دورية أكاديمية
Rethinking the Current "Stage-and-Wait" Paradigm.
| العنوان: | Rethinking the Current "Stage-and-Wait" Paradigm. |
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| المؤلفون: | Ragoler M; National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel., Radomislensky I; National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel., Dolev E; Tel-Hai Academic College, Upper Galilee, Israel., Renert L; Institute for Risk and Disaster Reduction, University College London, London, UK., Peleg K; Department of Emergency and Crisis Management, The Israel Academic College in Ramat Gan, Ramat Gan, Israel. |
| المصدر: | Prehospital and disaster medicine [Prehosp Disaster Med] 2023 Apr; Vol. 38 (2), pp. 185-192. Date of Electronic Publication: 2023 Jan 25. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Cambridge University Press Country of Publication: United States NLM ID: 8918173 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1945-1938 (Electronic) Linking ISSN: 1049023X NLM ISO Abbreviation: Prehosp Disaster Med |
| أسماء مطبوعة: | Publication: 2011- : New York : Cambridge University Press Original Publication: [Solana Beach, CA] : Jems Pub. Co., [c1989]- |
| مواضيع طبية MeSH: | Blast Injuries*/therapy , Emergency Medical Services* , Terrorism* , Bombs* , Mass Casualty Incidents* , Disaster Planning*, Humans ; Explosions |
| مستخلص: | Introduction: The experience of terrorist incidents involving a secondary explosive device that targeted rescue forces led to changes in the safety protocols of these forces in most countries of the world. These protocols are the foundation of the current "Stage-and-Wait" paradigm that prohibits the entry of Emergency Medical Services (EMS) from entering the scene and treating casualties until it is deemed safe. These guidelines were established absent of an evidence-base detailing the risk to responders and the potential consequences to the injured on-scene. The lack of clarity is compounded by the fact that different situations, as well as operational considerations, such as the length of time until bomb squad arrival at the scene versus time of massive bleeding injuries, for example, impact outcomes must be taken into account. Objective: This study sought to shed light on this matter while employing an evidence-based approach exploring the investigations of the frequency of secondary explosion threats in terrorist attacks over the last 20 years and discussing some of the ethical challenges and ramifications ensuing. While this study does not propose an outright change to current guidelines, in light of the evidence gathered, an open review and discussion based on the findings may be beneficial. Methods: The Global Terrorism Database (GTD) was used as the data source of bombing incidents world-wide. Results: The results revealed that approximately 70 per-1,000 bombing incidents involved secondary explosions across regions and countries within the study period. Conclusion: This study emphasizes the need to rethink the current "Stage-and-Wait" paradigm by recommending brainstorming conferences comprised of multi-sectoral experts aimed at deliberating the matter. World-wide experts in emergency medicine, bioethics, and disaster management should cautiously consider all aspects of bomb-related incidents. These brainstorming deliberations should consider the calculated risk of secondary explosions that account for approximately 70 per-1,000 bombing incidents. This study highlights the need to re-examine the current versus new paradigm to achieve a better balance between the need to ensure EMS safety while also providing the necessary and immediate care to improve casualty survival. This ethical dilemma of postponing urgent care needs to be confronted. |
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| فهرسة مساهمة: | Keywords: explosions; mass-casualty incidents; safety; secondary explosion |
| تواريخ الأحداث: | Date Created: 20230125 Date Completed: 20230321 Latest Revision: 20230322 |
| رمز التحديث: | 20240829 |
| مُعرف محوري في PubMed: | PMC10027492 |
| DOI: | 10.1017/S1049023X23000079 |
| PMID: | 36695069 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1945-1938 |
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| DOI: | 10.1017/S1049023X23000079 |