I congratulate the authors on their research. It is important to highlight that the Manchester triage system does incorporate shock or low blood pressure into its flow charts. It is described in the general discriminator text and flow chart. Any patients who are shocked should be triaged into priority one, if following the rules of MTS.
Therefore in this study all 9 of the 26 patients with a blood pressure of less than 90 mmHg should have been triaged into priority one, according to the rules of MTS. If these patients had been triaged in this way, the results of your study could be significantly affected.
We look forward to seeing further research from your selves in this area
As authors of a previous report about serious injuries that occurred
during an extreme sports obstacle course in the U.S. (1), we read with
interest the article by Alana Hawley, etal describing injury and illness
outcomes in a series of Canadian obstacle course events. (2) In this
Canadian study a small percentage of participants presented to onsite
medial services; the majority of complaints were minor and musculoskele...
As authors of a previous report about serious injuries that occurred
during an extreme sports obstacle course in the U.S. (1), we read with
interest the article by Alana Hawley, etal describing injury and illness
outcomes in a series of Canadian obstacle course events. (2) In this
Canadian study a small percentage of participants presented to onsite
medial services; the majority of complaints were minor and musculoskeletal
in nature. Only 2% of those treated were transferred to hospital through
EMS which is consistent with other types of mass gathering events. This
is in sharp contrast to our report in which over 100 EMS (advanced life
support calls) were activated on a single race. Social media drives
continued interest in these outcomes, and as authors, we were surprised by
the robust response of interest by a variety of media outlets in our 2014
manuscript. Particularly as these events become more popular
internationally, we just ask participants and readers to exercise caution
before they are left with the impression that these events are safe. Other
than the identified limitations that the Dr Hawley and her study team
expresses, it should be noted that they studied ONLY Mud Hero obstacle
courses. According to the Mud Hero frequently asked questions, (3) the
obstacles in these races have both hard and easy options and they do not
expose their participants to barbed wire, ice baths, or electric shocks.
The electrical shock injuries were the most severe type (myocarditis,
cerebrovascular accident) that we reported in our study. Ideally those in
the medical profession preparing for an event in their area would
determine the type of obstacles that will be used in the race, and
organize the appropriate EMS support. Likewise, participants preparing
for obstacle races should recognize the potential for increased personal
risk in those that have more dangerous obstacles (such as electrical
shocks).
(1) Greenberg MR, Kim PH, Duprey RT, etal. Unique obstacle race injuries
at an extreme sports event: a case series. Ann Emerg Med. 2014;63:361-6.
(2) Hawley A, Mercuri M, Hogg K, Hanel E. Obstacle Course Runs: Review of
Acquired injuries and illnesses at a Series of Canadian events (RACE)
Emerg Med J (online ahead of print) 9/15/2016
(3) Mud Hero Frequently Asked Questions. http://www.mudhero.com/en/faqs/
Accessed 09/20/2016
It would be useful to know the Total number of traumatic cardiac
arrests treated by the system during these three years. Hard to draw
conclusions on effectiveness without this figure. Also note different
results in the paper Chiang W-C et all on the next page of the journal.
(Emerg Med J 2017; 34: 39-45).
Dear Sirs,
I congratulate the authors on their research. It is important to highlight that the Manchester triage system does incorporate shock or low blood pressure into its flow charts. It is described in the general discriminator text and flow chart. Any patients who are shocked should be triaged into priority one, if following the rules of MTS.
Therefore in this study all 9 of the 26 patients with a blood pressure of less than 90 mmHg should have been triaged into priority one, according to the rules of MTS. If these patients had been triaged in this way, the results of your study could be significantly affected.
We look forward to seeing further research from your selves in this area
Kind Regards
Laura
As authors of a previous report about serious injuries that occurred during an extreme sports obstacle course in the U.S. (1), we read with interest the article by Alana Hawley, etal describing injury and illness outcomes in a series of Canadian obstacle course events. (2) In this Canadian study a small percentage of participants presented to onsite medial services; the majority of complaints were minor and musculoskele...
It would be useful to know the Total number of traumatic cardiac arrests treated by the system during these three years. Hard to draw conclusions on effectiveness without this figure. Also note different results in the paper Chiang W-C et all on the next page of the journal. (Emerg Med J 2017; 34: 39-45).
Conflict of Interest:
None declared
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