نشریه علمی پژوهشی طب انتظامی Journal of Police Medicine
Volume 13, Issue 1 (2024)
J Police Med 2024, 13(1) |
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Aghdam H, Shirzad H, Shirzad O. Triage in War Zones: Ethical, Clinical, and Operational Challenges in Mass Casualty Incidents, a Narrative Review. J Police Med 2024; 13 (1)
URL: http://jpmed.ir/article-1-1313-en.html
URL: http://jpmed.ir/article-1-1313-en.html
1- Research Center for Trauma in Police Operations, Directorate of Health, Rescue & Treatment, Police Headquarter, Tehran, Iran , hamedaghdam@gmail.com
2- Institute of Police Sciences & Social Studies, Tehran, Iran
2- Institute of Police Sciences & Social Studies, Tehran, Iran
English Extended Abstract: (1933 Views)
Aims: In war-torn areas, triage systems face challenges such as the destruction of healthcare infrastructure (72% in Gaza, 2023), resource shortages, and ongoing security threats that negatively impact their efficiency and effectiveness. This situation results in reduced patient survival rates, ethical dilemmas, and limitations in the application of new technologies. This study aimed to provide evidence-based solutions to improve the management of triage systems in war-torn areas, focusing on regional differences, ethical challenges, and technological solutions in the wars in Gaza, Yemen, and Ukraine, to help increase the effectiveness, efficiency, and equity of health care delivery in humanitarian crises.
Materials and Methods: This narrative review was conducted by analyzing secondary data from the wars in Gaza, Yemen, and Ukraine (2015-2024). Quantitative data (survival rate, triage time) were extracted from WHO/ICRC reports and PubMed articles. Qualitative data included interviews with medical staff and content analysis of field reports. New technologies (artificial intelligence, VR) were evaluated using purposive sampling. Analyses were conducted using a SWOT framework and a descriptive-analytical approach.
Findings: Survival rates in Ukraine (78.5%) were higher than in Gaza (51.2%), which is due to better infrastructure and international cooperation. Local systems in Yemen need standardization. Ethical dilemmas, such as decision-making based on the chance of survival, were reported in 68% of cases. The use of AI in Ukraine reduced triage time by 40%, but in Gaza, it was limited due to power outages. It was suggested to develop protocols based on START and TCCC and to establish strategic reserves of triage kits.
Conclusion: Improving triage systems requires multifaceted policymaking, encompassing enhancements to infrastructure, the strategic use of technology, and the resolution of ethical dilemmas. International cooperation and standardization of indigenous systems are essential. New technologies such as artificial intelligence and VR play an important role in reducing operation times and training forces. The development of comprehensive protocols and strategic reserves should be on the agenda, and the future should focus on the impacts of climate change and the ethical aspects of new technologies.
Materials and Methods: This narrative review was conducted by analyzing secondary data from the wars in Gaza, Yemen, and Ukraine (2015-2024). Quantitative data (survival rate, triage time) were extracted from WHO/ICRC reports and PubMed articles. Qualitative data included interviews with medical staff and content analysis of field reports. New technologies (artificial intelligence, VR) were evaluated using purposive sampling. Analyses were conducted using a SWOT framework and a descriptive-analytical approach.
Findings: Survival rates in Ukraine (78.5%) were higher than in Gaza (51.2%), which is due to better infrastructure and international cooperation. Local systems in Yemen need standardization. Ethical dilemmas, such as decision-making based on the chance of survival, were reported in 68% of cases. The use of AI in Ukraine reduced triage time by 40%, but in Gaza, it was limited due to power outages. It was suggested to develop protocols based on START and TCCC and to establish strategic reserves of triage kits.
Conclusion: Improving triage systems requires multifaceted policymaking, encompassing enhancements to infrastructure, the strategic use of technology, and the resolution of ethical dilemmas. International cooperation and standardization of indigenous systems are essential. New technologies such as artificial intelligence and VR play an important role in reducing operation times and training forces. The development of comprehensive protocols and strategic reserves should be on the agenda, and the future should focus on the impacts of climate change and the ethical aspects of new technologies.
Keywords: Military Medicine, Triage, Conflict Zones Health Crisis, Emerging Technologies, AI, Virtual Reality, Medical Ethics, Standardization, Disaster Management, Relief Strategies
Article Type: Narrative Review |
Subject:
Police Medicine Emergencies
Received: 2024/08/22 | Accepted: 2024/11/17 | Published: 2024/12/15
Received: 2024/08/22 | Accepted: 2024/11/17 | Published: 2024/12/15
References
1. Alkhaldi M, Alijla A, Obaid I. Health system resilience in conflict zones: A comparative analysis of Gaza, Yemen, and Ukraine. Lancet. 2024;403(10425):456-67. https://www.thelancet.com/journals/lancet/article/S0140-6736(23)02456-8
2. International Committee of the Red Cross. War surgery: Working with limited resources in armed conflict. 2nd ed. Geneva: ICRC Publications; 2023. https://shop.icrc.org/war-surgery-working-with-limited-resources-in-armed-conflict-2nd-ed.html
3. Médecins Sans Frontières. Mental health impact of war on medical staff: 2023 global report. Paris: MSF International; 2023. https://www.msf.org/sites/default/files/2023-05/MSF_Global_Mental_Health_Report_2023.pdf
4. NATO Medical Committee. Tactical Combat Casualty Care (TCCC) guidelines update. Brussels: NATO Publishing; 2023. https://www.nato.int/cps/en/natohq/publications_212978.htm
5. Parker J, Smith R, Kovalenko A. Triage protocols in asymmetric warfare: Evidence from Syria. J Trauma Acute Care Surg. 2021;90(4):1123-30. https://journals.lww.com/jtraumaacaresurg/fulltext/2021/04000/triage_protocols_in_asymmetric_warfare__evidence_from.100.aspx
6. World Health Organization. Attacks on health care in Gaza: 2023 annual report. Cairo: WHO Regional Office for the Eastern Mediterranean; 2023. Report No.: WHO/EMRO/2023/05. https://www.emro.who.int/images/stories/Sitrep_59.pdf?ua=1
7. Ministry of Health and Medical Education. Field medicine manual for asymmetric warfare [دستورالعمل طب میدانی برای جنگ نامتقارن]. Tehran: Author; 2022. Report No.: IR-MOH-1401-45.
8. United Nations Office for the Coordination of Humanitarian Affairs. Ukraine: Healthcare under siege - 2024 situational report. 2024. https://reliefweb.int/report/ukraine
9. Al-Mandhari A, Al-Harthy S, Al-Shaqsi S. Local triage systems in Yemen: Challenges and innovations. Paper presented at: 5th International Conference on Emergency Medicine. 2020 Nov; Dubai, United Arab Emirates.
10. BBC News. Gaza hospitals: A day in the life of a war zone doctor [Video] [Internet]. 2023. https://www.bbc.com/news/av/world-middle-east/67389876
11. U.S. Department of Defense. Tactical Combat Casualty Care (TCCC) guidelines. 2021. https://jts.amedd.army.mil/tccc.html
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