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      Facilitators and constrainers of civilian–military collaboration: the Swedish perspectives

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          Abstract

          Purpose

          An increasing number of international and domestic armed conflicts, including terror attacks on civilians, along with constrained healthcare finance and resource limitation, has made a civilian–military collaboration (CMC) crucial. The purpose of this study was to identify facilitators and constrainers in CMC in a national perspective with a specific focus on medical aspects.

          Method

          A literature review of recently published papers about civilian–military collaboration, along with a short survey, was conducted. For the review, major search engines were used.

          Results

          The results indicated many facilitators, but few important constrainers with a high impact on the outcome. The conducted survey indicated discrepancies between the needs and resources.

          Conclusion

          The current global and domestic security threats and challenges, make CMC critical and inevitable. However, there is a need for careful analysis of its consequences, impact, possibilities, and limitations to differentiate between our expectations and the current reality.

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          Most cited references43

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          Emergency Department Triage Scales and Their Components: A Systematic Review of the Scientific Evidence

          Emergency department (ED) triage is used to identify patients' level of urgency and treat them based on their triage level. The global advancement of triage scales in the past two decades has generated considerable research on the validity and reliability of these scales. This systematic review aims to investigate the scientific evidence for published ED triage scales. The following questions are addressed: 1. Does assessment of individual vital signs or chief complaints affect mortality during the hospital stay or within 30 days after arrival at the ED? 2. What is the level of agreement between clinicians' triage decisions compared to each other or to a gold standard for each scale (reliability)? 3. How valid is each triage scale in predicting hospitalization and hospital mortality? A systematic search of the international literature published from 1966 through March 31, 2009 explored the British Nursing Index, Business Source Premier, CINAHL, Cochrane Library, EMBASE, and PubMed. Inclusion was limited to controlled studies of adult patients (≥15 years) visiting EDs for somatic reasons. Outcome variables were death in ED or hospital and need for hospitalization (validity). Methodological quality and clinical relevance of each study were rated as high, medium, or low. The results from the studies that met the inclusion criteria and quality standards were synthesized applying the internationally developed GRADE system. Each conclusion was then assessed as having strong, moderately strong, limited, or insufficient scientific evidence. If studies were not available, this was also noted. We found ED triage scales to be supported, at best, by limited and often insufficient evidence. The ability of the individual vital signs included in the different scales to predict outcome is seldom, if at all, studied in the ED setting. The scientific evidence to assess interrater agreement (reliability) was limited for one triage scale and insufficient or lacking for all other scales. Two of the scales yielded limited scientific evidence, and one scale yielded insufficient evidence, on which to assess the risk of early death or hospitalization in patients assigned to the two lowest triage levels on a 5-level scale (validity).
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            Emergency department triage revisited.

            Triage is a process that is critical to the effective management of modern emergency departments. Triage systems aim, not only to ensure clinical justice for the patient, but also to provide an effective tool for departmental organisation, monitoring and evaluation. Over the last 20 years, triage systems have been standardised in a number of countries and efforts made to ensure consistency of application. However, the ongoing crowding of emergency departments resulting from access block and increased demand has led to calls for a review of systems of triage. In addition, international variance in triage systems limits the capacity for benchmarking. The aim of this paper is to provide a critical review of the literature pertaining to emergency department triage in order to inform the direction for future research. While education, guidelines and algorithms have been shown to reduce triage variation, there remains significant inconsistency in triage assessment arising from the diversity of factors determining the urgency of any individual patient. It is timely to accept this diversity, what is agreed, and what may be agreeable. It is time to develop and test an International Triage Scale (ITS) which is supported by an international collaborative approach towards a triage research agenda. This agenda would seek to further develop application and moderating tools and to utilise the scales for international benchmarking and research programmes.
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              Characterization of extremity wounds in Operation Iraqi Freedom and Operation Enduring Freedom.

              Extremity wounds and fractures traditionally comprise the majority of traumatic injuries in US armed conflicts. Little has been published regarding the extremity wounding patterns and fracture distribution in the current conflicts in Iraq and Afghanistan. The intent of this study was to describe the distribution of extremity fractures during this current conflict. Descriptive epidemiologic study. The Joint Theater Trauma Registry was queried for all US service members receiving treatment for wounds (ICD-9 codes 800-960) sustained in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) from October 2001 through January 2005. Returned-to-duty and nonbattle injuries were excluded. Wounds were classified according to region and type. Extremity wounds were analyzed in detail and compared to published results from previous conflicts. A total of 1281 soldiers sustained 3575 extremity combat wounds. Fifty-three percent of these were penetrating soft-tissue wounds and 26% were fractures. Of the 915 fractures, 758 (82%) were open fractures. The 915 fractures were evenly distributed between the upper (461, 50%) and lower extremities (454, 50%). The most common fracture in the upper extremity was in the hand (36%) and in the lower extremity was the tibia and fibula (48%). Explosive munitions accounted for 75% of the mechanisms of injury. The burden of wounds sustained in OIF/OEF is extremity injuries, specifically soft-tissue wounds and fractures. These results are similar to the reported casualties from previous wars.
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                Author and article information

                Contributors
                amir.khorram-manesh@surgery.gu.se
                Journal
                Eur J Trauma Emerg Surg
                Eur J Trauma Emerg Surg
                European Journal of Trauma and Emergency Surgery
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                1863-9933
                1863-9941
                12 December 2018
                12 December 2018
                2020
                : 46
                : 3
                : 649-656
                Affiliations
                GRID grid.8761.8, ISNI 0000 0000 9919 9582, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, , Gothenburg University, ; Gothenburg, Sweden
                Author information
                http://orcid.org/0000-0002-2734-5733
                Article
                1058
                10.1007/s00068-018-1058-9
                7280332
                30542745
                9f4a9a23-38b2-4b4f-9ae9-2b4eeddcc35b
                © The Author(s) 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 9 August 2018
                : 4 December 2018
                Categories
                Original Article
                Custom metadata
                © Springer-Verlag GmbH Germany, part of Springer Nature 2020

                Emergency medicine & Trauma
                civilian,military,healthcare,collaboration,facilitators,constrainers
                Emergency medicine & Trauma
                civilian, military, healthcare, collaboration, facilitators, constrainers

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