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In 2019, the World Health Organization (WHO) published the Health Emergency and Disaster Risk Management (H-EDRM) framework detailing how effective management of disasters, including mass-casualty incidents (MCIs), can be achieved through a whole-of-health system approach where each level of the health care system is involved in all phases of the disaster cycle. In light of this, a primary health care (PHC) approach can contribute to reducing negative health outcomes of disasters, since it encompasses the critical roles that primary care services can play during crises. Hospitals can divert non-severe MCI victims to primary care services by applying reverse triage (RT), thereby preventing hospital overloading and ensuring continuity of care for those who do not require hospital services during the incident.
Study Objective:
This study explores the topic by reviewing the literature published on early discharge of MCI victims through RT criteria and existing referral pathways to primary care services.
Methods:
A scoping literature review was performed and a total of ten studies were analyzed.
Results:
The results showed that integrating primary care facilities into disaster management (DM) through the use of RT may be an effective strategy to create surge during MCIs, provided that clear referral protocols exist between hospitals and primary care services to ensure continuity of care. Furthermore, adequate training should be provided to primary care professionals to be prepared and be able to provide quality care to MCI victims.
Conclusion:
The results of this current review can serve as groundwork upon which to design further research studies or to help devise strategies and policies for the integration of PHC in MCI management.
Principle-based medical ethics focuses on the four concepts of autonomy, beneficence, nonmaleficence and justice. Informed consent requires several elements: capacity of the patient to make a decision, freedom or voluntariness of the patient in decision-making, disclosure of adequate information to the patient, understanding of that information by the patient, and consent by the patient to the procedure. Ensuring that these elements have been addressed and obtaining consent for procedures in laboring patients can be extremely challenging. Every labor carries the risk of maternal-fetal conflicts. Cultural and religious beliefs may complicate care of the laboring patient and require consideration in managing ethical conflicts. When a laboring woman refuses critical intervention, all efforts should be made to inform her of the risks and benefits of refusal of treatment, including the use of interpreter services if needed to a conduct careful and complete discussion.
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