Initial Evaluation and Preemptive Measures

After primary assessment and triage by the surgeon in charge, urological consultations will be requested for patients triaged to group 2 (severe, nonimmediately life-threatening injuries) and group 3 (ambulatory patients with supposedly mild injuries). Gross hematuria, pelvic injuries with suspected urethral or bladder injuries, inability to insert a urethral catheter, and external genital trauma are likely scenarios that will make the patient a urologic patient in a mass casualty scenario. As discussed above, in these extreme scenarios, the luxury of a trauma surgeon who remains in charge of the patient with other specialists functioning as consultants does not exist. In mass casualty events, any available physician becomes responsible for the patients assigned by the surgeon in charge and is additionally expected to give consultations according to his or her specialty. Therefore, the consulting urologist should bear in mind that in the chaotic conditions of a mass casualty event undertriage is plausible, meaning that a complete assessment of the patient assigned should be performed and attention should not be addressed to the urogenital injury only. This assessment should be quick but comprehensive and intended to reveal any signs of life-threatening injuries that may have been missed by the primary triage. A rapid (ABCDE - airway, breathing, circulation, disability or neurological status, exposure) survey should be conducted as dictated by the ATLS principles (Weighlt et al. 1997). Only after this clearance should the specific urologic injury be approached.

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