The caseload of the Department of Surgery (Baragwanath Hospital, Johannesburg, South Africa) is characterised by a singularly heavy trauma component. Penetrating injuries account for the majority of cases. The managem...
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The caseload of the Department of Surgery (Baragwanath Hospital, Johannesburg, South Africa) is characterised by a singularly heavy trauma component. Penetrating injuries account for the majority of cases. The management of penetrating trauma is not as demanding as that of blunt trauma, yet the sheer number of cases, over the past four decades, has imposed a clinical burden that has never been met by commensurate resources. The organisation of the hospital and departmental responses has manifested itself on two different levels. The first one is the structural and functional deployment of insufficient staff, facilities and equipment to cope as flexibly as possible with the trauma epidemic. The second one is the gradual adaptation of the clinical management philosophy to ensure that the best possible quality of care is provided to the majority of trauma victims, with the full knowledge that better resources would sometimes have elicited a different clinical approach.
During a multiple-casualty incident, a large casualty caseload adversely affects the quality of trauma care given to individual patients. From a trauma care perspective, the goal of the hospital emergency plan is to p...
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During a multiple-casualty incident, a large casualty caseload adversely affects the quality of trauma care given to individual patients. From a trauma care perspective, the goal of the hospital emergency plan is to provide severely injured patients with a level of care that approximates the care given to similar patients under normal conditions. Therefore, the realistic admitting capacity of the hospital is determined primarily by the number of trauma teams that the hospital can recruit. Effective triage of these casualties is often not straightforward, with high over-triage rates. Simplified triage algorithms may be a practical alternative to more elaborate schemes. The concept of minimal acceptable care is the key to a staged management approach during a mass-casualty incident. Discrete-event computer simulation and war game tabletop exercises for key personnel are 2 new modalities that are supplementing the traditional mock disaster drill as effective planning and training tools.
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