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Triage and the Lost Art of Decoding Vital Signs: Restoring Physiologically Based Triage Skills in Complex Humanitarian Emergencies

Published online by Cambridge University Press:  21 April 2017

Frederick M. Burkle Jr.
Frederick M. Burkle Jr.*
Affiliation:
Harvard Humanitarian Initiative, Harvard University, and Harvard T.C. Chan School of Public Health, Cambridge, Massachusetts Woodrow Wilson International Center for Scholars, Washington, DC; Captain, Medical Corps, USNR (Ret)
*
Correspondence and reprint requests to Frederick M. Burkle, Jr., MD, Harvard Humanitarian Initiative, c/o 452 Iana Street, Kailua, Hawaii 96734 (e-mail: fburkle@hsph.harvard.edu; skipmd77@aol.com).
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Abstract

Triage management remains a major challenge, especially in resource-poor settings such as war, complex humanitarian emergencies, and public health emergencies in developing countries. In triage it is often the disruption of physiology, not anatomy, that is critical, supporting triage methodology based on clinician-assessed physiological parameters as well as anatomy and mechanism of injury. In recent times, too many clinicians from developed countries have deployed to humanitarian emergencies without the physical exam skills needed to assess patients without the benefit of remotely fed electronic monitoring, laboratory, and imaging studies. In triage, inclusion of the once-widely accepted and collectively taught “art of decoding vital signs” with attention to their character and meaning may provide clues to a patient’s physiological state, improving triage sensitivity. Attention to decoding vital signs is not a triage methodology of its own or a scoring system, but rather a skill set that supports existing triage methodologies. With unique triage management challenges being raised by an ever-changing variety of humanitarian crises, these once useful skill sets need to be revisited, understood, taught, and utilized by triage planners, triage officers, and teams as a necessary adjunct to physiologically based triage decision-making. (Disaster Med Public Health Preparedness. 2018;12:76–85)

Keywords

triagevital signscomplex humanitarian emergencieswardisaster medicine
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 12 , Issue 1 , February 2018 , pp. 76 - 85
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2017 

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