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

## TL;DR

This study creates ethical guidelines for treating severe limb injuries in resource-limited settings using expert consensus.

## Contribution

A modified Delphi method was used to generate 23 consensus-based ethical treatment statements for mangled extremities in resource-scarce environments.

## Key findings

- Seventy-seven experts participated in three rounds of consensus-building.
- Twenty-three statements achieved consensus for ethical triage and treatment guidelines.
- Twenty-one statements failed to reach consensus and require further research.

## Abstract

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

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 was repeated in the third round. Statements attaining consensus were moved to the final report. The remaining statements did not attain consensus.

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.

A modified 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 ethical treatment of the E&ME in RSEs.