Background
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▪ physician (emergency physician/anaesthesiologist1) and a
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▪ specialist nurse for anaesthesia and intensive care medicine.
The situation regarding the refugees
The rescue procedure for people in distress at Sea
Personal protection measures and working conditions
Medical examination and treatment options
Questions
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▪ Is the medical infrastructure suitable for a rescue mission of this nature?
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▪ Are the technical examinations carried out as part of the initial assessment (PR, CBT and SpO2) suitable for identifying sick or injured patients?
Material and methods
Inclusion and exclusion criteria
Variables examined
Data processing and analysis
Biometric methods
Results
General
Overall refugee population | |
---|---|
Number [n] |
n = 2656 |
Male Gender | 2048/2656 (77.1 %) |
Age structure | |
▪ Infant | 19/2656 (0.7 %) |
▪ Child | 274/2656 (10.3 %) |
▪ Adult | 2351/2656 (88.5 %) |
▪ Elderly | 31/2656 (1.2 %) |
Pregnant women | 24/2656 (0.9 %) |
Sick patients | 448/2656 (16.9 %) |
Admission to Emergency field hospitala
| 63/2056 (3.1 %) |
Initial assessment and triage
Category | ||||||||
---|---|---|---|---|---|---|---|---|
PR [/min] | ≤39 | 40-49 | 50-59 | 60-80 | 81-120 | 121-150 | ≥151 | Missing data |
Healthy participants | 0 (0.0 %) | 1 (0.1 %) | 5 (0.3 %) | 174 (9.0 %) | 1027 (53.0 %) | 344 (17.7 %) | 31 (1.6 %) | 717 (27.0 %) |
Sick patients | 0 (0.0 %) | 0 (0.0 %) | 1 (0.1 %) | 32 (1.7 %) | 200 (10.3 %) | 101 (5.2 %) | 23 (1.2 %) | |
CBT [°C] | ≤34.9 | 35.0-35.9 | 36.0-37.5 | 37.6-39.0 | ≥39.1 | Missing data | ||
Healthy participants | 37 (1.7 %) | 246 (11.1 %) | 1384 (62.4 %) | 160 (7.2 %) | 3 (0.1 %) | 439 (16.5 %) | ||
Sick patients | 7 (0.3 %) | 30 (1.4 %) | 247 (11.1 %) | 100 (4.5 %) | 3 (0.1 %) | |||
SpO2 [%] | ≤84 | 85-89 | 90-95 | 96-100 | Missing data | |||
Healthy participants | 6 (0.3 %) | 33 (1.7 %) | 76 (3.9 %) | 1469 (75.7 %) | 716 (27.0 %) | |||
Sick patients | 0 (0.0 %) | 12 (0.6 %) | 12 (0.6 %) | 332 (17.1 %) |
Variable | Category | Univariate binary logistic regression model | Multivariate binary logistic regression model without refugee boat Nagelkerkes R2 = .09 Sensitivity: 29.7 % Specifity = 89.4 % (Cut-Off: .25) | Multivariate binary logistic regression with refugee boat included: Nagelkerkes R2 = .21 Sensitivity: 54.0 % Specifity: 81.4 % (Cut-Off: .25) | ||||||
---|---|---|---|---|---|---|---|---|---|---|
R | P | OR [95 % CI] | R | P | OR [95 % CI] | R | P | OR [95 % CI] | ||
PR [/min] | ≤39 | not calculated a
| not calculated a
| not calculated a
| ||||||
40-49 | −21.20 | 1.000 | not calculated a
| not calculated a
| not calculated a
| |||||
50-59 | −1.61 | 0.14 | 0.20 [0.02-1.71] | −1.18 | .310 | 0.31 [0.03 - 2.99] | −0.61 | .617 | 0.54 [0.05-5.91] | |
60-80 | −1.69 | < .001 | 0.18 [0.13-0.27] | −1.07 | .004 | 0.34 [0.17 - 0.71] | −0.58 | .146 | 0.56 [0.26-1.22] | |
81-120 | −1.64 | < .001 | 0.20 [0.17-0.23] | −0.96 | .002 | 0.38 [0.21 - 0.71] | −0.75 | .027 | 0.47 [0.24-0.92] | |
121-150 | −1.23 | < .001 | 0.29 [0.24-0.37] | −0.71 | .025 | 0.49 [0.27 - 0.92] | −0.57 | .101 | 0.57 [0.29-1.12] | |
≥151 | −0,30 | .287 | 0.74 [0.43-1.27] | not included b
| not included b
| |||||
CBT [°C] | ≤34.9 | −1.67 | < .001 | 0.19 [0.08-0.42] | −1.18 | .264 | 0.31 [0.04 - 2.43] | −0.47 | .676 | 0.63 [0.07-5.57] |
35.0 – 35.9 | −2.10 | < .001 | 0.12 [0.08-0.18] | −1.58 | .062 | 0.21 [0.04 -1.09] | −1.33 | .145 | 0.26 [0.04-1.58] | |
36.0 – 37.5 | −1.72 | < .001 | 0.18 [0.15-0.20] | −1.53 | .065 | 0.22 [0.04 - 1.10] | −1.69 | .056 | 0.18 [0.03-1.05] | |
37.6 – 39.0 | −0.47 | < .001 | 0.63 [0.49-0.80] | −0.38 | .653 | 0.69 [0.13 -3.54] | −1.18 | .193 | 0.31 [0.05-1.81] | |
≥39.1 | 0.00 | 1.000 | 1.00 [0.20-5.0] | not included b
| not included b
| |||||
SpO2 [%] | ≤84 | −21.20 | 1.000 | not calculated a
| not calculated a
| not calculated a
| ||||
85-89 | −1.01 | .003 | 0.36 [0.19-0,70] | 1.22 | .339 | 3.37 [0.28 - 40.88] | 0.20 | .886 | 1.22 [0.08-17.71] | |
90-95 | −1.85 | < .001 | 0.16 [0.07-0.29] | 0.28 | .822 | 1.33 [0.11 - 15.91] | −0.64 | .639 | 0.53 [0.04-7.55] | |
96-100 | −1.49 | < .001 | 0.23 [0.20-0.26] | 0.52 | .669 | 1.68 [0.15-18.39] | −0.54 | .677 | 0.58 [0.05-7.52] | |
Age category | Infant | −2.83 | .006 | 0.06 [0.01-0.44] | −0.21 | .880 | 0.81 [0.05 -12.21] | −0.70 | .624 | 0.50 [0.03-8.10] |
Child | −1.80 | < .001 | 0.17 [0.12-0.23] | −0.14 | .873 | 0.87 [0.16 -4.72] | −0.35 | .695 | 0.70 [0.12-4.08] | |
Adult | −1.58 | < .001 | 0.21 [0.19-0.23] | −0.39 | .638 | 0.67 [0.13 -3.47] | −0.56 | .519 | 0.57 [0.10-3.14] | |
Elderly | −0.15 | .782 | 0.86 [0.29-2.55] | not included b
| not included b
| |||||
Gender | Male | 0.48 | < .001 | 1.62 [1.24-2.11] | 0.70 | < .001 | 2.01 [1.47 - 2.76] | 0.53 | .003 | 1.70 [1.21-2.40] |
Refugee Boat No. | 1 | 0.94 | < .001 | 2.56 [1.56-4.21] | 0.87 | .022 | 2.39 [1.14-5.01] | |||
2 | 1.17 | .001 | 3.23 [1.60-6.51] | 1.19 | .003 | 3.27 [1.50-7.14] | ||||
3 | 1.75 | < .001 | 5.77 [3.58-9.29] | 1.88 | < .001 | 6.56 [3.71-11.58] | ||||
4 | −0.05 | .863 | 0.95 [0.54-1.68] | −0.02 | .956 | 0.98 [0.47-2.06] | ||||
5 | 1.20 | < .001 | 3.33 [1.73-6.42] | 1.33 | < .001 | 3.79 [1.82-7.90] | ||||
6 | 1.80 | < .001 | 6.05 [3.20-11.44] | 1.84 | < .001 | 6.30 [3.06-12.95] | ||||
7 | 0.22 | .651 | 1.24 [0.49-3.16] | 0.41 | .418 | 1.51 [0.56-4.09] | ||||
8 | 1.79 | < .001 | 5.99 [3.60-9.96] | 1.98 | < .001 | 7.25 [3.90-13.49] | ||||
9 | 3.12 | < .001 | 22.59 [12.70-40.19] | 2.80 | < .001 | 16.52 [8.16-33.44] | ||||
10 | not calculatedb
| not included b
|
The patient population of people in distress at Sea
Overall patient population | |
---|---|
Number of sick/injured patients |
n = 448 |
Age group | |
▪ Infant | 1/448 (0.2 %) |
▪ Child | 38/448 (8.5 %) |
▪ Adult | 403/448 (90.0 %) |
▪ Elderly | 6/448 (1.3 %) |
Classification of symptoms | |
▪ Dermatological problems | 248/448 (55.4 %) |
▪ Cardiovascular problems | 99/448 (22.1 %) |
▪ Pulmonary problems | 20/448 (4.5 %) |
▪ Abdominal problems/GI infection | 5/448 (1.1 %) |
▪ Orthopaedic problems | 20/448 (4.5 %) |
▪ Injuries/Traumatological problems | 34/448 (7.6 %) |
▪ ENT/OMS problems | 8/448 (1.8 %) |
▪ Ophthalmological problems | 8/448 (1.8 %) |
▪ Gynaecological problems | 5/448 (1.1 %) |
Initial treatment | |
▪ Infusion therapy | 35/448 (7.8 %) |
▪ Analgesia | 39/448 (8.7 %) |
▪ Antibiotic treatment | 10/448 (2.2 %) |
▪ Bandages/wound cleaning | 19/448 (4.2 %) |
▪ Other medical measures | 14/448 (3.1 %) |
▪ Admission to emergency field hospital | 62/365 (17.0 %) |
Treatment during initial care
Follow-on care
Discussion
Discussion on the initial assessment
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▪ In addition, stress, physical exhaustion, and the climatic conditions led to pathologically higher PR although initial treatment had not been indicated [26].
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▪ The typical population observed in an A&E Department is “sick/injured” per definition [20]. In our unselected collective of people rescued from distress at sea 83.1 % were healthy participants.