Revisión sistemática triage en catástrofes y emergencias papel de enfermería.

espanolTriage (del frances triage) es un metodo de la medicina de emergencias y desastres para la seleccion y clasificacion de los pacientes basandose en las prioridades de atencion, privilegiando la posibilidad de supervivencia, de acuerdo con las necesidades terapeuticas y los recursos disponibles. Trata por tanto de evitar que se retrase la atencion del paciente que empeoraria su pronostico por la demora en su atencion. Existen diferentes tipos de triage: primer triage: sencillo, rapido y que puede ser realizado por cualquier profesional capacitado para ello. Un segundo triage que solo podra ser realizado por el medico o enfermera/o donde se realizara una clasificacion mas compleja y precisa con tecnicas de salvamento mas avanzadas. Y finalmente, un tercer triage realizado a nivel hospitalario en la sala de clasificacion por personal1. A nivel intrahospitalario existen seis sistemas: Australian Triage Scale (ATS). Canadian Emergency Department Triage and Acuity Scale (CTAS). Emergency Severit Index (ESI). Manchester Triage System (MTS). Model Andorra de Triage (MAT). Sistema Espanol de Triage (SET) que, originalmente, deriva del MAT. A nivel extrahospitalario se emplean otros sistemas: Basico y elemental: el enfermo camina o no. SHORT: de las siglas Sale caminando, Habla sin dificultad, Obedece ordenes sencillas, Respira, Taponar hemorragias. START: Simple Triage and Rapid Treatment. META: Modelo Extrahospitalario de Triage Avanzado. A nivel del estado espanol, la MTS y el SET son los dos sistemas que han alcanzado mayor difusion, aunque tambien coexisten con otros de implantacion local, mas adaptados a su propia realidad: “Sistema Donostiarra de triage” del Hospital Donostia y el “Sistema de triage de la red publica de hospitales de Navarra”, estos, trabajan sobre escalas de cinco prioridades. “Sistema de clasificacion en base a escalas de cuatro niveles de priorizacion” (Plan Andaluz de urgencias y Emergencias de la Consejeria de Salud)2. Actualmente el “triage” en emergencias no esta comprendido dentro de ninguna profesion en particular. Es por ello que, conocer las competencias de enfermeria en este ambito fundamental de las emergencias sanitarias se convierte en el objetivo principal de este trabajo, al tiempo que se especifica cual es el papel de otros profesionales3. Si bien no se ha encontrado literatura especifica sobre la existencia de funciones claramente diferenciadas entre el papel del medico y la enfermera en el desarrollo del triage extrahospitalario, todo apunta a que la clave no esta en la profesion sino en el “ojo clinico”, formacion y experiencia previa del profesional. EnglishTriage (from the French triage) is a method of emergency and disaster medicine for the selection and classification of patients based on the priorities of care, privileging the possibility of survival, according to the therapeutic needs and available resources. It therefore seeks to avoid delaying the patient’s attention that would worsen his prognosis because of the delay in his care. There are different types of triage: first triage, simple, fast and must be made by a well-prepared professional in this. A second triage that can only be performed by the doctor or nurse where a more complex and precise classification will be performed with more advanced rescue techniques. And finally, a third triage performed at the hospital level in the classification room by staff. At the intrahospital level there are six systems: The Australian Triage Scale (ATS). The Canadian Emergency Department Triage and Acuity Scale (CTAS). The Emergency Severit Index (ESI). The Manchester Triage System (MTS). The Model Andorra de Triage (MAT). The Spanish Triage System (SET), originally derived from the MAT. Other non-hospital systems are used: Basic and elemental: the patient walks or not. SHORT: from the acronym Walk out, speak without difficulty, obey simple commands, breathe, stop bleeding. START: Simple Triage and Rapid Treatment. GOAL: Advanced Triage Model of Advanced Triage. At the level of the Spanish state, MTS and SET are the two systems that have reached greater diffusion, but also coexist with others of local implementation, more adapted to their own reality: “Donostiarra triage system” of the Donostia Hospital and the “Triage system of the public network of hospitals in Navarre”, these work on scales of five priorities. “Classification system based on scales of four levels of prioritization” (Andalusian Plan of Emergency and Emergencies of the Ministry of Health) 2. Currently the “triage” in emergencies is not included in any profession. It is for this reason that knowing the competences of nursing in this fundamental area of health emergencies becomes the main objective of this work, while specifying the role of other professionals3. Although there is no specific literature on the existence of clearly differentiated roles between the role of the physician and the nurse in the development of the extra-hospital triage, everything points to the fact that the key is not in the profession but in the “clinical eye” Training and previous professional experience.

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