The theoretical ethical foundations of pre-hospital emergency healthcare systems are based on the principle of "beneficence" from the basic principles of medical ethics. The strongest criticism of triage practices is that the principle of "justice" is not taken into account. The “distributive justice” dimension of the principle of justice is in the focus of ethical discussions. Triage recommended to be applied in cases where resources are limited and the number of injured is high; it contains many ethical conflicts and it is difficult to justify cases. As soon as the necessary conditions are met, the triage must immediately be abandoned. In the prehospital triage; in addition to ethical approaches such as “beneficence/utilitarianism”, “justice”, “equality” and “equity”, there are also a variety of algorithms that derived from principles and values of different philosophical thoughts. In this study, the approaches related to pre-hospital triage are examined and the subject is interpreted in the context of medical ethics.
Barnett, AS., Wang, NE., Sahni, R., Hsia, RY., Haukoos, JS., Barton, ED., Holmes, JF., Newgard, CD. (2013). Variation in prehospital use and uptake of the national field triage decision scheme. Prehospital Emergency Care, 17(2), 135–148. doi: 10.3109/10903127.2012.749966
Bauzon, S. (2015). Classical distributive justice and the European healthcare system: rethinking the foundations of European health care in an age of crises. The Journal of Medicine and Philosophy, 40(2), 190–200. doi: 10.1093/jmp/jhu078
Beck, B., Smith, K., Mercier, E., Bernard, S., Jones, C., Meadley, B., Clair, TS., Jennings, PA., Nehme, Z., Burke, M., Bassed, R., Fitzgerald, M., Judson, R., Teague, W., Mitra, B., Mathew, J., Buck, A., Varma, D., Gabbe, B., … Cameron, P. (2019). Potentially preventable trauma deaths: A retrospective review. Injury, 50(5), 1009–1016. doi: 10.1016/j.injury.2019.03.003
Blagg, C. (2004). Triage: Napoleon to the present day. J Nephrol, 17(4), 629–632. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15372431
Braithwaite, SS. (2014). Ethics in Paramedic Practice: A Qualitative Case Study of Paramedic Perceptions of Ethical Decision-Making in Practice. North Carolina State University.
Bremer, A., Herrera, MJ., Axelsson, C., Martí, DB., Sandman, L., Casali, GL. (2015). Ethical values in emergency medical services: A pilot study. Nursing Ethics, 22(8), 928–942. doi: 10.1177/0969733014551597
Cairo, SB., Fisher, M., Clemency, B., Cipparone, C., Quist, E., Bass, KD. (2018). Prehospital education in triage for pediatric and pregnant patients in a regional trauma system without collocated pediatric and adult trauma centers. Journal of Pediatric Surgery, 53(5), 1037–1041. doi: 10.1016/j.jpedsurg.2018.02.033
Cooper, RJ., Schriger, DL., Flaherty, HL., Lin, EJ., Hubbell, KA. (2002). Effect of vital signs on triage decisions. Annals of Emergency Medicine, 39(3), 223–232. doi: 10.1067/mem.2002.121524
D’Empaire, G. (2009). Equality, Justice and Equity. In H. A. M. J. ten Have & M. S. Jean (Eds.), The UNESCO Universal Declaration on Bioethics and Human Rights Background , principles and application (pp. 173–185). Paris: UNESCO Publishing.
Demirhan Erdemir, A. (2006). Acil Tedavi ve Bakımda Tıp Etiği Sorunları. İstanbul: Nobel Tıp Kitabevi.
Demirhan, N. (2003). Türkiye’de 112 - İlk ve Acil Yardım Hizmetleri ve Afetlerdeki Rolü. İstanbul: Nobel Tıp Kitabevi.
Domres, B, Koch, M., Manger, A., Becker, HD. (2001). Ethics and triage. Prehospital and Disaster Medicine, 16(1), 53–58. doi: 10.1017/S1049023X00025590
Domres, Bernd, Kees, T., Gromer, S., Braitmaier, P., Tanja, G. (2010). Ethical aspects of triage. ROCNİK, 2(3), 76–82.
Dunlop, M., Savulescu, J. (2015). Distributive justice and cognitive enhancement in lower, normal intelligence. Monash Bioethics Review, 32(3–4), 189–204. doi: 10.1007/s40592-014-0014-7
Ekşi, A. (2015a). Afet Yöneti̇mi̇nde İçsel Deneti̇m Aracı Olarak Eti̇k. Uluslararası İktisadi ve İdari İncelemeler Dergisi, 15. doi: 10.18092/ijeas.80069
Ekşi, A. (2015b). Kitlesel Olaylarda Hastane Öncesi Acil Sağlık Hizmetleri Yönetimi. İzmir: kitapAna.
Ekşi, A., Şen, G., Çelikli, S. (2019). Afet Triajında Etik İkilemlerin Değerlendirilmesi-İzmir İli Örneği. Turkiye Klinikleri J Med Ethics, 27(1), 30–39. doi: 10.5336/mdethic.2018-62914
Erbay, H. (2014). Some Ethical Issues in Prehospital Emergency Medicine. Turk J Emerg Med, 14(4), 193–198. doi: 10.5505/1304.7361.2014.32656
Erbay, H., Can, R., Turkan, AH. (2018). For Whom the Sirens Toll: A Study on an Ethical Challenge in Prehospital Emergency Medicine. Eurasian Journal of Emergency Medicine, 17(3), 122–128. doi: 10.5152/eajem.2018.76476
Ersoy, N., Akpınar, A. (2010). Triage decisions of emergency physicians in Kocaeli and the principle of justice Kocaeli ili acil hekimlerinin triyaj kararları ve adalet. Turkish Journal of Trauma & Emergency Surgery, 16(3), 203–209.
French, E., Casali, GL. (2008). Ethics in Emergency Medical Services – Who Cares? An exploratory analysis from Australia. Electronic Journal of Business Ethics and Organization Studies, 13(2), 44–53. Retrieved from http://ejbo.jyu.fi/pdf/ejbo_vol13_no2_pages_44-53.pdf
Geale, SK. (2012). The ethics of disaster management. Disaster Prevention and Management, 21(4), 445–462. doi: 10.1108/09653561211256152
Gerdtz, MF., Bucknall, TK. (2007). Influence of task properties and subjectivity on consistency of triage: A simulation study. Journal of Advanced Nursing, 58(2), 180–190. doi: 10.1111/j.1365-2648.2007.04192.x
Giannou, C., Baldan, M. (2010). War Surgery vol-I. International Committee of the Red Cross. Retrieved from https://www.icrc.org/eng/assets/files/other/icrc-002-0973.pdf
Giannou, C., Baldan, M., Molde, A. (2013). War Surgery vol-II. International Committee of the Red Cross. Retrieved from https://www.icrc.org/fre/assets/files/publications/icrc-002-4105.pdf
Girard, E., Jegousso, Q., Boussat, B., François, P., Ageron, FX., Letoublon, C., Bouzat, P. (2019). Preventable deaths in a French regional trauma system: A six-year analysis of severe trauma mortality. Journal of Visceral Surgery, 156(1), 10–16. doi: 10.1016/j.jviscsurg.2018.05.002
Goniewicz, M. (2013). Effect of military conflicts on the formation of emergency medical services systems worldwide. Academic Emergency Medicine, 20(5), 507–513. doi: 10.1111/acem.12129
Huibers, L., Smits, M., Renaud, V., Giesen, P., Wensing, M. (2011). Safety of telephone triage in out-of-hours care: a systematic review. Scandinavian Journal of Primary Health Care, 29(4), 198–209. doi: 10.3109/02813432.2011.629150
Iserson, KV., Moskop, JC. (2007). Triage in Medicine, Part I: Concept, History, and Types. Annals of Emergency Medicine, 49(3), 275–281. doi: 10.1016/j.annemergmed.2006.05.019
Iserson, KV., Sanders, AB., Mathieu, D. (1995). Ethics in Emergency Medicine (Second). Tucson, Arizona: Galen Press.
Jonsen, A., Siegler, M., Winslade, W. (2006). Clinical Ethics: a practical approach to ethical decisions in clinical medicine (Sixth edit). McGraw-Hill Medical Publishing. doi: 0-07-144199-9
Kleber, C., Giesecke, MT., Tsokos, M., Haas, NP., Buschmann, CT. (2013). Trauma-related preventable deaths in Berlin 2010: Need to change prehospital management strategies and trauma management education. World Journal of Surgery, 37(5), 1154–1161. doi: 10.1007/s00268-013-1964-2
Küçükoğlu, S., Köse, S., Aytekin, A., Kılıç, T. (2017). Acil Birimlerde Çalışan Hemşirelerin Triyaj Konusundaki Bilgi Düzeylerinin Ölçülmesi. J Pediatr Emerg Intensive Care Med, 4, 116–122. doi: 10.4274/cayd.42714
Lidal, IB., Holte, HH., Vist, GE. (2013). Triage systems for pre-hospital emergency medical services - a systematic review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 21(1), 28. doi: 10.1186/1757-7241-21-28
Lounsbury, DE. (2003). - Military Medical Ethics. In E. D. Pellegrino, A. E. Hartle, & E. G. Howe (Eds.), Textbooks of Military Medicine (Vol. 1, pp. 1–127). Washington: TMM Publications.
Moll, HA. (2010). Challenges in the validation of triage systems at emergency departments. Journal of Clinical Epidemiology, 63(4), 384–388. doi: 10.1016/j.jclinepi.2009.07.009
Moskop, JC., Iserson, KV. (2007). Triage in medicine, part II: Underlying values and principles. Annals of Emergency Medicine, 49(3), 282–287. doi: 10.1016/j.annemergmed.2006.07.012
Nakao, H., Ukai, I., Kotani, J. (2017). A review of the history of the origin of triage from a disaster medicine perspective. Acute Medicine & Surgery, 4(4), 379–384. doi: 10.1002/ams2.293
Newgard, CD., Fu, R., Lerner, EB., Daya, M., Jui, J., Wittwer, L., Schmidt, TA., Zive, D., Bulger, EM., Sahni, R., Warden, C., Kuppermann, N. (2017). Role of Guideline Adherence in Improving Field Triage. Prehospital Emergency Care, 21(5), 545–555. doi: 10.1080/10903127.2017.1308612
Newgard, CD., Kampp, M., Nelson, M., Holmes, JF., Zive, D., Rea, T., Bulger, EM., Liao, M., Sherck, J., Hsia, RY., Wang, NE., Fleischman, RJ., Barton, ED., Daya, M., Heineman, J., Kuppermann, N. (2012). Deciphering the use and predictive value of “emergency medical services provider judgment” in out-of-hospital trauma triage: A multisite, mixed methods assessment. Journal of Trauma and Acute Care Surgery, 72(5), 1239–1248. doi: 10.1097/TA.0b013e3182468b51
Özcan, M., Akpınar, A., Fatma, B., Beydilli, H. (2014). Ethical Challenges in Emergency Medical Services and Ethical Reasoning Among Emergency Care Providers. Acta Medica Mediterranea, 30, 241–247. Retrieved from http://www.actamedicamediterranea.com/medica/2014/med2014_pag-241-247.pdf
Parikh, PP., Parikh, P., Guthrie, B., Mamer, L., Whitmill, M., Erskine, T., Woods, R., Saxe, J. (2017). Impact of triage guidelines on prehospital triage: comparison of guidelines with a statistical model. Journal of Surgical Research, 220(February), 255–260. doi: 10.1016/j.jss.2017.06.084
Rabinovici, R., Frankel, HL., Kirton, OC. (2010). Trauma, Critical Care, and Surgical Emergencies: A Case and Evidence-Based Textbook. In R. Rabinovici, H. L. Frankel, & O. C. Kirton (Eds.), Informa Healthcare. doi: 10.1097/SLA.0b013e3182337f1f
Repine, TB., Lisagor, P., Cohen, DJ. (2005). The Dynamics and Ethics of Triage: Rationing Care in Hard Times. Military Medicine, 170(6), 505–509. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16001601
Roberts, A., Heaney, D., Haddow, G., O’Donnell, CA. (2009). Implementation of a national, nurse-led telephone health service in Scotland: assessing the consequences for remote and rural localities. Rural and Remote Health, 9(2), 1079.
Robertson-Steel, I. (2006). Evolution of triage systems. Emergency Medicine Journal, 23(2), 154–155. doi: 10.1136/emj.2005.030270
Romero Pareja, R., Castro Delgado, R., Turégano Fuentes, F., Jhon Thissard-Vasallo, I., Sanz Rosa, D., Arcos González, P. (2018). Prehospital triage for mass casualty incidents using the META method for early surgical assessment: retrospective validation of a hospital trauma registry. Eur J Trauma Emerg Surg, 0(0), 0. doi: 10.1007/s00068-018-1040-6
Rørtveit, S., Meland, E., Hunskaar, S. (2013). Changes of triage by GPs during the course of prehospital emergency situations in a Norwegian rural community. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 21(1), 89. doi: 10.1186/1757-7241-21-89
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Hastane öncesi acil sağlık sistemlerinin, ilkesel bağlamdaki kuramsal etik temelleri, temel tıp etiği ilkelerinden “faydacılık” ilkesi üzerine kuruludur. Triyaj uygulamalarına yöneltilen en güçlü eleştiri, “adalet” ilkesinin dikkate alınmadığı ile ilgilidir. Adalet ilkesinin ise özellikle “dağıtıcı adalet” boyutu etik tartışmaların odağındadır. Kaynakların kısıtlı ve yaralıların fazla olduğu durumlarda uygulanması önerilen triyaj; etik açıdan pek çok sorun içermekte ve gerekçelendirilmesi zor, savunulması güç durumlara neden olabilmektedir. Gerekli şartlar sağlandığı an triyaj uygulamasından derhal vazgeçilmelidir. Hastane öncesi alan triyajında; “yarar sağlama/faydacılık”, “adalet”, “eşitlik” ve “adil olma” gibi etik yaklaşımların yanında, farklı felsefi akımlardan beslenen ilkeler ve değerler ile kaynağını bu etik kuramlardan alan çok çeşitli algoritmalar da mevcuttur. Bu çalışmada, hastane öncesi alan triyajıyla ilgili yaklaşımları incelenmiş ve konu tıp etiği bağlamında yorumlanmıştır.
Barnett, AS., Wang, NE., Sahni, R., Hsia, RY., Haukoos, JS., Barton, ED., Holmes, JF., Newgard, CD. (2013). Variation in prehospital use and uptake of the national field triage decision scheme. Prehospital Emergency Care, 17(2), 135–148. doi: 10.3109/10903127.2012.749966
Bauzon, S. (2015). Classical distributive justice and the European healthcare system: rethinking the foundations of European health care in an age of crises. The Journal of Medicine and Philosophy, 40(2), 190–200. doi: 10.1093/jmp/jhu078
Beck, B., Smith, K., Mercier, E., Bernard, S., Jones, C., Meadley, B., Clair, TS., Jennings, PA., Nehme, Z., Burke, M., Bassed, R., Fitzgerald, M., Judson, R., Teague, W., Mitra, B., Mathew, J., Buck, A., Varma, D., Gabbe, B., … Cameron, P. (2019). Potentially preventable trauma deaths: A retrospective review. Injury, 50(5), 1009–1016. doi: 10.1016/j.injury.2019.03.003
Blagg, C. (2004). Triage: Napoleon to the present day. J Nephrol, 17(4), 629–632. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15372431
Braithwaite, SS. (2014). Ethics in Paramedic Practice: A Qualitative Case Study of Paramedic Perceptions of Ethical Decision-Making in Practice. North Carolina State University.
Bremer, A., Herrera, MJ., Axelsson, C., Martí, DB., Sandman, L., Casali, GL. (2015). Ethical values in emergency medical services: A pilot study. Nursing Ethics, 22(8), 928–942. doi: 10.1177/0969733014551597
Cairo, SB., Fisher, M., Clemency, B., Cipparone, C., Quist, E., Bass, KD. (2018). Prehospital education in triage for pediatric and pregnant patients in a regional trauma system without collocated pediatric and adult trauma centers. Journal of Pediatric Surgery, 53(5), 1037–1041. doi: 10.1016/j.jpedsurg.2018.02.033
Cooper, RJ., Schriger, DL., Flaherty, HL., Lin, EJ., Hubbell, KA. (2002). Effect of vital signs on triage decisions. Annals of Emergency Medicine, 39(3), 223–232. doi: 10.1067/mem.2002.121524
D’Empaire, G. (2009). Equality, Justice and Equity. In H. A. M. J. ten Have & M. S. Jean (Eds.), The UNESCO Universal Declaration on Bioethics and Human Rights Background , principles and application (pp. 173–185). Paris: UNESCO Publishing.
Demirhan Erdemir, A. (2006). Acil Tedavi ve Bakımda Tıp Etiği Sorunları. İstanbul: Nobel Tıp Kitabevi.
Demirhan, N. (2003). Türkiye’de 112 - İlk ve Acil Yardım Hizmetleri ve Afetlerdeki Rolü. İstanbul: Nobel Tıp Kitabevi.
Domres, B, Koch, M., Manger, A., Becker, HD. (2001). Ethics and triage. Prehospital and Disaster Medicine, 16(1), 53–58. doi: 10.1017/S1049023X00025590
Domres, Bernd, Kees, T., Gromer, S., Braitmaier, P., Tanja, G. (2010). Ethical aspects of triage. ROCNİK, 2(3), 76–82.
Dunlop, M., Savulescu, J. (2015). Distributive justice and cognitive enhancement in lower, normal intelligence. Monash Bioethics Review, 32(3–4), 189–204. doi: 10.1007/s40592-014-0014-7
Ekşi, A. (2015a). Afet Yöneti̇mi̇nde İçsel Deneti̇m Aracı Olarak Eti̇k. Uluslararası İktisadi ve İdari İncelemeler Dergisi, 15. doi: 10.18092/ijeas.80069
Ekşi, A. (2015b). Kitlesel Olaylarda Hastane Öncesi Acil Sağlık Hizmetleri Yönetimi. İzmir: kitapAna.
Ekşi, A., Şen, G., Çelikli, S. (2019). Afet Triajında Etik İkilemlerin Değerlendirilmesi-İzmir İli Örneği. Turkiye Klinikleri J Med Ethics, 27(1), 30–39. doi: 10.5336/mdethic.2018-62914
Erbay, H. (2014). Some Ethical Issues in Prehospital Emergency Medicine. Turk J Emerg Med, 14(4), 193–198. doi: 10.5505/1304.7361.2014.32656
Erbay, H., Can, R., Turkan, AH. (2018). For Whom the Sirens Toll: A Study on an Ethical Challenge in Prehospital Emergency Medicine. Eurasian Journal of Emergency Medicine, 17(3), 122–128. doi: 10.5152/eajem.2018.76476
Ersoy, N., Akpınar, A. (2010). Triage decisions of emergency physicians in Kocaeli and the principle of justice Kocaeli ili acil hekimlerinin triyaj kararları ve adalet. Turkish Journal of Trauma & Emergency Surgery, 16(3), 203–209.
French, E., Casali, GL. (2008). Ethics in Emergency Medical Services – Who Cares? An exploratory analysis from Australia. Electronic Journal of Business Ethics and Organization Studies, 13(2), 44–53. Retrieved from http://ejbo.jyu.fi/pdf/ejbo_vol13_no2_pages_44-53.pdf
Geale, SK. (2012). The ethics of disaster management. Disaster Prevention and Management, 21(4), 445–462. doi: 10.1108/09653561211256152
Gerdtz, MF., Bucknall, TK. (2007). Influence of task properties and subjectivity on consistency of triage: A simulation study. Journal of Advanced Nursing, 58(2), 180–190. doi: 10.1111/j.1365-2648.2007.04192.x
Giannou, C., Baldan, M. (2010). War Surgery vol-I. International Committee of the Red Cross. Retrieved from https://www.icrc.org/eng/assets/files/other/icrc-002-0973.pdf
Giannou, C., Baldan, M., Molde, A. (2013). War Surgery vol-II. International Committee of the Red Cross. Retrieved from https://www.icrc.org/fre/assets/files/publications/icrc-002-4105.pdf
Girard, E., Jegousso, Q., Boussat, B., François, P., Ageron, FX., Letoublon, C., Bouzat, P. (2019). Preventable deaths in a French regional trauma system: A six-year analysis of severe trauma mortality. Journal of Visceral Surgery, 156(1), 10–16. doi: 10.1016/j.jviscsurg.2018.05.002
Goniewicz, M. (2013). Effect of military conflicts on the formation of emergency medical services systems worldwide. Academic Emergency Medicine, 20(5), 507–513. doi: 10.1111/acem.12129
Huibers, L., Smits, M., Renaud, V., Giesen, P., Wensing, M. (2011). Safety of telephone triage in out-of-hours care: a systematic review. Scandinavian Journal of Primary Health Care, 29(4), 198–209. doi: 10.3109/02813432.2011.629150
Iserson, KV., Moskop, JC. (2007). Triage in Medicine, Part I: Concept, History, and Types. Annals of Emergency Medicine, 49(3), 275–281. doi: 10.1016/j.annemergmed.2006.05.019
Iserson, KV., Sanders, AB., Mathieu, D. (1995). Ethics in Emergency Medicine (Second). Tucson, Arizona: Galen Press.
Jonsen, A., Siegler, M., Winslade, W. (2006). Clinical Ethics: a practical approach to ethical decisions in clinical medicine (Sixth edit). McGraw-Hill Medical Publishing. doi: 0-07-144199-9
Kleber, C., Giesecke, MT., Tsokos, M., Haas, NP., Buschmann, CT. (2013). Trauma-related preventable deaths in Berlin 2010: Need to change prehospital management strategies and trauma management education. World Journal of Surgery, 37(5), 1154–1161. doi: 10.1007/s00268-013-1964-2
Küçükoğlu, S., Köse, S., Aytekin, A., Kılıç, T. (2017). Acil Birimlerde Çalışan Hemşirelerin Triyaj Konusundaki Bilgi Düzeylerinin Ölçülmesi. J Pediatr Emerg Intensive Care Med, 4, 116–122. doi: 10.4274/cayd.42714
Lidal, IB., Holte, HH., Vist, GE. (2013). Triage systems for pre-hospital emergency medical services - a systematic review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 21(1), 28. doi: 10.1186/1757-7241-21-28
Lounsbury, DE. (2003). - Military Medical Ethics. In E. D. Pellegrino, A. E. Hartle, & E. G. Howe (Eds.), Textbooks of Military Medicine (Vol. 1, pp. 1–127). Washington: TMM Publications.
Moll, HA. (2010). Challenges in the validation of triage systems at emergency departments. Journal of Clinical Epidemiology, 63(4), 384–388. doi: 10.1016/j.jclinepi.2009.07.009
Moskop, JC., Iserson, KV. (2007). Triage in medicine, part II: Underlying values and principles. Annals of Emergency Medicine, 49(3), 282–287. doi: 10.1016/j.annemergmed.2006.07.012
Nakao, H., Ukai, I., Kotani, J. (2017). A review of the history of the origin of triage from a disaster medicine perspective. Acute Medicine & Surgery, 4(4), 379–384. doi: 10.1002/ams2.293
Newgard, CD., Fu, R., Lerner, EB., Daya, M., Jui, J., Wittwer, L., Schmidt, TA., Zive, D., Bulger, EM., Sahni, R., Warden, C., Kuppermann, N. (2017). Role of Guideline Adherence in Improving Field Triage. Prehospital Emergency Care, 21(5), 545–555. doi: 10.1080/10903127.2017.1308612
Newgard, CD., Kampp, M., Nelson, M., Holmes, JF., Zive, D., Rea, T., Bulger, EM., Liao, M., Sherck, J., Hsia, RY., Wang, NE., Fleischman, RJ., Barton, ED., Daya, M., Heineman, J., Kuppermann, N. (2012). Deciphering the use and predictive value of “emergency medical services provider judgment” in out-of-hospital trauma triage: A multisite, mixed methods assessment. Journal of Trauma and Acute Care Surgery, 72(5), 1239–1248. doi: 10.1097/TA.0b013e3182468b51
Özcan, M., Akpınar, A., Fatma, B., Beydilli, H. (2014). Ethical Challenges in Emergency Medical Services and Ethical Reasoning Among Emergency Care Providers. Acta Medica Mediterranea, 30, 241–247. Retrieved from http://www.actamedicamediterranea.com/medica/2014/med2014_pag-241-247.pdf
Parikh, PP., Parikh, P., Guthrie, B., Mamer, L., Whitmill, M., Erskine, T., Woods, R., Saxe, J. (2017). Impact of triage guidelines on prehospital triage: comparison of guidelines with a statistical model. Journal of Surgical Research, 220(February), 255–260. doi: 10.1016/j.jss.2017.06.084
Rabinovici, R., Frankel, HL., Kirton, OC. (2010). Trauma, Critical Care, and Surgical Emergencies: A Case and Evidence-Based Textbook. In R. Rabinovici, H. L. Frankel, & O. C. Kirton (Eds.), Informa Healthcare. doi: 10.1097/SLA.0b013e3182337f1f
Repine, TB., Lisagor, P., Cohen, DJ. (2005). The Dynamics and Ethics of Triage: Rationing Care in Hard Times. Military Medicine, 170(6), 505–509. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16001601
Roberts, A., Heaney, D., Haddow, G., O’Donnell, CA. (2009). Implementation of a national, nurse-led telephone health service in Scotland: assessing the consequences for remote and rural localities. Rural and Remote Health, 9(2), 1079.
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