今回は「トリアージ （Triage）」を取り上げてみます。
番組の「医療ワード」では、
トリアージ：
災害時や非常時に､病気やケガの緊急度や重症度を判定して、治療や搬送の優先順位を決めること。判定結果は４段階に分かれていて、軽傷＝緑､中等症＝黄､重症＝赤､死亡＝黒という風に、それぞれ別の色で示されるんだよ｡
日本ではTriage Categoryが提示され、分類する際に使用するtriage tagsの書式が規格として統一されているようです。しかし、これは日本先進的のようで、アメリカなどではまだ統一化されていないようです。
Hurricane Katrina後のNew Orleansの病院での災害時の医療活動について、今年の初めにNEJMで問題提起の主張が掲載されました。
ここで私自身は初めてtriageという言葉を意識しました。
少し長くなりますが引用します。
[http://content.nejm.org/cgi/content/full/358/1/1
Dr. Pou and the Hurricane — Implications for Patient Care during Disasters,Susan Okie, M.D.]
[前略]
About 2000 people — patients, staff members, family members, and neighbors — had taken shelter at Memorial, which put a strain on the supplies of food and water. To obtain medications, staff members had to walk through pitch-dark hallways and stairways to the pharmacy. In Code Blue, his harrowing Katrina memoir, Deichmann describes "dozens of people sprawled on the floors and corridors of the hospital, lifting their voices to ask for water and assistance." Routines for tasks such as drug ordering and charting broke down; the approximately 25 physicians in the hospital, assigned to nurses' stations, were to sort patients into triage categories so that sicker patients could be evacuated first. To evacuate nonambulatory patients, employees had to carry them on stretchers down multiple flights of stairs to the second floor, pass them through a narrow opening in a wall into the parking garage, and then either transport them to the helipad on the garage roof or load them onto boats. "Our intention was that we were going to evacuate all the patients, [but] we decided early on that the patients that were 'no codes' . . . were going to be lower on the priority list," Deichmann said. "Lots of no-code patients were evacuated. Some of them died awaiting evacuation."
[後略]
この混乱の中で医師は「選別」をすることを求められたのですが、
"triage, by definition, is a sorting of patients for care — something we would never do on a day-to-day basis."
というという記述があるように、災害の非常でこの「選別」をするのは、日常的な判断ではない、と指摘しています。
日本でも運用においてはまだまだ課題はあるようです。
一方、このNEJMの記事には、reverse triageという用語が出てきています。
The standard of rescue [had] changed from Tuesday to Thursday; initially the sickest patients were evacuated first. When we realized that help was not imminent, . . . the standard of rescue changed to that of reverse triage. It was recognized that some patients might not survive, and priority was given to those who had the best chance of survival. On Thursday morning, only category 3 patients [the most gravely ill] remained on the LifeCare unit."
この記事で使われている用例が、一般的かどうかは分かりません。ここでは、もっとも助かる可能性のある人を「選別」して、医療活動をするという方針をとった、ということだと思います。
このところテレビ番組の『小児救命』を観れなかったので、「トリアージ」という言葉がどのように使われた知りたいところです。
[参考]
[Disaster Respose:Principles of Preparation Coordination
Chapter 8: TRIAGE
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