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A T2 Translational Science Modified Delphi Study: The Ethical Triage and Treatment of the Entrapped and Mangled Extremities in Resource Scarce Environments

Published online by Cambridge University Press:  21 May 2025

Eric S Weinstein Open the ORCID record for Eric S Weinstein [Opens in a new window] ,
Zachary Gilbert ,
James Gosney ,
Brielle Weinstein Open the ORCID record for Brielle Weinstein [Opens in a new window] ,
Hannah Wild Open the ORCID record for Hannah Wild [Opens in a new window] ,
Joseph Cuthbertson Open the ORCID record for Joseph Cuthbertson [Opens in a new window] ,
Melissa Leming  and
Frederick M Burkle Open the ORCID record for Frederick M Burkle [Opens in a new window]
Eric S Weinstein
Affiliation:
Department of Emergency Medicine – Morsani College of Medicine, University of South Florida, Tampa, Fl, United States
Zachary Gilbert
Affiliation:
Department of Emergency Medicine – Morsani College of Medicine, University of South Florida, Tampa, Fl, United States
James Gosney
Affiliation:
Patrick & Henry Community College, Martinsville, Va, United States
Brielle Weinstein
Affiliation:
Department of Plastic Surgery Morsani College of Medicine, University of South Florida, Tampa, Fl, United States
Hannah Wild
Affiliation:
Program for Global and Rural Surgery University of Washington, Seattle, WA, United States Explosive weapons trauma care collective, International blast injury research network University of Southampton, Southampton, United Kingdom
Joseph Cuthbertson
Affiliation:
Monash University Disaster Resilience Initiative, Monash University, Monash, VIC, Australia Curtin University, Faculty of Health Sciences, Bentley, WA, Australia CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Novara, Italy
Melissa Leming
Affiliation:
Department of Emergency Medicine – Morsani College of Medicine, University of South Florida, Tampa, Fl, United States
Frederick M Burkle
Affiliation:
Global Scholar Woodrow Wilson International Center for Scholars, Washington, D.C., United States
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Abstract

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Background/Introduction:

There is a lack of ethical triage and treatment guidelines for the entrapped and mangled extremity (E&ME) in resource scarce environments: mass casualty incidents, low- to middle- income countries, complex humanitarian emergencies including conflict, and prolonged transport times (RSE).

Objectives:

The aim of this study is to use a modified Delphi (mD) approach to produce statements to develop treatment guidelines of the E&ME in RSE to advance the 2021 WHO EMT Minimum Standards (EMT) treating the E&ME.

Method/Description:

Experts rated their agreement with each statement on a 7- point linear numeric scale. Consensus amongst experts was defined as a standard deviation <= 1. Statements attaining consensus after the first round moved to the final report. Those not attaining consensus moved to the second round in which experts were shown the mean response of the expert panel and their own response for the opportunity to reconsider their rating for that round. Statements attaining consensus after the second round moved to the final report. This process repeated in the third round. Statements attaining consensus moved to the final report. The remaining statements did not attain consensus.

Results/Outcomes:

Seventy-seven experts participated in the first, 75 in the second, and 74 in the third round. Twenty-three statements attained consensus. Twenty-one statements did not attain consensus.

Conclusion:

A Delphi technique was used to establish consensus regarding the numerous complex factors influencing treatment of the E&ME in RSEs. Twenty-three statements attained consensus and can be incorporated into guidelines to advance the EMT treating the E&ME.

Type
Meeting Abstracts
Information
Prehospital and Disaster Medicine , Volume 40 , Supplement S1: Abstracts of the World Health Organization (WHO) 6th Emergency Medical Teams (EMT) Global Meeting 2024 , May 2025 , pp. s12 - s13
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Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of World Association for Disaster and Emergency Medicine