Citation

Yilmaz S, Tatliparmak AC, Ak R. Wilderness Environ. Med. 2024; ePub(ePub): ePub.

Copyright

(Copyright © 2024, Elsevier Publishing)

DOI

10.1177/10806032231222474

PMID

38379475

Abstract

We have critically engaged with the concept proposed by Valence and colleague in their significant work, "Time to Reconsider Analgesia in Mass Casualty Incidents."1 Their concept is commendable for bringing attention to the often inadequately addressed issue of pain management in mass casualty scenarios and for suggesting innovative analgesic approaches. Nonetheless, we propose that an enriched exploration and further clarification of certain points could serve to amplify the practical applicability of the suggested approaches. The article adeptly navigates the nuances of analgesia in disaster medicine, addressing the "why," "how," and "which" through a critical literature review and its nexus to patient care in mass casualty incidents (MCIs). In its assessment of disaster literature, the concept advances beyond the traditional maxim of "saving the most lives in the shortest time possible," advocating for an elevated standard of care.
A distinguishing feature of an MCI, relative to other events, is the simultaneous occurrence of numerous casualties and the scarcity of available resources. The article contributes valuable insights to MCI literature, yet it stops short of addressing the prioritization of analgesia in injury management--a perspective that, we note, coalesces organically when this research is viewed in concert with existing studies. Triage, as the cornerstone of patient prioritization, dictates a structured progression of interventions in disaster response, typically commencing with an expedited protocol that merges triage and immediate intervention. For this very purpose, the Simple Triage and Rapid Treatment (START) was created in 1980 by the Newport Beach Fire Department and Hoag Hospital in California and has since become one of the most frequently used algorithms.2 Scholarly discourse often highlights the triage component of the START protocol while neglecting its quintessential element: the seamless amalgamation of triage and emergent care. This synergy is pivotal to its status as the preeminent casualty management algorithm in MCIs. Despite this, the literature remains ambiguous in defining the subsequent steps post-triage and initial treatment within the START framework.
On February 6, 2023, twin earthquakes with magnitudes of 7.7 and 7.6 struck Kahramanmaraş, affecting 10 cities and resulting in 50,399 fatalities, 80,278 injuries, and 6444 collapsed buildings, with 13.5 million people impacted and 850 amputations in Turkey...

Language: en