在 2023-24 年对巴勒斯坦被占领土加沙地带的军事袭击期间,通过全球远程医疗倡议提供的创伤护理支持:病例系列。

IF 98.4 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Khaled Alser, Saad I Mallah, Yehya Rami Abu El-Oun, Mohammed Ghayada, Abd Al-Karim Sammour, Mads Gilbert, Simon Fitzgerald, Zarina Shaikh, Osaid Alser
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引用次数: 0

摘要

背景:医院、病人和医护人员在法律上受到国际人道主义法和《日内瓦公约》的保护。然而,自 2023 年 10 月 7 日以来,巴勒斯坦被占领土加沙地带的医疗保健系统一直受到以色列前所未有的直接军事攻击,事实证明,对病人的支持对剩余的医疗保健人员来说是一项挑战。点对点远程医疗有望为高风险、低资源环境中的外科医生提供帮助,但在极端艰苦的环境中,其效用可能会大打折扣:我们在一个国际远程医疗小组中介绍了由纳赛尔医疗中心(又称纳赛尔医院,是加沙现存最大的部分运作的医院)外科团队分享的创伤患者病例系列。WhatsApp(Meta;美国加利福尼亚州门洛帕克市)是一种广泛使用且用户友好的端到端加密智能手机应用程序,用于促进武器造成的伤害的会诊。在征得患者口头同意后,所有提交的患者病例都得到了共享,并通过多学科小组的方式进行了讨论。该小组已发展成为一个社区,拥有超过 15 个以专科和伤害为导向的子小组,以及通过非定向社交媒体宣传和滚雪球式招募加入的 1000 多名成员。由于卫生部(包括当地的赫尔辛基委员会)已经暂停了所有业务,因此我们无法在加沙进行前瞻性注册和正式的伦理审批。2024 年 6 月,我们获得了加沙当地赫尔辛基委员会的伦理批准:我们从 2024 年 1 月 28 日至 2 月 12 日期间纳赛尔医院收治的数百名患者中精选了 12 个病例进行研究。12 名患者中有 4 名(33%)为女性,8 名(67%)为男性,其中 4 名患者(33%)为儿童(18 岁以下)。年龄在 3 岁至 70 岁之间,中位年龄为 25 岁。大多数患者为穿透伤(12 人中有 11 人[92%]),6 名患者为继发性碎片伤,5 名患者为枪伤。一名患者为直接爆炸伤。报告的受伤部位包括头颈部(12 人中有 4 人[33%])、腹部(12 人中有 4 人[33%])、胸部(12 人中有 3 人[25%])、骨盆(12 人中有 2 人[17%])和四肢(12 人中有 1 人[8%])。大多数患者失去了随访机会(12 人中有 11 人[92%]),以色列国防军入侵医院,导致医院无法运作。一名患者在受伤后死亡:加沙南部现已无法运作的纳赛尔医院的医疗团队调整了他们对极少资源的分配和分配,并依靠智能手机进行专门的远程医疗外联。这增强了医疗队处理军事袭击造成的大量伤员的能力,而很少有人受过这方面的培训。尽管如此,对于一个人手不足、服务不足、处于围困之中的医疗系统来说,无论采取何种远程医疗举措,其可供选择的方案都极为有限:资金:无。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Trauma care supported through a global telemedicine initiative during the 2023-24 military assault on the Gaza Strip, occupied Palestinian territory: a case series.

Background: Hospitals, patients, and health-care workers are legally protected by international humanitarian law and the Geneva Convention. However, since Oct 7, 2023, the health-care system in the Gaza Strip, occupied Palestinian territory, has been under unprecedented direct military attacks by Israel, with support for patients proving to be challenging for the remaining health-care workers. Peer-to-peer telemedicine holds promise for assisting surgeons in high-risk, low-resource environments, but might be of reduced utility in extremely austere settings.

Methods: We present a patient case series of traumatic injuries shared in an international telemedicine group by the surgical team at Nasser Medical Complex, also known as Nasser Hospital, the largest remaining partially functioning hospital in Gaza. WhatsApp (Meta; Menlo Park, CA, USA), a widely available and user-friendly end-to-end encrypted smartphone application, was used to facilitate consultations for weapon-inflicted injuries. All the presented patient cases were shared after obtaining verbal consent from the patients and discussed through a multidisciplinary team approach. The group was developed into a community with more than 15 specialty and injury-oriented subgroups and over 1000 members who joined through non-targeted social media outreach followed by snowball recruitment. Prospective registration and formal ethics approval in Gaza was impossible because the Ministry of Health, including the local Helsinki Committee, had suspended all operations. In June, 2024, we obtained ethics approval from the local Helsinki committee in Gaza.

Findings: We present 12 select patient case studies from a pool of hundreds of patients admitted to Nasser Hospital between Jan 28 and Feb 12, 2024. Four (33%) of the 12 patients were female and eight (67%) were male, with four patients (33%) being children (younger than 18 years). The age range was between 3 years and 70 years, with a median age of 25 years. Most patients presented with penetrating injuries (11 [92%] of 12), with six patients presenting with wounds secondary to fragment injury, and five patients presenting with wounds due to gunshots. One patient presented with a direct blast injury. The site of reported injuries included head and neck areas (four [33%] of 12), abdomen (four [33%] of 12), chest (three [25%] of 12), pelvis (two [17%] of 12), and limbs (one [8%] of 12). Most patients were lost to follow-up (11 [92%] of 12) and were affected by the invasion of the hospital by the Israeli Defense Forces, which subsequently rendered the hospital non-functional. One patient died following their injury.

Interpretation: The health-care team at the now non-functioning Nasser Hospital in southern Gaza adapted their allocation and distribution of extremely low resources and relied on smartphones for specialised telemedicine outreach purposes. This enhanced the capability of the medical teams in management of mass casualties of military assaults that few are trained to work in. Nonetheless, the options available to a health-care system that is under-staffed, under-served, and under siege, are extremely constrained, regardless of such telemedicine initiatives.

Funding: None.

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来源期刊
The Lancet
The Lancet 医学-医学:内科
CiteScore
148.10
自引率
0.70%
发文量
2220
审稿时长
3 months
期刊介绍: The Lancet is a world-leading source of clinical, public health, and global health knowledge. It was founded in 1823 by Thomas Wakley and has been an independent, international weekly general medical journal since then. The journal has an Impact Factor of 168.9, ranking first among 167 general and internal medicine journals globally. It also has a Scopus CiteScore of 133·2, ranking it second among 830 general medicine journals. The Lancet's mission is to make science widely available to serve and transform society, positively impacting people's lives. Throughout its history, The Lancet has been dedicated to addressing urgent topics, initiating debate, providing context for scientific research, and influencing decision makers worldwide.
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