Planning of surgical resources in disaster settings

In October 1991, the education of nurses begun (anaesthesiology, intensive care, surgery), the list of essential medicals and supplies was created, needed quantities were calculated,"The plan of pharmacotherapeutic treatment of wounded” was written and entrusted to Topusko War Hospital. Education of general and emergency medical teams was planned but not implemented. In the hospital, technical provisions (space, beds, supply of gases, electricity, and water) were taken care of before the attack on Karlovac. Some organisational and expertise problems were taken care of during the war. There was a shortage of surgeons, anaesthesiologists, anaesthesiology technicians, nurses, physiotherapists in emergency admission, surgery, and ICU. Doctrines and knowledge of war medicine were missing. The approach to triage and care of wounded was not always standard. Particular problems were resolved in contacts with clinics. Hospital infections were more frequent. Burnout syndrome was also present. Donated medicines and medical supplies ware often wrongly distributed. Many pharmaceuticals were not used in Croatia, many were out of date and some were undersupplied. After the Homeland war, experiences, knowledge and problems were largely forgotten and physicians working during the war retired. With the advent of Covid-19 pandemic, medical staff organised their work, prepared resources and doctrines. The number of anaesthesiologists was not adequate. As in the war, there was a lack of anaesthesiology and intensive care nurses. Many problems were again solved on the fly. Working hours were increased as well as work intensity with psychical burden due to hopeless situations, lack of knowledge and skills. Burnout syndrome was again present. Teamwork was burdened by problems. It was necessary to establish conditions for the surgical work in specific circumstances. Healthcare system needs to be systematically and continuously prepared for the operation in disaster settings. © 2022 Hrvatski Lijecnicki Zbor. All rights reserved.

Vascular surgery triage during the coronavirus disease 2019 pandemic.

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has resulted in a marked increase in hospital usage, medical resource scarcity, and rationing of surgical procedures. This has created the need for strategies to triage surgical patients. We have described our experience using the American College of Surgeons (ACS) COVID-19 guidelines for triage of vascular surgery patients in an academic surgery practice. METHODS: We used the ACS guidelines as a framework to direct the triage of vascular surgery patients during the COVID-19 pandemic. We retrospectively analyzed the results of this triage during the first month of surgical restriction at our hospital. Patients undergoing surgery were identified by reviewing the operating room schedule. We reviewed the electronic medical records (EMRs) and assigned an ACS category, condition, and tier class to each completed surgery. Surgeries that were postponed during the same period were identified from a prospectively maintained list. We reviewed the EMRs for all postponed surgeries and assigned an ACS category, condition, and tier class to each surgery. We reviewed the EMRs for all postponed procedures to identify any adverse events related to the treatment delay. RESULTS: We performed 69 surgeries in 52 patients during the study period. All surgeries were performed to treat emergent, urgent, or time-sensitive elective diagnoses. Of the 69 surgeries, 47 (68%) were from tier 3 and 22 (32%) from tier 2b. We did not perform any surgeries from tier 1 or 2a. We postponed surgery for 66 patients during the same period, of which 36 (55%) were from tier 1, 22 (33%) from tier 2a, 5 (8%) from tier 2b, and 3 (5%) could not be assigned a tier class. No tier 3 surgeries were postponed. Of the 66 patients, 3 (4.5%) experienced an adverse event that could be attributed to the treatment delay. CONCLUSIONS: The ACS triage guidelines provided an effective method to decrease vascular surgical volumes during the COVID-19 pandemic without an increase in patient morbidity. We believe the clinical utility of the guidelines would be strengthened by incorporating the SURGCON/VASCCON (surgical activity condition/vascular activity condition) threat level alert system.

[Operate, cancel, postpone or select?] / Operieren, Absagen, Verschieben oder Selektionieren?: Ergebnisse einer Umfrage unter gefäßchirurgischen Zentren während der Covid-19-Krise in Österreich.

Regional centers performing vascular surgery in Austria (n = 15) were invited in mid-April 2020 by the Austrian Society of Vascular Surgery (ÖGG) to participate in a nationwide survey about implications of the COVID-19 pandemic. Ultimately, a total of 12 centers (80%) answered the questionnaire.All centers were confronted with patients who tested positive for COVID-19 and 75% also had medical personnel who were positive. In contrast, only 25% of the departments of vascular surgery had positively tested patients and 33% had positive staff members. In all departments of vascular surgery elective vascular procedures were either stopped (cancelled or deferred) or selectively limited, including patients with asymptomatic carotid stenosis, aortic aneurysms smaller than 7 cm, peripheral arterial aneurysm, peripheral artery occlusive disease Fontaine stage II and varicosities. All centers continued to carry out operations for all types of vascular surgical emergencies. The strategies of the centers were heterogeneous for patients with chronic ulcers, chronic mesenteric insufficiency, asymptomatic aortic aneurysms larger than 7 cm and shunt surgery.Decisions on surgery cancellation seemed to be particularly problematic due to the uncertain time period of the COVID-19 measures. As a consequence, the risk associated with cancellation or delayed treatment was difficult to assess. At present, especially indications with nonuniform management strategies need selective attention and additional analysis in single center and multicenter studies. In addition, patients might suffer from relevant psychological problems because of surgery cancellations. Changes in the daily routine due to the COVID-19 pandemic may have a long-term impact on health status and may show significant demographic and geographic variations.