male, Cardiac Catheterization, medicine.medical_specialty, medicine.medical_treatment, Shock, Cardiogenic, MEDLINE, Regional Medical Programs, 030204 cardiovascular system & hematology, Health Services Accessibility, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Health care, medicine, Humans, Hospital Mortality, 030212 general & internal medicine, Acute Coronary Syndrome, Coronary Artery Bypass, Aged, Cardiac catheterization, business.industry, Incidence, Cardiogenic shock, Mortality rate, Public health, Incidence (epidemiology), medicine.disease, Nova Scotia, Transportation of Patients, Emergency medicine, Female, Cardiology and Cardiovascular Medicine, business, Biomedical sciences
الوصف: Invasive cardiac care is the preferred method of treatment for patients with acute coronary syndromes (ACS) complicated by cardiogenic shock (CS). In Nova Scotia, invasive cardiac care is only available in Halifax at the Queen Elizabeth II Health Sciences Centre (QEII-HSC).All consecutive patients diagnosed with ACS and CS in 2009-2013 in Nova Scotia were included. Data were obtained from the clinical database of Cardiovascular Health Nova Scotia. The primary outcome was in-hospital mortality.A total of 418 patients with ACS and CS were admitted to the hospital. Access to invasive care was limited to 309 (73.9%) of these patients. For those who presented elsewhere in the province, 64.2% were transferred to the QEII-HSC. The mortality rate among the 309 patients with access to invasive care was significantly lower than that among the 109 patients who did not have access (41.7% vs 83.5%; P 0.0001). Unadjusted mortality was lowest among patients undergoing primary percutaneous coronary intervention (33.1%). After adjustment for clinical differences, access to cardiac catheterization remained an independent predictor of survival (odds ratio, 0.2; 95% confidence interval, 0.11-0.36). Heat map analysis revealed that access was lowest in regions furthest from Halifax.ACS complicated by CS has a high mortality rate. We demonstrate that access to health care centres offering cardiac catheterization is independently associated with survival, and public health initiatives that improve access should be considered. Patients presenting furthest from Halifax were the least likely to be transferred, suggesting that geography remains an important barrier to livesaving care.
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المؤلفون: Clint Leonard, Nicholas H. Carter, Lisa Rae
المصدر: Journal of burn careresearch : official publication of the American Burn Association. 39(2)
مصطلحات موضوعية: Adult, Male, Patient Transfer, medicine.medical_specialty, Resuscitation, Referral, Adolescent, medicine.medical_treatment, Burn Units, Regional Medical Programs, 030207 dermatology & venereal diseases, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Medicine, Intubation, Humans, Hospital Mortality, Child, Patient transfer, Referral and Consultation, Retrospective Studies, business.industry, Mortality rate, Rehabilitation, 030208 emergency & critical care medicine, Burn center, Retrospective cohort study, Emergency department, Community-Institutional Relations, Hospitalization, Transportation of Patients, Emergency medicine, Emergency Medicine, Surgery, Female, business, Burns
الوصف: The objectives of this study were to identify trends in preburn center care, assess needs for outreach and education efforts, and evaluate resource utilization with regard to referral criteria. We hypothesized that many transferred patients were discharged home after brief hospitalizations and without need for operation. Retrospective chart review was performed for all adult and pediatric transfers to our regional burn center from July 2012 to July 2014. Details of initial management including TBSA estimation, fluid resuscitation, and intubation status were recorded. Mode of transport, burn center length of stay, need for operation, and in-hospital mortality were analyzed. In two years, our burn center received 1004 referrals from other hospitals including 713 inpatient transfers. Within this group, 621 were included in the study. Among transferred patients, 476 (77%) had burns less than 10% TBSA, 69 (11%) had burns between 10-20% TBSA, and 76 (12%) had burns greater than 20% TBSA. Referring providers did not document TBSA for 261 (42%) of patients. Among patients with less than 10% TBSA burns, 196 (41%) received fluid boluses. Among patients with TBSA < 10%, 196 (41%) were sent home from the emergency department or discharged within 24 hours, and an additional 144 (30%) were discharged within 48 hours. Overall, 187 (30%) patients required an operation. In-hospital mortality rates were 1.5% for patients who arrived by ground transport, 14.9% for rotor wing transport, and 18.2% for fixed wing transport. Future education efforts should emphasize the importance of calculating TBSA to guide need for fluid resuscitation and restricting fluid boluses to patients that are hypotensive. Clarifying the American Burn Association burn center referral criteria to distinguish between immediate transfer vs outpatient referral may improve patient care and resource utilization.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::3f97d2cb50d06e902aa9be49b355063f
https://pubmed.ncbi.nlm.nih.gov/28570315 -
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المؤلفون: Shahriar Shahrokhi, Marc G. Jeschke, Russell D. MacDonald, Sofie Schlagintweit, Mahvareh Ahghari, Ryan E Austin
المصدر: Journal of burn careresearch : official publication of the American Burn Association. 39(2)
مصطلحات موضوعية: Adult, Male, Patient Transfer, medicine.medical_specialty, Burn injury, Cost estimate, Adolescent, Burn Units, Poison control, Regional Medical Programs, Occupational safety and health, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Transfer (computing), Injury prevention, Medicine, Humans, 030212 general & internal medicine, Aged, Retrospective Studies, Aged, 80 and over, Ontario, business.industry, Rehabilitation, 030208 emergency & critical care medicine, Retrospective cohort study, Burn center, Middle Aged, Surgery, Hospitalization, Transportation of Patients, Emergency medicine, Emergency Medicine, Costs and Cost Analysis, Female, business, Burns
الوصف: The transport of thermally injured patients can involve significant costs; however, not all thermally injured patients necessitate transfer to a burn center. The purpose of this study was to review transfers to an American Burn Association-verified regional burn center to determine whether the transfers were necessary and the cost associated with unnecessary transfers. A retrospective chart review identified 707 patients transferred to an American Burn Association-verified burn center with an acute burn injury during a 7-year period. For the purposes of this study, "unnecessary transfer" was defined as any patient admitted fewer than 7 days who did not undergo operative intervention. Transfer cost estimates were based on records from regional land paramedic and land and air medical transport services. In total, 27.3% of transfers were potentially "unnecessary transfers," with an associated cost of approximately $227,396.93 (18.9% of total transfer costs in study). Average unnecessary transfer cost varied by method of transport: land ambulance (n = 130) $285.72, helicopter (n = 27) $4,136.34, and airplane (n = 15) $4,908.67. The transfer of thermally injured patients is associated with significant cost. Unnecessary transfers represent an inefficient use of a limited resource in an already strained healthcare system. The findings of this study suggest that further initiatives should be explored to ensure the appropriate transfer of thermally injured patients.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::1c9a991f8ebc268428f4a67836b239da
https://pubmed.ncbi.nlm.nih.gov/28570313 -
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المؤلفون: Lani Clark, Daniel W. Spaite, Vatsal Chikani, Ben Bobrow, Terry Mullins, Arthur B. Sanders, Tyler F. Vadeboncoeur
المصدر: Resuscitation. 79:61-66
مصطلحات موضوعية: Male, Emergency Medical Services, Resuscitation, medicine.medical_specialty, Time Factors, Population, Regional Medical Programs, Emergency Nursing, Return of spontaneous circulation, Intensive care, Emergency medical services, Humans, Medicine, Prospective Studies, Intensive care medicine, Prospective cohort study, education, Survival rate, Aged, education.field_of_study, business.industry, Arizona, medicine.disease, Heart Arrest, Survival Rate, Logistic Models, Transportation of Patients, Ventricular fibrillation, Emergency medicine, Emergency Medicine, Female, Cardiology and Cardiovascular Medicine, business
الوصف: Summary Objective There is growing evidence that therapeutic hypothermia and other post-resuscitation care improves outcomes in out-of-hospital cardiac arrest (OHCA). Thus, transporting patients with return of spontaneous circulation (ROSC) to specialized facilities may increase survival rates. However, it is unknown whether prolonging transport to reach a designated facility would be detrimental. Methods Data from OHCA patients treated in EMS systems that cover approximately 70% of Arizona's population were evaluated (October 2004–December 2006). We analyzed the association between transport interval (depart scene to ED arrival) and survival to hospital discharge in adult, non-traumatic OHCA patients and in the subgroup who achieved ROSC and remained comatose. Results 1846 OHCA occurred prior to EMS arrival. Complete transport interval data were available for 1177 (63.8%) patients (study group). 253 patients (21.5%) achieved ROSC and remained comatose making them theoretically eligible for transport to specialized care. Overall, 70 patients (5.9%) survived and 43 (17.0%) comatose ROSC patients survived. Mean transport interval for the study group was 6.9 min (95% CI: 6.7, 7.1). Logistic regression revealed factors that were independently associated with survival: witnessed arrest, bystander CPR, method of CPR, initial rhythm of ventricular fibrillation, and shorter EMS response time interval. There was no significant association between transport interval and outcome in either the overall study group (OR = 1.2; 0.77, 1.8) or in the comatose, ROSC subgroup (OR 0.94; 0.51, 1.8). Conclusion Survival was not significantly impacted by transport interval. This suggests that a modest increase in transport interval from bypassing the closest hospital en route to specialized care is safe and warrants further investigation.
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المؤلفون: Hilary Whyte, John A.F. Zupancic, Robin K. Whyte, Robin L. Walker, Margaret Pendray, Joanna Sale, David Brabyn, Shoo K. Lee
المصدر: Medical Care. 40:705-716
مصطلحات موضوعية: Male, Research design, Canada, medicine.medical_specialty, Cost effectiveness, Cost-Benefit Analysis, Population, Regional Medical Programs, Risk Assessment, Chart, Humans, Medicine, Operations management, Prospective Studies, education, Decision Making, Organizational, Patient Care Team, education.field_of_study, business.industry, Infant, Newborn, Public Health, Environmental and Occupational Health, Infant, Gestational age, medicine.disease, Outcome and Process Assessment, Health Care, Transportation of Patients, Emergency medicine, Intensive Care, Neonatal, Small for gestational age, Female, Observational study, Apgar score, Health Services Research, business
الوصف: OBJECTIVE. To compare cost-effectiveness of three types of infant transport models (Emergency Medical Technicians [EMT], Registered Nurses [RN], or Combined Teams [CT] of RNs and Respiratory Therapists) and to derive a decision model to guide choice of a transport system. RESEARCH DESIGN. A prospective, multi-center, observational study was conducted to compare infant physiologic status before and after transport. Cost-effectiveness analysis from the perspective of the third-party payer, sensitivity analysis and threshold analysis were performed. SUBJECTS. All (n = 1931) out born infants with complete transport data admitted to 11 regional tertiary-level Canadian NICUs from January 1996 to October 1997. MEASURES. Change in Transport Risk Index of Physiologic Stability (TRIPS) Score before and after transport, transport costs. RESULTS. Change in TRIPS was predicted by gestational age at transport, transport duration, and pretransport TRIPS score, but not the type (EMT, RN, CT) of transport team, mode (air/ground) or direction (forward/retrograde) of transport, presence of a physician, and other baseline population risks (sex, small for gestational age, antenatal corticosteroid treatment, Apgar score). The RN model is least costly under most assumptions. At high transport volumes (>2760 transports per year) and long average transport times (>6.8 h per transport), the EMT model was less costly. Cost drivers of transport were volume of transport, relative wages of transport personnel, and percent of waiting time dedicated to infant transport. CONCLUSIONS. A deterministic decision-analytic model can be used to model transport cost-effectiveness and derive a thresold analytic chart for identifying the lest costyl transport model.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0c7c7f0f4fdc3ae7932608def6d62255
https://doi.org/10.1097/00005650-200208000-00010 -
6
المصدر: The journal of trauma and acute care surgery. 73(3)
مصطلحات موضوعية: Male, medicine.medical_specialty, Databases, Factual, Regional Medical Programs, Critical Care and Intensive Care Medicine, Health Services Accessibility, Health administration, Cohort Studies, Injury Severity Score, Trauma Centers, Medicine, Humans, Program Development, System development, Geography, business.industry, Trauma center, Triage, Organizational Innovation, Patient Discharge, Geographic distribution, Transportation of Patients, Emergency medicine, Florida, Wounds and Injuries, Surgery, Female, Catchment area, business, Needs Assessment, Cohort study, Program Evaluation, Total Quality Management
الوصف: Background Despite decades of trauma system development, many severely injured patients fail to reach a trauma center for definitive care. The purpose of this study was to define the regions served by Florida's designated trauma centers and define the geographic distribution of severely injured patients who do not access the state's trauma system. Methods Severely injured patients discharged from Florida hospitals were identified using the 2009 Florida Agency for Health Care Administration database. The home zip codes of patients discharged from trauma and nontrauma center hospitals were used as a surrogate for injury location and plotted on a map. A radial distance containing 75% of trauma center discharges defined trauma center catchment area. Results Only 52% of severely injured patients were discharged from trauma centers. The catchment areas varied from 204 square miles to 12,682 square miles and together encompassed 92% state's area. Although 93% of patients lived within a trauma center catchment area, the proportion treated at a trauma center in each catchment area varied from 13% to 58%. Mapping of patient residences identified regions of limited access to the trauma system despite proximity to trauma centers. Conclusions The distribution of severely injured patients who do not reach trauma centers presents an opportunity for trauma system improvement. Those in proximity to trauma centers may benefit from improved and secondary triage guidelines and interfacility transfer agreements, whereas those distant from trauma centers may suggest a need for additional trauma system resources. Level of evidence Epidemiologic study, level III.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a457b616cf12dcb45920709bf15eab84
https://pubmed.ncbi.nlm.nih.gov/22710789 -
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المؤلفون: Mark A. Tannenbaum, Sue Brown, Anil Poulose, Sue Duval, David M. Larson, Lindsay G Smith, Liberato A. Iannone, Timothy D. Henry, Magdi Ghali
المصدر: The American journal of cardiology. 109(11)
مصطلحات موضوعية: Male, medicine.medical_specialty, Ticlopidine, Time Factors, Databases, Factual, medicine.medical_treatment, Minnesota, Adrenergic beta-Antagonists, Myocardial Infarction, Regional Medical Programs, Single Center, Clinical Protocols, Fibrinolytic Agents, St elevation myocardial infarction, Internal medicine, medicine, Humans, In patient, cardiovascular diseases, Myocardial infarction, Hospital Mortality, Prospective Studies, Angioplasty, Balloon, Coronary, Aged, Aspirin, business.industry, Heparin, Percutaneous coronary intervention, Middle Aged, medicine.disease, Iowa, Clopidogrel, surgical procedures, operative, Outcome and Process Assessment, Health Care, Transportation of Patients, Tissue Plasminogen Activator, Conventional PCI, Cardiology, Geographic regions, Tenecteplase, Female, Cardiology and Cardiovascular Medicine, business, Platelet Aggregation Inhibitors
الوصف: Primary percutaneous coronary intervention (PCI) is the preferred reperfusion method in patients with ST-elevation myocardial infarction (STEMI) if it can be performed in a timely manner in high-volume centers. Regional STEMI networks improve timely access to PCI but are frequently criticized for being single center. To determine if results of regional STEMI systems could be replicated and achieve similar outcomes in 2 separate geographic regions, we examined the prospective databases of 2 large regional STEMI networks that use identical standardized protocols and integrated transfer systems. The Minneapolis Heart Institute (MHI) database included 2,266 patients with STEMI from 31 hospitals (498 at the PCI hospital, 1,033 transferred from 11 hospitals60 miles away, and 735 transferred from 19 hospitals 60 to 210 miles away). The Iowa Heart Center (IHC) database included 1,206 patients with STEMI from 24 hospitals (710 at the PCI hospital, 266 transferred from 10 hospitals60 miles away, and 230 transferred from 13 hospitals 60 to 120 miles away). Median total door-to-balloon times for the PCI hospital, zone 1, and zone 2 patients were 64, 95, and 123 minutes for the MHI and 59, 102, and 136 for the IHC (p0.05 for each comparison between MHI and IHC). Overall in-hospital, 30-day, and 1-year mortalities was 4.8%, 5.4%, and 8.0% respectively (p = NS for each comparison between MHI and IHC). In conclusion, the use of identical protocols in 2 large regional STEMI systems in geographically separate locations produced nearly identical outcomes, adding to evidence that regional STEMI centers expand timely access to PCI.
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المؤلفون: Dorothe Ahlersmann, Karsten Möller, Georg von Knobelsdorff, Karl Heinrich Scholz, Friederike K. Keating, Holger Duwald, Reinhard Hilgers, Rolf Nitsche, Berthold Volger
المصدر: The American journal of cardiology. 101(1)
مصطلحات موضوعية: Male, medicine.medical_specialty, Emergency Medical Services, Time Factors, medicine.medical_treatment, Myocardial Infarction, 030204 cardiovascular system & hematology, Regional Medical Programs, Balloon, Revascularization, Community Networks, Feedback, 03 medical and health sciences, Electrocardiography, 0302 clinical medicine, Internal medicine, Angioplasty, Germany, medicine, Humans, Telemetry, Myocardial infarction, Prospective Studies, Angioplasty, Balloon, Coronary, Aged, medicine.diagnostic_test, business.industry, ST elevation, Percutaneous coronary intervention, 030208 emergency & critical care medicine, Middle Aged, medicine.disease, Hospitals, 3. Good health, Surgery, Transportation of Patients, Emergency medicine, Cardiology, Door-to-balloon, Female, Cardiology and Cardiovascular Medicine, business, Emergency Service, Hospital
الوصف: For many patients with ST-segment elevation myocardial infarctions (STEMIs), the time from presentation to percutaneous coronary intervention exceeds established goals. This study was conducted to examine the effects of formalized data assessment and systematic feedback on treatment times. All patients with STEMIs treated with percutaneous coronary intervention in a semi-rural 3-hospital network from January 1, 2006, to December 31, 2006, were prospectively analyzed (n = 114). Patients presenting during the first 3-month period (January 1, 2006, to March 31, 2006) were included as the reference group (n = 33). Time points from initial contact with the medical system to revascularization were assessed, analyzed, and presented in an interactive session to hospital and emergency services staff members. Data from patients with STEMIs presenting during the next 3 quarters were presented in the same manner (n = 28, 25, and 28). The median contact-to-balloon time was 113 minutes in the reference quarter, decreasing to 83, 66, and 74 minutes in the intervention groups (p0.0001), whereas the median door-to-balloon time decreased from 54 minutes in the reference group to 35, 31, and 26 minutes in the intervention groups (p0.0001). The proportion of patients with contact-to-balloon times90 minutes increased from 21% to 79% (p0.0001). There were significant reductions in the durations of initial treatment on location and in the emergency room and in puncture-to-balloon-time in the catheterization laboratory, and more patients were transported directly to the catheterization laboratory, bypassing the emergency room (from 23% in the reference quarter to 76% in the last intervention quarter, p0.0001). In conclusion, formalized data feedback leads to marked reduction in revascularization times in patients with STEMIs.
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المؤلفون: T, Brenner, M, Bernhard, C, Hainer, H, Winkler, R, Schmidt, J, Berentelg, B, Kuhnert-Frey, H, Krauss, E, Giannitsis, A, Gries
المصدر: Der Anaesthesist. 56(3)
مصطلحات موضوعية: Aged, 80 and over, Male, Emergency Medical Services, Anticoagulants, Blood Pressure, Coronary Disease, Guidelines as Topic, Middle Aged, Regional Medical Programs, Electrocardiography, Transportation of Patients, Germany, Acute Disease, Humans, Female, Oximetry, Aged
الوصف: The acute coronary syndrome (ACS) with 16% is one of the most common indication for emergency missions. Care of ACS patients in the Heidelberg emergency service region has been carried out since the beginning of 2005 following an interdisciplinary developed concept based on the current guidelines of the German Society for Cardiology (DGK), the American College of Cardiology (ACC), the American Heart Association (AHA), the European Society of Cardiology (ESC) and the European Resuscitation Council (ERC).Evaluation of the emergency diagnostic and therapeutic measures for the diagnosis of ACS before and after the introduction of the ACS care concept, was carried out retrospectively for the years 2004 (group 1) and 2005 (group 2) by electronic data processing of the records stored in the emergency medical services documentaion system (NADOK).In the years 2004 before (group 1, n=633) and 2005 after (group 2, n=628) introduction of the ACS care concept, there was a comparable basic diagnostic consisting of a 3-lead electrocardiogram (ECG; 95 versus 97%), manual blood pressure measurement (93 versus 95%) and pulse oxymetry (94 versus 91%) as well as a comparable proportion of patients who received a peripheral vene access (99 versus 100%). There were no significant differences between the two groups. However, after the introduction of the ACS concept, the 12-lead ECG was used significantly more often (49 versus 71%, p=0.0001). Furthermore, a guideline-conform medicinal treatment of ACS patients was used inceasingly more often for anticoagulation with heparin/acetylsalicylic acid (75 versus 84%,p=0.0001) and the use of beta-receptor blockers (32 versus 39%, p=0.009) after introduction of the ACS concept.The introduction of a regional care concept leads to an optimisation of guideline-conform prehospital treatment for ACS patients.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=pmid________::bb687e4b939e968f2c71d5c36e98e140
https://pubmed.ncbi.nlm.nih.gov/17287995 -
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المؤلفون: Eric J. Mahoney, Jane Metzger, David T. Harrington, Tomomi Oka, Walter L. Biffl, William G. Cioffi
المصدر: The Journal of trauma. 58(3)
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Adolescent, Poison control, Disaster Planning, Regional Medical Programs, Critical Care and Intensive Care Medicine, Suicide prevention, Occupational safety and health, Fires, Bronchoscopies, Age Distribution, Trauma Centers, Surveys and Questionnaires, medicine, Humans, Registries, Intensive care medicine, Retrospective Studies, business.industry, Trauma center, Health services research, Rhode Island, Retrospective cohort study, Emergency department, Hospital Bed Capacity, 500 and over, Length of Stay, Middle Aged, Smoke Inhalation Injury, medicine.disease, Transportation of Patients, Surgery, Female, Medical emergency, Health Services Research, Triage, business, Burns, Needs Assessment, Program Evaluation
الوصف: Background: On February 20, 2003, a nightclub fire caused a multiple casualty disaster, with 215 victims requiring treatment at area hospitals. In this report, we describe the events, the surgical response at our trauma center, and the lessons learned in institutional disaster preparedness. Methods: Information regarding the fire was obtained from public access media and state governmental and hospital reports. Patient information was obtained through review of our trauma registry, patient records, and questionnaires sent to regional hospitals. Results: Four hundred thirty-nine patrons were in the building at the time of the fire, of whom 96 died at the scene. One hundred people ultimately died. Two hundred fifteen patients were evaluated at area hospitals: 64 at our trauma center and 151 at 15 other area facilities. Seventy-nine patients were admitted: 47 to our center and 32 to other hospitals. Eight patients were transferred from Rhode Island Hospital (RIH) to other Level I trauma centers. Twenty-eight (60%) of the patients admitted to RIH were intubated for inhalation injury. For patients admitted to RIH, the extent of the total body surface burn was less than 20% in 33 patients (70%), 21% to 40% in 12 patients (26%), and greater than 40% in 2 patients (4%). The average age was 31 years (range, 18-43 years). Previous disaster planning drills facilitated a quick institutional response directed by a surgeon. The trauma floor of the hospital, which normally consists of a 10-bed trauma intensive care unit (ICU), an 11-bed step-down unit, and a 22-bed medical-surgical floor, was cleared of patients and converted into a 21-bed burn ICU and a 34-bed acute burn ward. Surgical residents were mobilized into teams assigned to the emergency department, ICUs, and surgical floors. In addition to the in-house trauma attending already present, four additional surgical staff members were called in to help man the emergency department and burn wards. Two operating rooms became dedicated burn rooms where 23 cases were performed the first week. In total, 43 operative procedures and 9 bedside tracheostomies were performed over 8 weeks. Over the first 4 weeks, 132 bronchoscopies were performed for diagnostic purposes and pulmonary toilet. There were no deaths. Conclusion: Disaster planning as well as personnel and institutional commitment resulted in an optimal response to a multiple casualty incident. Still, lessons were learned that will further improve readiness for future disasters.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::7dd6ae16a504c3943a2886e53be41de0
https://pubmed.ncbi.nlm.nih.gov/15761341
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