背景:医院,病人,和卫生保健工作者受到国际人道主义法和《日内瓦公约》的法律保护。然而,自2023年10月7日以来,加沙地带的医疗保健系统,巴勒斯坦被占领土,遭到以色列前所未有的直接军事攻击,对患者的支持被证明对剩余的医护人员来说是具有挑战性的。点对点远程医疗有望帮助高风险的外科医生,低资源环境,但在极其严峻的环境中可能会降低效用。
方法:我们介绍了NasserMedicalComplex外科团队在国际远程医疗小组中共享的一系列创伤性损伤患者病例,也被称为纳赛尔医院,加沙最大的剩余部分运作的医院。WhatsApp(Meta;门洛帕克,CA,美国),广泛可用且用户友好的端到端加密智能手机应用程序,被用来促进对武器造成的伤害的咨询。所有提出的患者病例在获得患者的口头同意后进行共享,并通过多学科团队方法进行讨论。该小组发展成为一个社区,拥有超过15个专业和面向伤害的子小组,以及1000多名成员,他们通过非目标社交媒体外展活动加入,然后进行滚雪球招募。在加沙的预期登记和正式的道德批准是不可能的,因为卫生部,包括当地的赫尔辛基委员会,暂停了所有操作。六月,2024年,我们获得了加沙赫尔辛基当地委员会的道德批准。
结果:我们提供了2024年1月28日至2月12日纳赛尔医院收治的数百名患者中的12项精选病例研究。12例患者中有4例(33%)为女性,8例(67%)为男性,4名患者(33%)为儿童(18岁以下)。年龄范围在3岁到70岁之间,平均年龄为25岁。大多数患者出现穿透性损伤(12例患者中的11例[92%]),有六名患者出现继发于碎片损伤的伤口,和五名因枪伤受伤的病人。一名患者出现直接爆炸伤。报告的受伤部位包括头部和颈部(12个中的4个[33%]),腹部(12个中的4个[33%]),胸部(12个中的三个[25%]),骨盆(12个中的两个[17%]),和四肢(12个中的一个[8%])。大多数患者失去随访(12人中有11人[92%]),并受到以色列国防军入侵医院的影响,随后导致医院无法正常工作。一名患者受伤后死亡。
结论: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低资源的分配和分配,并依靠智能手机进行专门的远程医疗外展目的。这增强了医疗队管理军事攻击的大规模伤亡的能力,很少有人接受过培训。尽管如此,人手不足的医疗保健系统可以选择,服务不足,在围困之下,受到极大的限制,不管这样的远程医疗举措。
背景:无。
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.
RESULTS: 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.
CONCLUSIONS: 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.
BACKGROUND: None.