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Lemarquand A, Jannot P, Kammerlocher L, Lissorgues G, Behr M, Arnoux PJ, Boussen S. A new trauma severity scoring system adapted to wearable monitoring: A pilot study. PLoS One 2025; 20:e0318290. [PMID: 40036212 PMCID: PMC11878944 DOI: 10.1371/journal.pone.0318290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 01/13/2025] [Indexed: 03/06/2025] Open
Abstract
Wearable technologies represent a strong development axis for various medical applications and these devices are increasingly used in daily life as illustrated by smart watches' popularisation. Combined with new data processing methods, it constitutes a promising opportunity for telemonitoring, triage in mass casualty situations, or early diagnosis after a traffic or sport accident. An approach to processing the physiological data is to develop severity scoring systems to quantify the critical level of an individual's health status. However, the existing severity scores require a human evaluation. A first version of a severity scoring system adapted to continuous and real-time wearable monitoring is proposed in this article. The focus is made on three physiological parameters straightforwardly measurable with wrist-wearables: heart rate, respiratory rate, and SpO2, which may be enough to characterise continuously hemodynamic and respiratory status. Intermediate score functions corresponding to each physiological parameter have been established using a sigmoid model. The boundary conditions have been defined based on a survey conducted among 54 health professionals. An adapted function has also been developed to merge the three intermediate scores into a global score. The scores are associated with a triage tricolour code: green for a low-priority casualty, orange for a delayable one, red for an urgent one. Preliminary confrontation of the new severity scoring system with real data has been carried out using a database of 84 subjects admitted to the intensive care unit. Colour classification by the new scoring system was compared with independent physicians' direct evaluation as a reference. The prediction success rate values 74% over the entire database. Two examples of continuous monitoring over time are also given. The new score has turned out to be consistent, and may be easily upgraded with the integration of additional vital signs monitoring or medical information.
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Affiliation(s)
- Alice Lemarquand
- Laboratoire de Biomécanique Appliquée, Université Gustave Eiffel, Aix-Marseille Université, Marseille, France
- Laboratoire ESYCOM, Université Gustave Eiffel, Noisy-le-Grand, France
| | - Pierre Jannot
- Laboratoire de Biomécanique Appliquée, Université Gustave Eiffel, Aix-Marseille Université, Marseille, France
- Ecole National Supérieure des Officiers Sapeurs-Pompiers, Aix-en-Provence, France
| | - Léo Kammerlocher
- Laboratoire de Biomécanique Appliquée, Université Gustave Eiffel, Aix-Marseille Université, Marseille, France
| | - Gaëlle Lissorgues
- Laboratoire ESYCOM, Université Gustave Eiffel, Noisy-le-Grand, France
| | - Michel Behr
- Laboratoire de Biomécanique Appliquée, Université Gustave Eiffel, Aix-Marseille Université, Marseille, France
| | - Pierre-Jean Arnoux
- Laboratoire de Biomécanique Appliquée, Université Gustave Eiffel, Aix-Marseille Université, Marseille, France
| | - Salah Boussen
- Laboratoire de Biomécanique Appliquée, Université Gustave Eiffel, Aix-Marseille Université, Marseille, France
- Intensive Care and Anesthesiology Department, La Timone Teaching Hospital, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille, Marseille, France
- Anesthesiology and Intensive Care Unit, Sainte Anne National Military Teaching Hospital, Toulon, France
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Carenzo L, Gamberini L, Crimaldi F, Colombo D, Ingrassia PL, Ragazzoni L, Della Corte F, Caviglia M. Factors affecting the accuracy of prehospital triage application and prehospital scene time in simulated mass casualty incidents. Scand J Trauma Resusc Emerg Med 2024; 32:97. [PMID: 39327602 PMCID: PMC11426006 DOI: 10.1186/s13049-024-01257-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 08/30/2024] [Indexed: 09/28/2024] Open
Abstract
BACKGROUND The contemporary management of mass casualty incidents (MCIs) relies on the effective application of predetermined, dedicated response plans based on current best evidence. Currently, there is limited evidence regarding the factors influencing the accuracy of first responders (FRs) in applying the START protocol and the associated prehospital times during the response to MCIs. The objective of this study was to investigate factors affecting FRs' accuracy in performing prehospital triage in a series of simulated mass casualty exercises. Secondly, we assessed factors affecting triage-to-scene exit time in the same series of exercises. METHODS This retrospective study focused on simulated casualties in a series of simulated MCIs Full Scale Exercises. START triage was the triage method of choice. For each Full-Scale Exercise (FSEx), collected data included exercise and casualty-related information, simulated casualty vital parameters, simulated casualty anatomic lesions, scenario management times, and responder experience. RESULTS Among the 1090 casualties included in the primary analysis, 912 (83.6%) were correctly triaged, 137 (12.6%) were overtriaged, and 41 (3.7%) were undertriaged. The multinomial regression model indicated that increasing heart rate (RRR = 1.012, p = 0.008), H-AIS (RRR = 1.532, p < 0.001), and thorax AIS (T-AIS) (RRR = 1.344, p = 0.007), and lower ISS (RRR = 0.957, p = 0.042) were independently associated with overtriage. Undertriage was significantly associated with increasing systolic blood pressure (RRR = 1.013, p = 0.005), AVPU class (RRR = 3.104 per class increase), and A-AIS (RRR = 1.290, p = 0.035). The model investigating the factors associated with triage-to-scene departure time showed that the assigned prehospital triage code red (TR = 0.841, p = 0.002), expert providers (TR = 0.909, p = 0.015), and higher peripheral oxygen saturation (TR = 0.998, p < 0.001) were associated with a reduction in triage-to-scene departure time. Conversely, increasing ISS was associated with a longer triage-to-scene departure time (TR = 1.004, 0.017). CONCLUSIONS Understanding the predictors influencing triage and scene management decision-making by healthcare professionals responding to a mass casualty may facilitate the development of tailored training pathways regarding mass casualty triage and scene management.
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Affiliation(s)
- Luca Carenzo
- Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy.
| | - Lorenzo Gamberini
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
| | - Federico Crimaldi
- Department of Anesthesia and Critical Care, Ospedale "Ss. Trinità", Borgomanero, Italy
| | - Davide Colombo
- Department of Anesthesia and Critical Care, Ospedale "Ss. Trinità", Borgomanero, Italy
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
| | - Pier Luigi Ingrassia
- Centro Professionale Sociosanitario, Centro di Simulazione (CeSi), Lugano, Switzerland
| | - Luca Ragazzoni
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
| | - Francesco Della Corte
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Marta Caviglia
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
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Vernon TE, April MD, Fisher AD, Rizzo JA, Long BJ, Schauer SG. An Assessment of Clinical Accuracy of Vital Sign-based Triage Tools Among U.S. and Coalition Forces. Mil Med 2024; 189:e1528-e1536. [PMID: 38285545 DOI: 10.1093/milmed/usad500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/04/2023] [Accepted: 01/04/2024] [Indexed: 01/31/2024] Open
Abstract
INTRODUCTION Early appropriate allocation of resources for critically injured combat casualties is essential. This is especially important when inundated with an overwhelming number of casualties where limited resources must be efficiently allocated, such as during mass casualty events. There are multiple scoring systems utilized in the prehospital combat setting, including the shock index (SI), modified shock index (MSI), simple triage and rapid treatment (START), revised trauma score (RTS), new trauma score (NTS), Glasgow Coma Scale + age + pressure (GAP), and the mechanism + GAP (MGAP) score. The optimal score for application to the combat trauma population remains unclear. MATERIALS AND METHODS This is a secondary analysis of a previously described dataset from the Department of Defense Trauma Registry from January 1, 2007 through March 17, 2020. We constructed univariable analyses to determine the area under the receiving operator characteristic (AUROC) for the scoring systems of interest. Our primary outcomes were early death (within 24 hours) or early massive transfusion, as defined by ≥3 units. RESULTS There were 12,268 casualties that met inclusion criteria. There were 168 (1%) who died within the first 24 hours and 2082 (17%) that underwent significant transfusion within the first 24 hours. When assessing the predictive capabilities for death within 24 hours, the AUROCs were 0.72 (SI), 0.69 (MSI), 0.89 (START), 0.90 (RTS), 0.83 (NTS), 0.90 (GAP), and 0.91 (MGAP). The AUROCs for massive transfusion were 0.89 (SI), 0.89 (MSI), 0.82 (START), 0.81 (RTS), 0.83 (NTS), 0.85 (MGAP), and 0.86 (GAP). CONCLUSIONS This study retrospectively applied seven triage tools to a database of 12,268 cases from the Department of Defense Trauma Registry to evaluate their performance in predicting early death or massive transfusion in combat. All scoring systems performed well with an AUROC >0.8 for both outcomes. Although the SI and MSI performed best for predicting massive transfusion (both had an AUROC of 0.89), they ranked last for assessment of mortality within 24 hours, with the other tools performing well. START, RTS, NTS, MGAP and GAP reliably identified early death and need for massive transfusion, with MGAP and GAP performing the best overall. These findings highlight the importance of assessing triage tools to best manage resources and ultimately preserve lives of traumatically wounded warfighters. Further studies are needed to explain the surprising performance discrepancy of the SI and MSI in predicting early death and massive transfusion.
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Affiliation(s)
- Tate E Vernon
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Michael D April
- 14th Field Hospital, Fort Stewart, GA 31314, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Andrew D Fisher
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM 87106, USA
| | - Julie A Rizzo
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Brit J Long
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Steven G Schauer
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO 80045, USA
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
- Center for Combat and Battlefield (COMBAT) Research, University of Colorado School of Medicine, Aurora, CO 80045, USA
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Açıksarı K, Koçak M, Solakoğlu GA, Bodas M. The effect of multiple triage points on the outcomes (time and accuracy) of hospital triage during mass casualty incidents. Injury 2024; 55:111318. [PMID: 38238120 DOI: 10.1016/j.injury.2024.111318] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 12/27/2023] [Accepted: 01/07/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION During mass casualty incidents (MCIs), the accuracy and timing of the triage of patients by the emergency department (ED) triage officers are essential. The primary triage is performed at the event's location by paramedics and intends a quick evaluation of the victims. Secondary triage may be used when the transfer of the victim is delayed. In this study, we aimed to investigate the effectiveness of two-point triage in a simulated environment of an MCI in the hospital setting. MATERIALS AND METHODS In this case-control study, we used an online test module to assess single triage points (Group 1, n = 41) and two triage points (Group 2, n = 40). 60 vignettes for Group 1 and 55 vignettes (5 deceased cases removed) for Group 2 were used. The assessment utilized clinical MCI scenarios in a scheduled online meeting by using the Simple Triage and Rapid Treatment (START) system. Triage time and accuracy of the triage, along with the experience, and previous training of the participants, were assessed. RESULTS A total of 81 triage officers participated in this study. The participants were divided into two independent groups homogenously according to their profession and experience. Groups were comparable primarily without any statistically significant difference in terms of the profession (p = 0.101), sex (p = 0.923), and MCI experience (p = 0.785). The difference between the two groups was not significant with regard to having received practical or theoretical triage training (p = 0.099). The mean time of a single vignette triage was 19.2 (SD 6.5) seconds and mean percentage of correct triage score was 65.0 (SD 12.6). The participants had a statistically significantly better performance in the single-point triage group regarding the median triage time (p < 0.001) and median percentages of under triage (p = 0.001), but a worse median percentage of over triage (p < 0.001). However, there was no significant difference between the two groups in terms of the percentage of accurate triage. Emergency residents performed better in accuracy and triage time than their non-physician colleagues (p = 0.019). CONCLUSIONS Two-point triage does not demonstrate better outcomes in terms of accuracy and timing. Triage officers should be trained frequently with the preferred training methodology to prevent improper triage accuracy and timing. Well-defined medical disaster planning should include frequent training of the triage officers with case scenarios.
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Affiliation(s)
- Kurtulus Açıksarı
- Department of Emergency Medicine, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Mehmet Koçak
- Department of Emergency Medicine, Primary Health Care Corporation, Doha, Qatar.
| | - Görkem Alper Solakoğlu
- Department of Emergency Medicine, Faculty of Medicine, Istanbul Medeniyet University Istanbul, Turkey
| | - Moran Bodas
- Department of Emergency & Disaster Management, School of Public Health, Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, Israel
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Khorram-Manesh A, Carlström E, Burkle FM, Goniewicz K, Gray L, Ratnayake A, Faccincani R, Bagaria D, Phattharapornjaroen P, Sultan MAS, Montán C, Nordling J, Gupta S, Magnusson C. The implication of a translational triage tool in mass casualty incidents: part three: a multinational study, using validated patient cards. Scand J Trauma Resusc Emerg Med 2023; 31:88. [PMID: 38017553 PMCID: PMC10683288 DOI: 10.1186/s13049-023-01128-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/09/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Mass casualty incidents (MCI) pose significant challenges to existing resources, entailing multiagency collaboration. Triage is a critical component in the management of MCIs, but the lack of a universally accepted triage system can hinder collaboration and lead to preventable loss of life. This multinational study uses validated patient cards (cases) based on real MCIs to evaluate the feasibility and effectiveness of a novel Translational Triage Tool (TTT) in primary triage assessment of mass casualty victims. METHODS Using established triage systems versus TTT, 163 participants (1575 times) triaged five patient cases. The outcomes were statistically compared. RESULTS TTT demonstrated similar sensitivity to the Sieve primary triage method and higher sensitivity than the START primary triage system. However, the TTT algorithm had a lower specificity compared to Sieve and higher over-triage rates. Nevertheless, the TTT algorithm demonstrated several advantages due to its straightforward design, such as rapid assessment, without the need for additional instrumental interventions, enabling the engagement of non-medical personnel. CONCLUSIONS The TTT algorithm is a promising and feasible primary triage tool for MCIs. The high number of over-triages potentially impacts resource allocation, but the absence of under-triages eliminates preventable deaths and enables the use of other personal resources. Further research involving larger participant samples, time efficiency assessments, and real-world scenarios is needed to fully assess the TTT algorithm's practicality and effectiveness in diverse multiagency and multinational contexts.
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Affiliation(s)
- Amir Khorram-Manesh
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, 405 30, Gothenburg, Sweden.
- Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska Academy, 413 45, Gothenburg, Sweden.
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, 405 30, Gothenburg, Sweden.
- Center for Disaster Medicine, Gothenburg University, 405 30, Gothenburg, Sweden.
| | - Eric Carlström
- Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska Academy, 413 45, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, 405 30, Gothenburg, Sweden
- USN School of Business, University of South-Eastern Norway, 3199, Borre, Norway
| | | | | | - Lesley Gray
- Department of Primary Health Care & General Practice, University of Otago, Wellington, New Zealand
- Joint Centre for Disaster Research, Massey University, Wellington, New Zealand
| | - Amila Ratnayake
- Sri Lanka Army Hospital, Narahenpita, Colombo, 08, Sri Lanka
| | - Roberto Faccincani
- Emergency Department, Humanitas Mater Domini, 210 53, Castellanza, Italy
| | - Dinesh Bagaria
- Division of Trauma Surgery & Critical Care, J.P.N. Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Carl Montán
- Karolinska MRMID-International Association for Medical Response to Major Incidents, Stockholm, Sweden
- Disasters, and Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Johan Nordling
- Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska Academy, 413 45, Gothenburg, Sweden
| | - Shailly Gupta
- Division of Trauma Surgery & Critical Care, J.P.N. Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Carl Magnusson
- Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska Academy, 413 45, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, 405 30, Gothenburg, Sweden
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Alruqi F, Aglago EK, Cole E, Brohi K. Factors Associated With Delayed Pre-Hospital Times During Trauma-Related Mass Casualty Incidents: A Systematic Review. Disaster Med Public Health Prep 2023; 17:e525. [PMID: 37947290 DOI: 10.1017/dmp.2023.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Critically injured patients have experienced delays in being transported to hospitals during Mass Casualty Incidents (MCIs). Extended pre-hospital times (PHTs) are associated with increased mortality. It is not clear which factors affect overall PHT during an MCI. This systematic review aimed to investigate PHTs in trauma-related MCIs and identify factors associated with delays for triaged patients at incident scenes. METHODS This systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Web of Science, CINAHL, MEDLINE, and EMBASE were searched between January and February 2022 for evidence. Research studies of any methodology, and grey literature in English, were eligible for inclusion. Studies were narratively synthesized according to Cochrane guidance. RESULTS Of the 2025 publications identified from the initial search, 12 papers met the inclusion criteria. 6 observational cohort studies and 6 case reports described a diverse range of MCIs. PHTs were reported variably across incidents, from a median of 35 minutes to 8 hours, 8 minutes. Factors associated with prolonged PHT included: challenging incident locations, concerns about scene safety, and adverse decision-making in MCI triage responses. Casualty numbers did not consistently influence PHTs. Study quality was rated moderate to high. CONCLUSION PHT delays of more than 2 hours were common. Future MCI planning should consider responses within challenging environments and enhanced timely triage decision-making.
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Affiliation(s)
- Fayez Alruqi
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
- Emergency Medical Services Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Elom K Aglago
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Elaine Cole
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - Karim Brohi
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
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Cuthbertson J, Weinstein E, Franc JM, Jones P, Lamine H, Magalini S, Gui D, Lennquist K, Marzi F, Borrello A, Fransvea P, Fidanzio A, Benítez CY, Achaz G, Dobson B, Malik N, Neeki M, Pirrallo R, Castro Delgado R, Strapazzon G, Farah Dell’Aringa M, Brugger H, Rafalowsky C, Marzoli M, Fresu G, Kolstadbraaten KM, Lennquist S, Tilsed J, Claudius I, Cheeranont P, Callcut R, Bala M, Kerbage A, Vale L, Hecker NP, Faccincani R, Ragazzoni L, Caviglia M. Sudden-Onset Disaster Mass-Casualty Incident Response: A Modified Delphi Study on Triage, Prehospital Life Support, and Processes. Prehosp Disaster Med 2023; 38:570-580. [PMID: 37675480 PMCID: PMC10548019 DOI: 10.1017/s1049023x23006337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/26/2023] [Accepted: 08/03/2023] [Indexed: 09/08/2023]
Abstract
The application and provision of prehospital care in disasters and mass-casualty incident response in Europe is currently being explored for opportunities to improve practice. The objective of this translational science study was to align common principles of approach and action and to identify how technology can assist and enhance response. To achieve this objective, the application of a modified Delphi methodology study based on statements derived from key findings of a scoping review was undertaken. This resulted in 18 triage, eight life support and damage control interventions, and 23 process consensus statements. These findings will be utilized in the development of evidence-based prehospital mass-casualty incident response tools and guidelines.
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Affiliation(s)
- Joe Cuthbertson
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Monash University Disaster Resilience Initiative, Monash University, ClaytonVICAustralia
| | - Eric Weinstein
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
| | - Jeffrey Michael Franc
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Peter Jones
- Assistance Publique – Hópitaux de Paris (APHP), SAMU de Paris Hôpital Necker, Paris, France
| | - Hamdi Lamine
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
| | - Sabina Magalini
- Department of Surgery, Catholic University of the Sacred Heart, Policlinico Gemelli, Rome, Italy
| | - Daniele Gui
- Department of Neurosciences, Catholic University of the Sacred Heart, Policlinico Gemelli, Rome, Italy
| | - Kristina Lennquist
- Department of Neurosciences, Catholic University of the Sacred Heart, Policlinico Gemelli, Rome, Italy
| | - Federica Marzi
- Department of Neurosciences, Catholic University of the Sacred Heart, Policlinico Gemelli, Rome, Italy
| | - Alessandro Borrello
- Department of Neurosciences, Catholic University of the Sacred Heart, Policlinico Gemelli, Rome, Italy
| | - Pietro Fransvea
- Department of Neurosciences, Catholic University of the Sacred Heart, Policlinico Gemelli, Rome, Italy
| | - Andrea Fidanzio
- Department of Neurosciences, Catholic University of the Sacred Heart, Policlinico Gemelli, Rome, Italy
| | | | - Gerhard Achaz
- London Ambulance Service NHS Trust, London, London, United Kingdom
| | - Bob Dobson
- London Ambulance Service NHS Trust, London, London, United Kingdom
| | - Nabeela Malik
- University Hospitals Birmingham NHS Trust, Edgbaston, Birmingham, United Kingdom
| | - Michael Neeki
- Clinical Professor of Emergency Medicine, Arrowhead Regional Medical Center, Colton, CaliforniaUSA; Professor of Medical Education, California University of Science and Medicine, Colton, California USA
| | - Ronald Pirrallo
- Department of Emergency Medicine, Prisma Health University of South Carolina School of Medicine Greenville, Greenville, South CarolinaUSA
| | - Rafael Castro Delgado
- Health Service of the Principality of Asturias (SAMU-Asturias), Health Research Institute of the Principality of Asturias (Team Leader of the Research Group on Prehospital Care and Disasters, GIAPREDE), Oviedo, Spain
- Department of Medicine, Oviedo University, Oviedo, Spain
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy; University of Padova, Padova, Italy; International Commission for Mountain Emergency Medicine, Zurich, Switzerland
| | - Marcelo Farah Dell’Aringa
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy; Medical University Innsbruck, Innsbruck, Austria; International Commission of Mountain Emergency Medicine-ICAR MedCom, Zurich, Switzerland
| | - Chaim Rafalowsky
- Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Marcello Marzoli
- Department of Fire Service, Public Rescue and Civil Defence, Ministero dell’Interno, Rome, Italy
| | - Giovanni Fresu
- Department of Surgery, Catholic University of the Sacred Heart, Policlinico Gemelli, Rome, Italy
| | | | - Stenn Lennquist
- Department of Neurosciences, Catholic University of the Sacred Heart, Policlinico Gemelli, Rome, Italy
| | - Jonathan Tilsed
- London Ambulance Service NHS Trust, London, London, United Kingdom
| | - Ilene Claudius
- Department of Emergency Medicine, Harbor-UCLA, Torrence, CaliforniaUSA
| | - Piyapan Cheeranont
- Faculty of Medicine, Praboromarajchanok Institute, Ministry of Public Health, Nonthaburi, Thailand
| | - Rachel Callcut
- University of California Davis Department of Surgery, Sacramento, CaliforniaUSA
| | - Miklosh Bala
- Department of Fire Service, Public Rescue and Civil Defence, Ministero dell’Interno, Rome, Italy
| | - Anthony Kerbage
- Department of Internal Medicine, Hôtel-Dieu de France hospital, Beirut, Lebanon
| | - Luis Vale
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
| | - Norman Philipp Hecker
- ESTES—European Society for Trauma and Emergency Surgery, Disaster and Military Surgery Section, Milan, Italy
| | - Roberto Faccincani
- ESTES—European Society for Trauma and Emergency Surgery, Disaster and Military Surgery Section, Milan, Italy
| | - Luca Ragazzoni
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
| | - Marta Caviglia
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
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Abu-Zidan FM, Idris K, Cevik AA. Prehospital management of earthquake crush injuries: A collective review. Turk J Emerg Med 2023; 23:199-210. [PMID: 38024191 PMCID: PMC10664202 DOI: 10.4103/tjem.tjem_201_23] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/13/2023] [Indexed: 12/01/2023] Open
Abstract
Earthquakes are natural disasters which can destroy the rural and urban infrastructure causing a high toll of injuries and death without advanced notice. We aim to review the prehospital medical management of earthquake crush injuries in the field. PubMed was searched using general terms including rhabdomyolysis, crush injury, and earthquake in English language without time restriction. Selected articles were critically evaluated by three experts in disaster medicine, emergency medicine, and critical care. The medical response to earthquakes includes: (1) search and rescue; (2) triage and initial stabilization; (3) definitive care; and (4) evacuation. Long-term, continuous pressure on muscles causes crush injury. Ischemia-reperfusion injury following the relieving of muscle compression may cause metabolic changes and rhabdomyolysis depending on the time of extrication. Sodium and water enter the cell causing cell swelling and hypovolemia, while potassium and myoglobin are released into the circulation. This may cause sudden cardiac arrest, acute extremity compartment syndrome, and acute kidney injury. Recognizing these conditions and treating them timely and properly in the field will save many patients. Majority of emergency physicians who have worked in the field of the recent Kahramanmaraş 2023, Turkey, earthquakes, have acknowledged their lack of knowledge and experience in managing earthquake crush injuries. We hope that this collective review will cover the essential knowledge needed for properly managing seriously crushed injured patients in the earthquake field.
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Affiliation(s)
- Fikri M. Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, United Arab Emirates
| | - Kamal Idris
- Department of Critical Care and the Intensive Care Unit, Burjeel Royal Hospital, Al-Ain, United Arab Emirates
| | - Arif Alper Cevik
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, United Arab Emirates
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Jerome D, Savage DW, Pietrosanu M. An assessment of mass casualty triage systems using the Alberta trauma registry. CAN J EMERG MED 2023; 25:659-666. [PMID: 37306923 DOI: 10.1007/s43678-023-00529-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/23/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Triage is the process of identifying patients with both the greatest clinical need and the greatest likelihood of benefit in the setting of limited clinical resources. The primary objective of this study was to assess the ability of formal mass casualty incident triage tools to identify patients requiring urgent lifesaving interventions. METHODS Data from the Alberta Trauma Registry (ATR) was used to assess seven triage tools: START, JumpSTART, SALT, RAMP, MPTT, BCD and MITT. Clinical data captured in the ATR was used to determine which triage category each of the seven tools would have applied to each patient. These categorizations were compared to a reference standard definition based on the patients' need for specific urgent lifesaving interventions. RESULTS Of the 9448 records that were captured 8652 were included in our analysis. The most sensitive triage tool was MPTT, which demonstrated a sensitivity of 0.76 (0.75, 0.78). Four of the seven triage tools evaluated had sensitivities below 0.45. JumpSTART had the lowest sensitivity and the highest under-triage rate for pediatric patients. All the triage tools evaluated had a moderate to high positive predictive value (> 0.67) for patients who had experienced penetrating trauma. CONCLUSIONS There was a wide range in the sensitivity of triage tools to identify patients requiring urgent lifesaving interventions. MPTT, BCD and MITT were the most sensitive triage tools assessed. All of the triage tools assessed should be employed with caution during mass casualty incidents as they may fail to identify a large proportion of patients requiring urgent lifesaving interventions.
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Affiliation(s)
- David Jerome
- Division of Clinical Sciences, NOSM University, Thunder Bay, ON, Canada.
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada.
| | - David W Savage
- Division of Clinical Sciences, NOSM University, Thunder Bay, ON, Canada
| | - Matthew Pietrosanu
- Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, Canada
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Lee E, Baek G, Hwang Y. Effectiveness of the Patient's Severity Classification Competency Promotion Virtual Reality Program of Nursing Students during the COVID-19 Pandemic Period. Healthcare (Basel) 2023; 11:healthcare11081122. [PMID: 37107957 PMCID: PMC10137825 DOI: 10.3390/healthcare11081122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/31/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
The purpose of this study was to develop a virtual reality-based nursing education program aimed at improving nursing students' severity classification competency. Severity classification in the emergency room is key to improving the efficiency of emergency room services worldwide. Prioritizing treatment based on correctly identifying the severity of a disease or an injury also ensures patients' safety. The five actual clinical scenarios in the program helped to promptly classify patients into five clinical situations based on the 2021 Korean Emergency Patient Classification Tool. Seventeen nursing students were in an experimental group that had access to a virtual reality-based simulation combined with clinical practice. Seventeen nursing students were in a control group that only participated in routine clinical practice. The virtual reality-based nursing education program effectively improved students' severity classification competency, performance confidence, and clinical decision-making ability. Although the pandemic continues, the virtual reality-based nursing education program provides realistic indirect experiences to nursing students in situations where clinical nursing practice is not possible. In particular, it will serve as basic data for the expansion and utilization strategy of virtual reality-based nursing education programs to improve nursing capabilities.
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Affiliation(s)
- Eunju Lee
- Nursing College, Keimyung University, Daegu 42601, Republic of Korea
| | - Gyuli Baek
- Nursing College, Keimyung University, Daegu 42601, Republic of Korea
| | - Yeonhui Hwang
- Nursing College, Keimyung University, Daegu 42601, Republic of Korea
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Tulay CM, Gurmen ES. Dyspnea: perfus?on ?ndex and tr?age status. J Clin Monit Comput 2023:10.1007/s10877-023-00995-6. [PMID: 37004661 PMCID: PMC10066968 DOI: 10.1007/s10877-023-00995-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/12/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE To determine the relationship between perfusion index and the emergency triage classification in patients admitted to the emergency department with dyspnea. METHODS Adult patients who presented with dyspnea and whose perfusion index values were measured with Masimo Radical-7 device at the time of admission, at the first hour and the second hour of admission were included in the study. The PI and oxygen saturation measured by finger probes were compared and the superiority of their effects on the emergency triage classification was compared. RESULTS For the 0.9 cut- off value of the arrival PI level according to the triage status; sensitivity 79.25%; specificity 78.12%; positive predictive value is 66.7 and negative predictive value is 87.2. A statistically significant correlation was found between the triage status and the 0.9 cut- off value of the admission PI level. We can say that the ODDS rate of red triage is 13.63 times (95% CI: 5.99-31.01) times higher in cases with a PI level of 0.9 and below. In the ROC analysis, the cut-off value of 1.1 and above the admission PI level was determined as the most appropriate point for discharge. CONCLUSION The perfusion index can help to determine the triage classification in emergency departments for dyspnea.
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Affiliation(s)
- Cumhur Murat Tulay
- Thoracic Surgery Department, Manisa Celal Bayar University School of Medicine, Manisa, Turkey
| | - Ekim Saglam Gurmen
- Emergency Department, Manisa Celal Bayar University School of Medicine, Manisa, Turkey.
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Zhao F, Zhao C, Bai S, Yao L, Zhang Y. Triage Algorithms for Mass-Casualty Bioterrorism: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20065070. [PMID: 36981980 PMCID: PMC10049471 DOI: 10.3390/ijerph20065070] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To understand existing triage algorithms, propose improvement measures through comparison to better deal with mass-casualty incidents caused by bioterrorism. STUDY DESIGN Systematic review. METHODS Medline, Scopus and Web of Science were searched up to January 2022. The studies investigating triage algorithms for mass-casualty bioterrorism. Quality assessment was performed using the International Narrative Systematic Assessment tool. Data extractions were performed by four reviewers. RESULTS Of the 475 titles identified in the search, 10 studies were included. There were four studies on triage algorithms for most bioterrorism events, four studies on triage algorithms for anthrax and two studies on triage algorithms for mental or psychosocial problems caused by bioterrorism events. We introduced and compared 10 triage algorithms used for different bioterrorism situations. CONCLUSION For triage algorithms for most bioterrorism events, it is necessary to determine the time and place of the attack as soon as possible, control the number of exposed and potentially exposed people, prevent infection and determine the type of biological agents used. Research on the effects of decontamination on bioterrorism attacks needs to continue. For anthrax triage, future research should improve the distinction between inhalational anthrax symptoms and common disease symptoms and improve the efficiency of triage measures. More attention should be paid to triage algorithms for mental or psychosocial problems caused by bioterrorism events.
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Affiliation(s)
- Feida Zhao
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China
| | - Chao Zhao
- Center for Biosafety Research and Strategy, Tianjin University, Tianjin 300072, China
| | - Song Bai
- Evaluation and Optimization of Health Emergency Response Capacity, Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China
| | - Lulu Yao
- Emergency Medicine, Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China
| | - Yongzhong Zhang
- Epidemiology and Health Statistics, Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China
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Samarkandi OA, Aljuaid M, Abdulrahman Alkohaiz M, Al-Wathinani AM, Alobaid AM, Alghamdi AA, Alhallaf MA, Albaqami NA. Societal vulnerability in the context of population aging-Perceptions of healthcare students' in Saudi Arabia. Front Public Health 2022; 10:955754. [PMID: 36238236 PMCID: PMC9552710 DOI: 10.3389/fpubh.2022.955754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/09/2022] [Indexed: 01/24/2023] Open
Abstract
Background and objective Healthcare professionals have an important role in increasing awareness and protecting populations from natural disasters. This study aimed to assess the perception of healthcare students toward societal vulnerability in the context of population aging. Methods This is a cross-sectional questionnaire-based study conducted among students from two different health colleges over 4 months from February to May 2021. Descriptive analysis was used to assess the perception, and inferential testing was used to assess the various association of knowledge toward societal vulnerability using SPSS. Results The majority of respondents were male (69.2%), between 20 and 24 years of age (91.2%), and studying for a nursing degree (76.6%). Only 4.7% had previously completed a previous degree. The mean score of perceptions on the Aging and Disaster Vulnerability Scale among nursing students was 42.5 ± 10.3 (0-65) while for paramedicine 48.1 ± 9.7 (0-65). Similarly, the mean score among male students was 44.1 ±10.5. The mean PADVS total score for the cohort was 43.8 (SD = 10.5). The mean PADVS total score for nursing students was significantly lower than paramedic students (42.5 vs. 48.1; p < 0.001). There was no correlation between PADVS total score and gender, age, area of residence, or previous degree. Conclusion Our results indicate that Saudi healthcare students perceive older adults are somewhat vulnerable to disasters with significant differences between nursing and paramedic students. Furthermore, we suggest informing emergency services disaster response planning processes about educational intervention to overcome disasters in Saudi Arabia and other countries.
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Affiliation(s)
- Osama A. Samarkandi
- Nursing Informatics, Department of Basic Sciences, Vice Dean for Academic Affairs, Dean of Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia,*Correspondence: Osama A. Samarkandi
| | - Mohammed Aljuaid
- Department of Health Administration, College of Business Administration, King Saud University, Riyadh, Saudi Arabia
| | | | - Ahmed M. Al-Wathinani
- Department of Emergency Medical Services (EMS), Prince Sultan College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Mohammed Alobaid
- Department of Trauma and Accident, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah A. Alghamdi
- Department of Emergency Medical Services (EMS), Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed A. Alhallaf
- Department of Emergency Medical Services (EMS), Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | - Nawaf A. Albaqami
- Department of Emergency Medical Services (EMS), Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
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Accuracy of prehospital triage systems for mass casualty incidents in trauma register studies - A systematic review and meta-analysis of diagnostic test accuracy studies. Injury 2022; 53:2725-2733. [PMID: 35660101 DOI: 10.1016/j.injury.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 05/06/2022] [Accepted: 05/07/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Prioritising patients in mass casualty incidents (MCI) can be extremely difficult. Therefore, triage systems are important in every emergency medical service. This study reviews the accuracy of primary triage systems for MCI in trauma register studies. METHODS We registered a protocol at PROSPERO ID: CRD42018115438. We searched MEDLINE, EMBASE, Central, Web of Science, Scopus, Clinical Trials, Google Scholar, and reference lists for eligible studies. We included studies that both examined a primary triage system for MCI in trauma registers and provided sensitivity and specificity for critically injured vs non-critically injured as results. We excluded studies that used paediatric, chemical, biological, radiological or nuclear MCIs populations or triage systems. Finally, we calculated intra-study relative sensitivity, specificity and diagnostic odds ratio for each triage system. RESULTS Triage Sieve (TS) significantly underperformed in relative diagnostic odds ratio (DOR) when compared to START and CareFlight (CF) (START vs TS: 19.85 vs 13.23 (p<0.0001)│CF vs TS: 23.72 vs 12.83 (p<0.0001)). There was no significant difference in DOR between TS and Military Sieve (MS) (p<0.710). Compared to START, MS and CF TS had significantly higher relative specificity (START vs TS: 93.6% vs 96.1% (p=0.047)│CF vs TS: 96% vs 95.3% (p=0.0006)│MS vs TS: 94% vs 88.3% (p=0.0002)) and lower relative sensitivity (START vs TS: 57.8% vs 34.8% (p<0.0001)│CF vs TS: 53.9% vs 34.7% (p<0.0001)│MS vs TS: 51.9% vs 35.2% p<0.0001)). CF had significantly better relative DOR than START (CF vs START: 23.56 vs 27.79 (p=0.043)). MS had significantly better relative sensitivity than CF and START (MS vs CF: 49.5% vs 38.7% (p<0.0001)│MS vs START: 49.4% vs 43.9% (p=0.01)). In contrast, CF had significantly better relative specificity than MS (MS vs CF: 91.3% vs 93.3% (p<0.0001)). The remaining comparisons did not yield any significant differences. CONCLUSION As the included studies were at risk of bias and had heterogenic characteristics, our results should be interpreted with caution. Nonetheless, our results point towards inferior accuracy of Triage Sieve compared to START and CareFlight, and less firmly point towards superior accuracy of Military Sieve compared to START, CareFlight and Triage Sieve.
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Wisnesky UD, Kirkland SW, Rowe BH, Campbell S, Franc JM. A Qualitative Assessment of Studies Evaluating the Classification Accuracy of Personnel Using START in Disaster Triage: A Scoping Review. Front Public Health 2022; 10:676704. [PMID: 35284379 PMCID: PMC8907512 DOI: 10.3389/fpubh.2022.676704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 01/31/2022] [Indexed: 11/18/2022] Open
Abstract
Background Mass casualty incidents (MCIs) can occur as a consequence of a wide variety of events and often require overwhelming prehospital and emergency support and coordinated emergency response. A variety of disaster triage systems have been developed to assist health care providers in making difficult choices with regards to prioritization of victim treatment. The simple triage and rapid treatment (START) triage system is one of the most widely used triage algorithms; however, the research literature addressing real-world or simulation studies documenting the classification accuracy of personnel using START is lacking. Aims and Objectives To explore the existing literature related to the current state of knowledge about studies assessing the classification accuracy of the START triage system. Design Scoping review based on Arksey and O'Malley's methodological framework and narrative synthesis based on methods described by Popay and colleagues were performed. Results The literature search identified 1,820 citations, of which 32 studies met the inclusion criteria. Thirty were peer-reviewed articles and 28 published in the last 10 years (i.e., 2010 and onward). Primary research studies originated in 13 countries and included 3,706 participants conducting triaging assessments involving 2,950 victims. Included studies consisted of five randomized controlled trials, 17 non-randomized controlled studies, eight descriptive studies, and two mixed-method studies. Simulation techniques, mode of delivery, contextual features, and participants' required skills varied among studies. Overall, there was no consistent reporting of outcomes across studies and results were heterogeneous. Data were extracted from the included studies and categorized into two themes: (1) typology of simulations and (2) START system in MCIs simulations. Each theme contains sub-themes regarding the development of simulation employing START as a system for improving individuals' preparedness. These include types of simulation training, settings, and technologies. Other sub-themes include outcome measures and reference standards. Conclusion This review demonstrates a variety of factors impacting the development and implementation of simulation to assess characteristics of the START system. To further improve simulation-based assessment of triage systems, we recommend the use of reporting guidelines specifically designed for health care simulation research. In particular, reporting of reference standards and test characteristics need to improve in future studies.
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Affiliation(s)
- Uirá Duarte Wisnesky
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Scott W. Kirkland
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Brian H. Rowe
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Sandra Campbell
- J.W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Jeffrey Michael Franc
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Simple triage and rapid treatment protocol for emergency department mass casualty incident victim triage. Am J Emerg Med 2021; 53:99-103. [PMID: 35007873 DOI: 10.1016/j.ajem.2021.12.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Triage plays an essential role in emergency medical care. It is crucial to adopt appropriate triage in a mass casualty incident (MCI) when resources are limited. The simple triage and rapid treatment (START) protocol is commonly used worldwide; however, the effectiveness of the START protocol for emergency department (ED) triage is unclear. This study aimed to examine the accuracy of START for the ED triage of victims following a MCI. METHODS We retrospectively reviewed the records of victims who presented to our ED during a MCI response after a train crash. The ED nurses applied the START protocol upon patient arrival, and we used a consensus-based standard to determine the outcome-based categories of these same patients. We compared the START protocol and outcome-based categories. In addition, the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of START in terms of predicting surgery and ED disposition were determined. RESULTS This study enrolled 47 patients (predominantly women, 68.1%; median age: 39.0years). Most victims were triaged into the START minor category (61.7%) and discharged from the ED (68.1%). Twenty-nine patients had matched START and outcome-based categories, whereas 2 patients were over-triaged and 16 patients were under-triaged. Additionally, the START system had acceptable AUC and sensitivities for predicting surgery and ED disposition (AUC/sensitivity/specificity for surgery: 0.850/100%/69.1%; AUC/sensitivity/specificity for admission: 0.917/93.3%/87.5%; AUC/sensitivity/specificity for intensive care unit (ICU)/ED death: 0.994/100%/97.8%). CONCLUSIONS This study demonstrated poor agreement between START categories, as determined in the ED, and the consensus-based standard categories. However, the START protocol was acceptable in terms of identifying emergent patients (100% sensitivity for the immediate and deceased categories) and predicting ED disposition (surgery, admission, and ICU/ED mortality). Although START is not perfect, our findings suggest that it could be used for the ED triage of trauma-related MCI victims.
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METASTART: A Systematic Review and Meta-Analysis of the Diagnostic Accuracy of the Simple Triage and Rapid Treatment (START) Algorithm for Disaster Triage. Prehosp Disaster Med 2021; 37:106-116. [PMID: 34915954 DOI: 10.1017/s1049023x2100131x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION The goal of disaster triage at both the prehospital and in-hospital level is to maximize resources and optimize patient outcomes. Of the disaster-specific triage methods developed to guide health care providers, the Simple Triage and Rapid Treatment (START) algorithm has become the most popular system world-wide. Despite its appeal and global application, the accuracy and effectiveness of the START protocol is not well-known. OBJECTIVES The purpose of this meta-analysis was two-fold: (1) to estimate overall accuracy, under-triage, and over-triage of the START method when used by providers across a variety of backgrounds; and (2) to obtain specific accuracy for each of the four START categories: red, yellow, green, and black. METHODS A systematic review and meta-analysis was conducted that searched Medline (OVID), Embase (OVID), Global Health (OVID), CINAHL (EBSCO), Compendex (Engineering Village), SCOPUS, ProQuest Dissertations and Theses Global, Cochrane Library, and PROSPERO. The results were expanded by hand searching of journals, reference lists, and the grey literature. The search was executed in March 2020. The review considered the participants, interventions, context, and outcome (PICO) framework and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Accuracy outcomes are presented as means with 95% confidence intervals (CI) as calculated using the binomial method. Pooled meta-analyses of accuracy outcomes using fixed and random effects models were calculated and the heterogeneity was assessed using the Q statistic. RESULTS Thirty-two studies were included in the review, most of which utilized a non-randomized study design (84%). Proportion of victims correctly triaged using START ranged from 0.27 to 0.99 with an overall triage accuracy of 0.73 (95% CI, 0.67 to 0.78). Proportion of over-triage was 0.14 (95% CI, 0.11 to 0.17) while the proportion of under-triage was 0.10 (95% CI, 0.072 to 0.14). There was significant heterogeneity of the studies for all outcomes (P < .0001). CONCLUSION This meta-analysis suggests that START is not accurate enough to serve as a reliable disaster triage tool. Although the accuracy of START may be similar to other models of disaster triage, development of a more accurate triage method should be urgently pursued.
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Vassallo J, Chernbumroong S, Malik N, Xu Y, Keene D, Gkoutos G, Lyttle MD, Smith J. Comparative analysis of major incident triage tools in children: a UK population-based analysis. Emerg Med J 2021; 39:emermed-2021-211706. [PMID: 34706900 PMCID: PMC9510399 DOI: 10.1136/emermed-2021-211706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/08/2021] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Triage is a key principle in the effective management of major incidents. There is currently a paucity of evidence to guide the triage of children. The aim of this study was to perform a comparative analysis of nine adult and paediatric triage tools, including the novel 'Sheffield Paediatric Triage Tool' (SPTT), assessing their ability in identifying patients needing life-saving interventions (LSIs). METHODS A 10-year (2008-2017) retrospective database review of the Trauma Audit Research Network (TARN) Database for paediatric patients (<16 years) was performed. Primary outcome was identification of patients receiving one or more LSIs from a previously defined list. Secondary outcomes included mortality and prediction of Injury Severity Score (ISS) >15. Primary analysis was conducted on patients with complete prehospital physiological data with planned secondary analyses using first recorded data. Performance characteristics were evaluated using sensitivity, specificity, undertriage and overtriage. RESULTS 15 133 patients met TARN inclusion criteria. 4962 (32.8%) had complete prehospital physiological data and 8255 (54.5%) had complete first recorded physiological data. The majority of patients were male (69.5%), with a median age of 11.9 years. The overwhelming majority of patients (95.4%) sustained blunt trauma, yielding a median ISS of 9 and overall, 875 patients (17.6%) received at least one LSI. The SPTT demonstrated the greatest sensitivity of all triage tools at identifying need for LSI (92.2%) but was associated with the highest rate of overtriage (75.0%). Both the Paediatric Triage Tape (sensitivity 34.1%) and JumpSTART (sensitivity 45.0%) performed less well at identifying LSI. By contrast, the adult Modified Physiological Triage Tool-24 (MPTT-24) triage tool had the second highest sensitivity (80.8%) with tolerable rates of overtriage (70.2%). CONCLUSION The SPTT and MPTT-24 outperform existing paediatric triage tools at identifying those patients requiring LSIs. This may necessitate a change in recommended practice. Further work is needed to determine the optimum method of paediatric major incident triage, but consideration should be given to simplifying major incident triage by the use of one generic tool (the MPTT-24) for adults and children.
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Affiliation(s)
- James Vassallo
- Institute of Naval Medicine, Gosport, UK
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - Saisakul Chernbumroong
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Birmingham, UK
- Centre for Computational Biology, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Nabeela Malik
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Birmingham, UK
- Centre for Computational Biology, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Yuanwei Xu
- Centre for Computational Biology, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Damian Keene
- Department of Anaesthesia, University Hospitals Birmingham, Birmingham, UK
| | - George Gkoutos
- Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- MRC Health Data Research UK (HDR UK), Birmingham, UK
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Children's Hospital, Bristol, UK
| | - Jason Smith
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
- Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
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Prehospital Disaster Triage Does Not Predict Pediatric Outcomes: Comparing the Criteria Outcomes Tool to Three Mass-Casualty Incident Triage Algorithms. Prehosp Disaster Med 2021; 36:503-510. [PMID: 34392857 DOI: 10.1017/s1049023x21000856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION It remains unclear which mass-casualty incident (MCI) triage tool best predicts outcomes for child disaster victims. STUDY OBJECTIVES The primary objective of this study was to compare triage outcomes of Simple Triage and Rapid Treatment (START), modified START, and CareFlight in pediatric patients to an outcomes-based gold standard using the Criteria Outcomes Tool (COT). The secondary outcomes were sensitivity, specificity, under-triage, over-triage, and overall accuracy at each level for each MCI triage algorithm. METHODS Singleton trauma patients under 16 years of age with complete prehospital, emergency department (ED), and in-patient data were identified in the 2007-2009 National Trauma Data Bank (NTDB). The COT outcomes and procedures were translated into ICD-9 procedure codes with added timing criteria. Gold standard triage levels were assigned using the COT based on outcomes, including mortality, injury type, admission to the hospital, and surgical procedures. Comparison triage levels were determined based on algorithmic depictions of the three MCI triage tools. RESULTS A total of 31,093 patients with complete data were identified from the NTDB. The COT was applied to these patients, and the breakdown of gold standard triage levels, based on their actual clinical outcomes, was: 17,333 (55.7%) GREEN; 11,587 (37.3%) YELLOW; 1,572 (5.1%) RED; and 601 (1.9%) BLACK. CareFlight had the best sensitivity for predicting COT outcomes for BLACK (83% [95% confidence interval, 80%-86%]) and GREEN patients (79% [95% CI, 79%-80%]) and the best specificity for RED patients (89% [95% CI, 89%-90%]). CONCLUSION Among three prehospital MCI triage tools, CareFlight had the best performance for correlating with outcomes in the COT. Overall, none of three tools had good test characteristics for predicting pediatric patient needs for surgical procedures or hospital admission.
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Adaptation of the Competencies for Disaster Nursing Management Questionnaire: Turkish Version. Disaster Med Public Health Prep 2021; 16:1496-1502. [PMID: 34284838 DOI: 10.1017/dmp.2021.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to carry out the validity and reliability study for the adaptation of the Competencies for Disaster Nursing Management Questionnaire (CDNMQ), which was developed by Al Thobaity and others in 2016, (https://pubmed.ncbi.nlm.nih.gov/26778698/) to Turkish, and to be able to use in the nursing literature. METHOD This study was conducted in a methodological approach. The scale used in this study was a 10-point Likert scale with 43 items and 3 subfactors. The questionnaire was applied to 450 nurses. The validity and reliability of the scale were evaluated using the exploratory and confirmatory factor analysis. The content validity index was measured within the scope of the internal consistency measurements, and the Pearson's product-moment correlation coefficient was examined for the test-retest. RESULTS The content validity index score was found to be 0.98. As a result of the confirmatory factor analysis of the CDNMQ, it was found that the 3-factor structure of the scale was valid and the goodness of fit tests was appropriate. CONCLUSION The findings have shown that the CDNMQ study is similar to the original scale and an adequate measurement tool in determining competencies in disaster nursing management.
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Malik NS, Chernbumroong S, Xu Y, Vassallo J, Lee J, Bowley DM, Hodgetts T, Moran CG, Lord JM, Belli A, Keene D, Foster M, Gkoutos GV. The BCD Triage Sieve outperforms all existing major incident triage tools: Comparative analysis using the UK national trauma registry population. EClinicalMedicine 2021; 36:100888. [PMID: 34308306 PMCID: PMC8257989 DOI: 10.1016/j.eclinm.2021.100888] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Natural disasters, conflict, and terrorism are major global causes of death and disability. Central to the healthcare response is triage, vital to ensure the right care is provided to the right patient at the right time. The ideal triage tool has high sensitivity for the highest priority (P1) patients with acceptably low over-triage. This study compared the performance of major incident triage tools in predicting P1 casualty status in adults in the prospective UK Trauma Audit and Research Network (TARN) registry. METHODS TARN patients aged 16+ years (January 2008-December 2017) were included. Ten existing triage tools were applied using patients' first recorded pre-hospital physiology. Patients were subsequently assigned triage categories (P1, P2, P3, Expectant or Dead) based on pre-defined, intervention-based criteria. Tool performance was assessed by comparing tool-predicted and intervention-based priority status. FINDINGS 195,709 patients were included; mortality was 7·0% (n=13,601); median Injury Severity Score (ISS) was 9 (IQR 9-17); 97·1% sustained blunt injuries. 22,144 (11·3%) patients fulfilled intervention-based criteria for P1 status, exhibiting higher mortality (12·8% vs. 5·0%, p<0.001), increased intensive care requirement (52·4% vs 5·0%, p<0.001), and more severe injuries (median ISS 21 vs 9, p<0.001) compared with P2 patients.In 16-64 year olds, the highest performing tool was the Battlefield Casualty Drills (BCD) Triage Sieve (Prediction of P1 status: 70·4% sensitivity, over-triage 70·9%, area under the receiver operating curve (AUC) 0·068 [95%CI 0·676-0·684]). The UK National Ambulance Resilience Unit (NARU) Triage Sieve had sensitivity of 44·9%; over-triage 56·4%; AUC 0·666 (95%CI 0·662-0·670). All tools performed poorly amongst the elderly (65+ years). INTERPRETATION The BCD Triage Sieve performed best in this nationally representative population; we recommend it supersede the NARU Triage Sieve as the UK primary major incident triage tool. Validated triage category definitions are recommended for appraising future major incidents. FUNDING This study is funded by the National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre. GVG also acknowledges support from the MRC Heath Data Research UK (HDRUK/CFC/01). The views expressed are those of the authors and not necessarily those of the NIHR, the Department of Health and Social Care, or the Ministry of Defence.
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Affiliation(s)
- Nabeela S. Malik
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- 212 (Yorkshire) Field Hospital, Endcliffe Hall, Endcliffe Vale Road, Sheffield S10 3EU, UK
- Corresponding author at: NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK.
| | - Saisakul Chernbumroong
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Yuanwei Xu
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - James Vassallo
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Justine Lee
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
- NHS England London, Skipton House, 80 London Road, London SE1 6LH, UK
| | - Douglas M. Bowley
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Timothy Hodgetts
- Army Health, Army Headquarters, Monxton Road, Andover SP11 8HT, UK
| | - Christopher G Moran
- NHS England London, Skipton House, 80 London Road, London SE1 6LH, UK
- Nottingham University Hospitals NHS Trust, Derby Road, Nottingham NG7 2UH, UK
| | - Janet M Lord
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
| | - Antonio Belli
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Damian Keene
- Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Mark Foster
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Georgios V Gkoutos
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK
- MRC Health Data Research UK (HDR UK), Midlands Site, B15 2TT UK
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Thompson L, Hill M, Lecky F, Shaw G. Defining major trauma: a Delphi study. Scand J Trauma Resusc Emerg Med 2021; 29:63. [PMID: 33971922 PMCID: PMC8108467 DOI: 10.1186/s13049-021-00870-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/31/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction Retrospective trauma scores are often used to categorise trauma, however, they have little utility in the prehospital or hyper-acute setting and do not define major trauma to non-specialists. This study employed a Delphi process in order to gauge degrees of consensus/disagreement amongst expert panel members to define major trauma. Method A two round modified Delphi technique was used to explore subject-expert consensus and identify variables to define major trauma through systematically collating questionnaire responses. After initial descriptive analysis of variables, Kruskal-Wallis tests were used to determine statistically significant differences (p < 0.05) in response to the Delphi statements between professional groups. A hierarchical cluster analysis was undertaken to identify patterns of similarity/difference of response. A grounded theory approach to qualitative analysis of data allowed for potentially multiple iterations of the Delphi process to be influenced by identified themes. Results Of 55 expert panel members invited to participate, round 1 had 43 participants (Doctor n = 20, Paramedic n = 20, Nurse n = 5, other n = 2). No consistent patterns of opinion emerged with regards to professional group. Cluster analysis identified three patterns of similar responses and coded as trauma minimisers, the middle ground and the risk averse. Round 2 had 35 respondents with minimum change in opinion between rounds. Consensus of > 70% was achieved on many variables which included the identification of life/limb threatening injuries, deranged physiology, need for intensive care interventions and that extremes of age need special consideration. It was also acknowledged that retrospective injury severity scoring has a role to play but is not the only method of defining major trauma. Various factors had a majority of agreement/disagreement but did not meet the pre-set criteria of 70% agreement. These included the topics of burns, spinal immobilisation and whether a major trauma centre is the only place where major trauma can be managed. Conclusion Based upon the output of this Delphi study, major trauma may be defined as: “Significant injury or injuries that have potential to be life-threatening or life-changing sustained from either high energy mechanisms or low energy mechanisms in those rendered vulnerable by extremes of age”. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00870-w.
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Affiliation(s)
- Lee Thompson
- North East Ambulance Service NHS Foundation Trust, Ambulance HQ, Bernicia House, Goldcrest Way, Newburn Riverside, Newcastle Upon Tyne, NE15 8NY, England. .,Northumbria University, Coach Lane Campus, Coach Lane, Newcastle Upon Tyne, NE7 7TR, England.
| | - Michael Hill
- Northumbria University, Coach Lane Campus, Coach Lane, Newcastle Upon Tyne, NE7 7TR, England
| | - Fiona Lecky
- University of Sheffield, Western Bank, Sheffield, S10 2TN, England.,University of Manchester, Oxford Rd, Manchester, M13 9PL, England.,Salford Royal Hospitals NHS Foundation Trust, Stott Lane, Salford, M6 8HD, England.,Trauma Audit and Research Network, Summerfield House, 544 Eccles New Road, Salford, M5 5AP, England
| | - Gary Shaw
- North East Ambulance Service NHS Foundation Trust, Ambulance HQ, Bernicia House, Goldcrest Way, Newburn Riverside, Newcastle Upon Tyne, NE15 8NY, England
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Aslan R, Şahinöz S, Şahinöz T. Determination of START triage skill and knowledge levels of Prehospital Emergency Medical Staff: A cross sectional study. Int Emerg Nurs 2021; 56:101004. [PMID: 33957489 DOI: 10.1016/j.ienj.2021.101004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 02/28/2021] [Accepted: 03/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Emergency medical staff working in pre-hospital (PH-staff) may encounter mass casualty incident (MCI) events. In these events these medical personnel should perform triage. The objective of this study is to determine the skill and knowledge levels of PH-staff about Simple Triage and Rapid Treatment (START) triage. METHODS With this cross-sectional, observational study we analyzed data from 127 PH-staff. Data was collected with the survey tool (response rate = 74.7%). Kruskal-Wallis H Test, Mann-Whitney U Test, and Spearman's Correlation analyzes were used in the data analysis by means of SPSS Software. RESULTS Of the participants, 63% were men, the median age was 24 years, 88 PH-staff (69.3%) intervened in MCI events, and 37 PH-staff (29.1%) applied START triage. The skill score was 60% and the knowledge score was 72.5%. There was a weak positive correlation between knowledge and skill scores (r = 0.337, p < 0.01). The knowledge level of the emergency medical technicians (EMTs) and paramedics was higher than those from the other professions. CONCLUSIONS The triage knowledge and skill levels of the PH-staff were not low contrary to the expectations. The triage knowledge and skill levels of professions that did not have pre-hospital training such as paramedics and EMTs were low.
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Affiliation(s)
- Ramazan Aslan
- Department of Emergency and Disaster Management, Faculty of Health Sciences, Gümüşhane University, Gümüşhane, Turkey.
| | - Saime Şahinöz
- Department of Public Health, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Turgut Şahinöz
- Department of Healthc Management, Faculty of Health Sciences, Ordu University, Ordu, Turkey
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Sengoren Dikis O, Demirci H, Sezgin B, Haberal MA, Akar E, Kaya H. What is the emergency application differences concerning diseases pertinent to the chest between Turkish citizens and Syrian refugees: A cross-sectional study. THE CLINICAL RESPIRATORY JOURNAL 2020; 14:725-731. [PMID: 32202394 DOI: 10.1111/crj.13189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 02/25/2020] [Accepted: 03/08/2020] [Indexed: 11/29/2022]
Abstract
AIM Millions of Syrians were displaced after the Syrian civil war broke in 2011. Turkey hosts the largest number of refugees. This study aimed to describe the disease patterns of Syrian refugees applying to an emergency department. MATERIAL AND METHODS The study included patients who presented to an emergency department between 2017 and 2018. Study data were retrieved from the hospital's electronic medical records registry. The main study outcome was the ICD-10 codes pertinent to "chest diseases." Additionally, analyzed data were nationality, age, sex, triage status on admission, hospitalization status, and examination date. RESULTS The number of emergency department admissions included in the study period was 378 487 persons, of which 14 262 (3.8%) were Syrian refugees. A total of 62 345 diagnoses (16.5%) were related to the respiratory system. Turkish patients had a significantly higher median age than Syrian refugees. Also, there were significantly more women among Syrian applicants, and acute bronchitis and asthma were more common among Syrian patients. However, the hospitalization rates were similar between the two groups. Moreover, Syrian patients had more applications during the summer seasons and had higher "Yellow" labels in the emergency triage. CONCLUSION There are differences in the disease patterns of Syrian refugees and Turkish citizens applying to the emergency department. This may be explained by the difficulty in communication which, to our opinion, may be reversed as language barriers are overcome and adaptation to the society is completed over time.
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Affiliation(s)
- Ozlem Sengoren Dikis
- Department of Pulmonary Diseases, Health Sciences University Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Hakan Demirci
- Department of Family Medicine, Health Sciences University Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Bişar Sezgin
- Deparment of Emergency Medicine, Health Sciences University Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Miktat Arif Haberal
- Department of Thoracic Surgery, Health Sciences University Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Erkan Akar
- Department of Thoracic Surgery, Health Sciences University Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Halil Kaya
- Deparment of Emergency Medicine, Health Sciences University Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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Henning E, Bakir MS, Haralambiev L, Kim S, Schulz-Drost S, Hinz P, Kohlmann T, Ekkernkamp A, Gümbel D. Digital versus analogue record systems for mass casualty incidents at sea-Results from an exploratory study. PLoS One 2020; 15:e0234156. [PMID: 32502206 PMCID: PMC7274416 DOI: 10.1371/journal.pone.0234156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/19/2020] [Indexed: 11/30/2022] Open
Abstract
Objective Mis-triage may have serious consequences for patients in mass casualty incidents (MCI) at sea. The purpose of this study was to assess outcome, reliability and validity of an analogue and a digital recording system for triage of a MCI at sea. Methods The study based on a triage exercise conducted with a cross-over-design. Forty-eight volunteers were presented a fictional MCI with 50 cases. The volunteers were randomly assigned to start with the analogue (Group A, starting with the analogue followed by the digital system) or digital system (Group B, starting with the digital followed by the analogue system). Triage score distribution and agreement between the triage methods and a predefined standard were reported. Reliability was analysed using Cronbach’s Alpha and Cohen’s Kappa. Validity was measured through sensitivity, specificity and predictive value. Treatment, period and carry-over-effects were analysed using a linear mixed-effects model. Results The number of patients triaged (total: n = 3545) with the analogue system (n = 1914; 79.75%) was significantly higher (p = 0.001) than with the digital system (n = 1631; 67.96%). A trend towards a higher percentage of correct triages with the digital system was observed (p = 0.282). Ratio of under-triage was significantly smaller with the digital system (p = 0.001). Validity measured with Cronbach’s Alpha and Cohen’s Kappa was higher with the digital system. So was sensitivity (category; green: 80.67%, yellow: 73.24%, red: 83.54%; analogue: green: 93.28%, yellow: 82.36%, red: 94.04%) and specificity of the digital system (green: 78.07%, yellow: 63.75%, red: 66.25%; analogue: green: 85.50%, yellow: 79.88%, red: 91.50%). Comparing the predictive values and accuracy, the digital system showed higher scores than the analogue system. No significant patterns of carry-over-effects were observed. Conclusions Significant differences were found for the number of triages comparing the analogue and digital recording system. The digital system has a slightly higher reliability and validity than the analogue triage system.
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Affiliation(s)
- Esther Henning
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
- * E-mail:
| | - Mustafa Sinan Bakir
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
- Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Lyubomir Haralambiev
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
- Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Simon Kim
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | | | - Peter Hinz
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Thomas Kohlmann
- Institute for Community Medicine, Section Methods in Community Medicine, University Medicine Greifswald, Germany
| | - Axel Ekkernkamp
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
- Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Denis Gümbel
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
- Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
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Memari P, Tavakkoli-Moghaddam R, Navazi F, Jolai F. Air and ground ambulance location-allocation-routing problem for designing a temporary emergency management system after a disaster. Proc Inst Mech Eng H 2020; 234:812-828. [PMID: 32484021 DOI: 10.1177/0954411920925207] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Disasters cause a huge number of injured patients in a short time while existing emergency facilities encountered devastation and cannot respond properly. Here, the importance of implementing temporary emergency management becomes clear. This study aims to locate some temporary emergency stations across the area by maximal covering after a disaster. Furthermore, a multi-mode fleet is used for transferring patients using different modes of transportation (e.g. helicopter ambulance and bus ambulance). Since the type of patients may change over periods, medical servers can displace among temporary emergency stations dynamically according to disaster severity. For this purpose, a new bi-objective dynamic location-helicopter ambulance allocation-ambulance routing model with multi-medical servers is presented. The first objective function minimizes the operational costs related to the newly designed Emergency Medical Service along with the rate of human loss. The second objective function minimizes the critical time spent before the medical treatment. To validate the developed model, the augmented ε-constraint method is used and applied for the Tehran city, which shows the applicability of the model. Finally, two meta-heuristic algorithms are customized for large-sized problems, and the related results are compared based on multi-objective algorithms' performance comparison metrics to find the more efficient one.
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Affiliation(s)
- Pedram Memari
- School of Industrial Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Reza Tavakkoli-Moghaddam
- School of Industrial Engineering, College of Engineering, University of Tehran, Tehran, Iran.,Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Fatemeh Navazi
- School of Industrial Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Fariborz Jolai
- School of Industrial Engineering, College of Engineering, University of Tehran, Tehran, Iran
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Lin YK, Niu KY, Seak CJ, Weng YM, Wang JH, Lai PF. Comparison between simple triage and rapid treatment and Taiwan Triage and Acuity Scale for the emergency department triage of victims following an earthquake-related mass casualty incident: a retrospective cohort study. World J Emerg Surg 2020; 15:20. [PMID: 32156308 PMCID: PMC7065314 DOI: 10.1186/s13017-020-00296-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Triage plays a crucial role in the emergency department (ED) management of mass casualty incidents (MCIs) when resources are limited. This study aimed to compare the performance of simple triage and rapid treatment (START) with that of the Taiwan Triage and Acuity Scale (TTAS) for the ED triage of victims following an earthquake-related MCI. METHODS We retrospectively reviewed the records of victims presenting at our ED with earthquake-related injuries within 24 h of a large-scale earthquake. TTAS was initially used at our ED for this event, and START was performed by retrospectively reviewing the patient records in a blinded manner. Area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of START and TTAS were determined for predicting ED discharge. RESULTS We enrolled 105 patients (predominantly women, 60.0%; median age, 45.0 years) in this study; most of them presented with traumatic injuries and were initially triaged as TTAS level III (78.1%), followed by TTAS level II (11.4%). Although the majority of the victims (81.0%) were discharged, four deaths occurred. A moderate agreement in differentiating emergency from nonemergency patients was observed between START and TTAS. Furthermore, both the triage systems showed similar predictions for ED disposition (START AUC/sensitivity/specificity: 0.709/82.35%/55.00%; TTAS AUC/sensitivity/specificity: 0.709/90.59%/45.00%). CONCLUSIONS The present study demonstrated that START and TTAS have similar triage accuracy and ability to predict ED disposition. Our findings demonstrate that START may be used as an alternative to TTAS for the ED triage of victims following earthquake-related MCIs.
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Affiliation(s)
- Yun-Kuan Lin
- Department of Emergency Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Kuang-Yu Niu
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chen-June Seak
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Ming Weng
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Emergency Medicine, Prehospital Care Division, Taoyuan General Hospital, Taoyuan, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Pei-Fang Lai
- Department of Emergency Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan. .,Department of Medicine, Tzu Chi University, Hualien, Taiwan.
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Abstract
INTRODUCTION The use of triage systems is one of the most important measures in response to mass-casualty incidents (MCIs) caused by emergencies and disasters. In these systems, certain principles and criteria must be considered that can be achieved with a lack of resources. Accordingly, the present study was conducted as a systematic review to explore the principles of triage systems in emergencies and disasters world-wide. METHODS The present study was conducted as a systematic review of the principles of triage in emergencies and disasters. All papers published from 2000 through 2019 were extracted from the Web of Science, PubMed, Scopus, Cochrane Library, and Google Scholar databases. The search for the articles was conducted by two trained researchers independently. RESULTS The classification and prioritization of the injured people, the speed, and the accuracy of the performance were considered as the main principles of triage. In certain circumstances, including chemical, biological, radiation, and nuclear (CBRN) incidents, certain principles must be considered in addition to the principles of the triage based on traumatic events. Usually in triage systems, the classification of the injured people is done using color labeling. The short duration of the triage and its accuracy are important for the survival of the injured individuals. The optimal use of available resources to protect the lives of more casualties is one of the important principles of triage systems and does not conflict with equity in health. CONCLUSION The design of the principles of triage in triage systems is based on scientific studies and theories in which attempts have been made to correctly classify the injured people with the maximum correctness and in the least amount of time to maintain the survival of the injured people and to achieve the most desirable level of health. It is suggested that all countries adopt a suitable and context-bond model of triage in accordance with all these principles, or to propose a new model for the triage of injured patients, particularly for hospitals in emergencies and disasters.
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Performance of First Aid Trained Staff using a Modified START Triage Tool at Achieving Appropriate Triage Compared to a Physiology-Based Triage Strategy at Australian Mass Gatherings. Prehosp Disaster Med 2020; 35:184-188. [PMID: 31983350 DOI: 10.1017/s1049023x20000102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Triage at mass gatherings in Australia is commonly performed by staff members with first aid training. There have been no evaluations of the performance of first aid staff with respect to diagnostic accuracy or identification of presentations requiring ambulance transport to hospital. HYPOTHESIS It was hypothesized that triage decisions by first aid staff would be considered correct in at least 61% of presentations. METHODS A retrospective audit of 1,048 presentations to a single supplier of event health care services in Australia was conducted. The presentations were assessed based on the first measured set of physiological parameters, and the primary triage decision was classified as "expected" if the primary and secondary triage classifications were the same or "not expected" if they differed. The performance of the two triage systems was compared using area under the receiver operating characteristic curve (AUROC) analysis. RESULTS The expected decision was made by first aid staff in 674 (71%) of presentations. Under-triage occurred in 131 (14%) presentations and over-triage in 142 (15%) presentations. The primary triage strategy had an AUROC of 0.7644, while the secondary triage strategy had an AUROC of 0.6280, which was significantly different (P = .0199). CONCLUSION The results support the continued use of first aid trained staff members in triage roles at Australian mass gatherings. Triage tools should be simple, and the addition of physiological variables to improve the sensitivity of triage tools is not recommended because such an approach does not improve the discriminatory capacity of the tools.
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Lin HA, Wang TH, Kao WF, Chao CC. Patients’ survival rates and their correlated factors in the prehospital setting of a dust explosion incident. HONG KONG J EMERG ME 2019. [DOI: 10.1177/1024907919883137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Triage plays a critical role in mass casualty incidents by optimizing the use of medical resources. The Formosa Fun Coast (Baxian Water Park) dust explosion incident in 2015 revealed the lack of resources in the Taiwanese medical system to handle large-scale burn and scald casualties; however, this incident resulted in only 3% mortalities (15/499) by the end of 2015. Objective: This study aims to examine the key features and correlated factors of the prehospital setting in 15 mortalities. Materials and methods: This retrospective cohort study enrolled all patients from the Formosa Fun Coast incident (N = 499). The follow-up period was from 27 June to 31 December 2015. We first examined the correlation between patient survival and various variables and then tested the correlation between survival-correlated variables and the level of hospitals that provided treatment. Results: The survivor and nonsurvivor groups shared similar distributions of all study variables. Emergency medical technician performed the triage assessment, and the Baux score correlated with patient survival. This study further tested whether the hospital level correlated with the emergency medical technician–performed triage assessment or Baux score. A chi-square test revealed that the emergency medical technician–performed triage assessment and Baux score correlated with patient survival, thereby indirectly affirming the planning, training, and auditing of the Taiwanese emergency medical technician system. Conclusion: The lack of the effect of the hospital level on patient mortality indicated that mortality might be related to the severity of burn injury rather than the level of hospital chosen for initial treatment, besides being related to a satisfactory emergency medical technician–performed triage system.
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Affiliation(s)
- Hui-An Lin
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, ROC
| | - Tsung-Hsi Wang
- Ministry of Health and Welfare, ROC
- School of Medicine, National Yang-Ming University, ROC
| | - Wei-Fong Kao
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, ROC
| | - Chun-Chieh Chao
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, ROC
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, ROC
- Graduate Institute of Clinical Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, ROC
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Operation continued care: A large mass-casualty, full-scale exercise as a test of regional preparedness. Surgery 2019; 166:587-592. [PMID: 31447104 DOI: 10.1016/j.surg.2019.05.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/02/2019] [Accepted: 05/15/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Our regional trauma organization, which comprises 7 trauma centers, 30 acute care hospitals and free-standing emergency departments, and 42 emergency medical services agencies, conducted possibly the largest mass-casualty drill to date, totaling 445 victims at 3 sites involving 11 hospitals and 25 agencies and organizations. METHODS The drill was preceded by a tabletop exercise 4 months beforehand called Operation Continued Care Full-Scale Exercise, which consisted of simulated terrorist events at 3 sites to wound 445 moulaged patients. Four law enforcement and 5 fire and emergency medical services departments and 16 supporting organizations and agencies were involved in transporting patients to 11 different hospitals. The 7 objectives for the event addressed coordinating emergency operations, sustaining adequate communications, updating regional bed status, processing resource requests, triaging patients, tracking patients, and patient identification. RESULTS Of the 445 transported patients, 270 (60%) were entered correctly into the state patient tracking system; 68 (25.2%) upgrades and 34 (12.6%) downgrades from scene triage categories were noted. Multiple opportunities for improvement were identified, with major weaknesses noted in communication and coordination from event sites to the regional trauma organizations and hospitals. CONCLUSION The size and complexity of the drill provided experience and knowledge to facilitate future disaster preparedness and highlighted weaknesses in communication and coordination. Large, multijurisdictional, multiagency exercises provide opportunities to stress, evaluate, and improve regional disaster preparedness.
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Why Is Treatment Urgency Often Overestimated? An Experimental Study on the Phenomenon of Over-triage. Disaster Med Public Health Prep 2019; 14:563-567. [PMID: 31416493 DOI: 10.1017/dmp.2019.74] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In the 19th century, triage emerged as an administrative concept to overcome the unjust and medically unreasonable consequences of an unsystematic adhoc selection of casualties. Until today, however, triage concepts are often applied incorrectly. High over-triage rates are a well-known phenomenon, which increase mortality rates. In order to examine their frequent occurrences, the article discusses different reasons and presents results of an experimental study. Two triage exercises were conducted: a paper-based triage exercise and a real-world simulation. Both exercises used the same case-vignettes consisting of 5 pairs. Each pair described a patient with the same injury pattern and vital parameters but with differing behaviour (calm/highly excited). Different behavior has a minor but no significant effect on over-triage rates. Over-triage is significantly higher in the real-world simulation than in the paper exercise. This is explained by the characteristics of face-to-face situations themselves: they are more complex and ambiguous, and hold more normative power. Accordingly, over-triage is understood as a means to resolve unclear situations ("better to over- than to under-triage") and to comply with normative demands "within" the strict margins of an administrative concept.
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McKee CH, Heffernan RW, Willenbring BD, Schwartz RB, Liu JM, Colella MR, Lerner EB. Comparing the Accuracy of Mass Casualty Triage Systems When Used in an Adult Population. PREHOSP EMERG CARE 2019; 24:515-524. [PMID: 31287350 DOI: 10.1080/10903127.2019.1641579] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To use a previously published criterion standard to compare the accuracy of 4 different mass casualty triage systems (Sort, Assess, Lifesaving Interventions, Treatment/Transport [SALT], Simple Triage and Rapid Treatment [START], Triage Sieve, and CareFlight) when used in an emergency department-based adult population. Methods: We performed a prospective, observational study of a convenience sample of adults aged 18 years or older presenting to a single tertiary care hospital emergency department. A co-investigator with prior emergency medical services (EMS) experience observed each subject's initial triage in the emergency department and recorded all data points necessary to assign a triage category using each of the 4 mass casualty triage systems being studied. Subjects' medical records were reviewed after their discharge from the hospital to assign the "correct" triage category using the criterion standard. The 4 mass casualty triage system assignments were then compared to the "correct" assignment. Descriptive statistics were used to compare accuracy and over- and under-triage rates for each triage system. Results: A total of 125 subjects were included in the study. Of those, 53% were male and 59% were transported by private vehicle. When compared to the criterion standard definitions, SALT was found to have the highest accuracy rate (52%; 95% CI 43-60) compared to START (36%; 95% CI 28-44), CareFlight (36%; 95% CI 28-44), and TriageSieve (37%; 95% CI 28-45). SALT also had the lowest under-triage rate (26%; 95% CI 19-34) compared to START (57%; 95% CI 48-66), CareFlight (58%; 95% CI 49-66), and TriageSieve (58%; 95% CI 49-66). SALT had the highest over-triage rate (22%; 95% CI 14-29) compared to START (7%; 95% CI 3-12), CareFlight (6%; 95% CI 2-11) and TriageSieve (6%; 95% CI 2-11). Conclusion: We found that SALT triage most often correctly triaged adult emergency department patients when compared to a previously published criterion standard. While there are no target under- and over-triage rates that have been published for mass casualty triage, all 4 systems had relatively high rates of under-triage.
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Sergi C. Promptly reporting of critical laboratory values in pediatrics: A work in progress. World J Clin Pediatr 2018; 7:105-110. [PMID: 30479975 PMCID: PMC6242778 DOI: 10.5409/wjcp.v7.i5.105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/30/2018] [Accepted: 10/17/2018] [Indexed: 02/06/2023] Open
Abstract
In the 21st century, the determination of alert thresholds remains the most challenging and controversial issue in clinical pediatrics. Pre-analytical, analytical, and post-analytical matters will consolidate or undermine the fate of any laboratory process. Pre-analytical issues need to be cleared off before the laboratory physician can dispatch the result to the pediatrician in charge. Once it is cleared off, the classification of essential laboratory results is paramount. It is more than an academic exercise and may be subdivided in the order of priority we handle it to inform promptly and safely the primary physicians. Currently, we are applying new modes of making sure relevant information is transmitted without interrupting the standard workflow of the primary physicians in charge for the child, who eventually need a fast line of action for results that may be life-threatening.
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Affiliation(s)
- Consolato Sergi
- Department of Laboratory Medicine and Pathology, Stollery Children’s Hospital, University of Alberta, Edmonton, AB T6G 2B7, Canada
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Romero Pareja R, Castro Delgado R, Turégano Fuentes F, Jhon Thissard-Vasallo I, Sanz Rosa D, Arcos González P. Prehospital triage for mass casualty incidents using the META method for early surgical assessment: retrospective validation of a hospital trauma registry. Eur J Trauma Emerg Surg 2018; 46:425-433. [PMID: 30406394 DOI: 10.1007/s00068-018-1040-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 10/28/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND In mass casualty incidents (MCI), death usually occurs within the first few hours and thus early transfer to a trauma centre can be crucial in selected cases. However, most triage systems designed to prioritize the transfer to hospital of these patients do not assess the need for surgery, in part due to inconclusive evidence regarding the value of such an assessment. Therefore, the aim of the present study was to evaluate the capacity of a new triage system-the Prehospital Advanced Triage Method (META)-to identify victims who could benefit from urgent surgical assessment in case of MCI. METHODS Retrospective, descriptive, observational study of a multipurpose cohort of patients included in the severe trauma registry of the Gregorio Marañón University General Hospital (Spain) between June 1993 and December 2011. All data were prospectively evaluated. All patients were evaluated with the META system to determine whether they met the criteria for urgent transfer. The META defines patients in need of urgent surgical assessment: (a) All penetrating injuries to head, neck, torso and extremities proximal to elbow or knee, (b) Open pelvic fracture, (c) Closed pelvic fracture with mechanical or haemodynamic instability and (d) Blunt torso trauma with haemodynamic instability. Patients who fulfilled these criteria were designated as "Urgent Evacuation for Surgical Assessment" (UESA) cases; all other cases were designated as non-UESA. The following variables were assessed: patient status at the scene; severity scales [RTS, Shock index, MGAP (Mechanism, Glasgow coma scale, Age, pressure), GCS]; need for surgery and/or interventional procedure to control bleeding (UESA); and mortality. The two groups (UESA vs. non-UESA) were then compared. RESULTS A total of 1882 cases from the database were included in the study. Mean age was 39.2 years and most (77%) patients were male. UESA patients presented significantly worse on-scene hemodynamic parameters (systolic blood pressure and heart rate) and greater injury severity (RTS, shock index, and MGAP scales). No differences were observed for respiratory rate, need for orotracheal intubation, or GCS scores. The anatomical injuries of patients in the UESA group were less severe but these patients had a greater need for urgent surgery and higher mortality rates. CONCLUSION These findings suggest that the META triage classification system could be beneficial to help identify patients with severe trauma and/or in need of urgent surgical assessment at the scene of injury in case of MCI. These findings demonstrate that, in this cohort, the META fulfils the purpose for which it was designed.
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Affiliation(s)
- Rodolfo Romero Pareja
- Servicio de urgencias, Hospital Universitario de Getafe, Universidad Europea de Madrid Medical School, Madrid, Spain
| | - Rafael Castro Delgado
- Unit for Research in Emergency and Disaster, Department of Medicine, Public Health Area, Faculty of Medicine, Universidad de Oviedo, C/ Julián Clavería, 6, 33006, Oviedo, Spain.
- SAMU-Asturias, Servicio de Salud del Principado de Asturias, Oviedo, Spain.
| | | | | | - David Sanz Rosa
- School of Doctoral Studies and Research, Universidad Europea, Madrid, Spain
| | - Pedro Arcos González
- Unit for Research in Emergency and Disaster, Department of Medicine, Public Health Area, Faculty of Medicine, Universidad de Oviedo, C/ Julián Clavería, 6, 33006, Oviedo, Spain
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Ng CJ, You SH, Wu IL, Weng YM, Chaou CH, Chien CY, Seak CJ. Introduction of a mass burn casualty triage system in a hospital during a powder explosion disaster: a retrospective cohort study. World J Emerg Surg 2018; 13:38. [PMID: 30181768 PMCID: PMC6114838 DOI: 10.1186/s13017-018-0199-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/09/2018] [Indexed: 11/10/2022] Open
Abstract
Background The triage system used during an actual mass burn casualty (MBC) incident is a major focus of concern. This study introduces a MBC triage system that was used by a burn center during an actual MBC incident following a powder explosion in New Taipei City, Taiwan. Methods This study retrospectively analyzed data from patients who were sent to the study hospital during a MBC incident. The patient list was retrieved from a national online management system. A MBC triage system was developed at the study hospital using the following modifiers: consciousness, breathing, and burn size. Medical records were retrieved from electronic records for analysis. Patient outcomes consisted of emergency department (ED) disposition and intervention. Results The patient population was predominantly female (56.3%), with an average age of 24.9 years. Mean burn sizes relative to the TBSA of triage level I, II, and III patients were 57.9%, 40.5%, and 8.7%, respectively. ICU length of stay differed markedly according to triage level (mean days for levels I vs II vs III: 57.9 vs 39.9 vs 2.5 days; p < 0.001). Triage system levels I and II indicate ICU admission with a sensitivity of 93.9% (95%CI 80.4-98.3%) and a specificity of 86.7% (62.1-96.3%).Overall, 3 (6.3%) patients were under-triaged. Two (4.2%) patients were over-triaged. Sixteen (48.5%) and 21 (63.6%) patients of triage levels I and II received endotracheal intubation and central venous catheterization, respectively. Sorting of the study population with simple triage and rapid treatment (START) showed great sensitivity (100.0%) but poor specificity (53.3%). The Taiwan Triage and Acuity Scale (TTAS) presented 87.9% sensitivity and 93.9% specificity. Conclusions The current MBC triage algorithm served as a good indicator of ED disposition but might have raised excessive immediate attention and had the potential to exhaust the available resources. These findings add to our knowledge of the MBC triage system and should help future researchers in adjusting the triage criteria to fit actual disasters.
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Affiliation(s)
- Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linko, Taiwan
| | - Shih-Hao You
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linko, Taiwan
| | - I-Lin Wu
- Department of Emergency, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Yi-Ming Weng
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linko, Taiwan
- Department of Emergency Medicine, Prehospital Care Division, Taoyuan General Hospital, Ministry of Health and Welfare, No. 1492 Zhongshan Rd., Taoyuan Dist, Taoyuan City, 330 Taiwan
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chung-Hsien Chaou
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linko, Taiwan
| | - Cheng-Yu Chien
- Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei, Hsinchu County Taiwan
| | - Chen-June Seak
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linko, Taiwan
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Abstract
AbstractIntroductionThe most commonly used methods for triage in mass-casualty incidents (MCIs) rely upon providers to take exact counts of vital signs or other patient parameters. The acuity and volume of patients which can be present during an MCI makes this a time-consuming and potentially costly process.HypothesisThis study evaluates and compares the speed of the commonly used Simple Triage and Rapid Treatment (START) triage method with that of an “intuitive triage” method which relies instead upon the abilities of an experienced first responder to determine the triage category of each victim based upon their overall first-impression assessment. The research team hypothesized that intuitive triage would be faster, without loss of accuracy in assigning triage categories.MethodsLocal adult volunteers were recruited for a staged MCI simulation (active-shooter scenario) utilizing local police, Emergency Medical Services (EMS), public services, and government leadership. Using these same volunteers, a cluster randomized simulation was completed comparing START and intuitive triage. Outcomes consisted of the time and accuracy between the two methods.ResultsThe overall mean speed of the triage process was found to be significantly faster with intuitive triage (72.18 seconds) when compared to START (106.57 seconds). This effect was especially dramatic for Red (94.40 vs 138.83 seconds) and Yellow (55.99 vs 91.43 seconds) patients. There were 17 episodes of disagreement between intuitive triage and START, with no statistical difference in the incidence of over- and under-triage between the two groups in a head-to-head comparison.Conclusion:Significant time may be saved using the intuitive triage method. Comparing START and intuitive triage groups, there was a very high degree of agreement between triage categories. More prospective research is needed to validate these results.HartA, NammourE, MangoldsV, BroachJ. Intuitive versus algorithmic triagePrehosp Disaster Med.2018;33(4):355–361.
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Health Care Student Perceptions of Societal Vulnerability to Disasters in the Context of Population Aging. Disaster Med Public Health Prep 2018; 13:449-455. [PMID: 30041707 DOI: 10.1017/dmp.2018.65] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This paper reports on undergraduate health care students' perception of societal vulnerability to disasters in the context of population aging. Forecast increases in extreme weather events are likely to have a particularly devastating effect on older members of the community. METHODS Undergraduate paramedicine and nursing students were surveyed using the Perceptions of Ageing and Disaster Vulnerability Scale (PADVS) to determine their views on the risks posed to older members of the community by disasters. Data analysis included a comparison of subscales relating to isolation, health system readiness, declining function, and community inclusiveness. RESULTS Students reported a moderate level of concern about disaster vulnerability. Students who had previously completed another university degree reported significantly higher levels of concern than those without a prior degree. Australian students reported lower concern about societal vulnerability compared to a previously reported cohort of Japanese students. CONCLUSION Our study suggests current education of future health care students does not promote adequate levels of awareness of the health-related challenges posed by disasters, particularly among older members of the community. Without addressing this gap in education, the risk of negative outcomes for both unprepared first responders and older members of the community is significant. (Disaster Med Public Health Prep. 2019;13:449-455).
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START versus SALT Triage: Which is Preferred by the 21st Century Health Care Student? Prehosp Disaster Med 2018; 33:381-386. [PMID: 30001759 DOI: 10.1017/s1049023x18000547] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
IntroductionWhile the art and science of disaster triage continue to evolve, the education of the US health care student in matters pertaining to disaster preparedness and response remains stifled. Unfortunately, these students will be assuming major decision-making responsibilities regarding catastrophes that will be complicated by climate change, nuclear threats, global terrorism, and pandemics. Meanwhile, Sort, Assess, Life-Saving Interventions, Treatment, and/or Transport (SALT) triage is being advocated over the globally popular Simple Triage and Rapid Treatment (START) algorithm for multiple reasons: (1) it's an all-hazard approach; (2) it has four medical interventions; and (3) it has an additional triage color for victims with non-survivable injuries.Hypothesis/ProblemAs present-day threats become more ominous and health care education emphasizes the needs of vulnerable populations and palliative care, the authors hypothesize that, when given a choice, health care students will prefer SALT triage. METHODS A convenience sample of 218 interprofessional, disaster-naïve health care students received just-in-time, unbiased education on both START and SALT triage systems. Students then completed a survey asking them to decide which triage system they believe would be most effective in their community. RESULTS A total of 123 health care students (56.4%) preferred SALT while 95 (43.6%) preferred START; however, only the physician assistant students showed a statistically significantly preference (28 versus six, respectively; P=.042). Interestingly, there was also a statistically significant difference in preference by gender (Chi-square=5.02; P=.025) of the observed distribution versus expected distribution in SALT and START. The females preferred SALT (61.0%) while the males preferred START (55.9%).Among those who preferred START, START being easier to learn was the most important reason cited. Among those who preferred SALT, the most important reason cited was that the number of patient triage categories seemed more logical, comprehensible, and consistent with traditional medical care. CONCLUSION While SALT's preference among females and physician assistant students was based on the addition of medical interventions and the provision of palliative care, START's preference was related to expediency. Based on this research, incorporating disaster concepts into US health care students' curricula encourages thoughtful consideration among the future health care leaders about the most effective approach to triage care. It is critical that further research be completed to determine, without reservation, which triage system will not only save the most lives but provide the most humane care to victims.Fink BN, Rega PP, Sexton ME, Wishner C. START versus SALT triage: which is preferred by the 21st century health care student? Prehosp Disaster Med. 2018;33(4):381-386.
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Boltin N, Valdes D, Culley JM, Valafar H. Mobile Decision Support Tool for Emergency Departments and Mass Casualty Incidents (EDIT): Initial Study. JMIR Mhealth Uhealth 2018; 6:e10727. [PMID: 29934288 PMCID: PMC6035350 DOI: 10.2196/10727] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Chemical exposures pose a significant threat to life. A rapid assessment by first responders and emergency nurses is required to reduce death and disability. Currently, no informatics tools exist to process victims of chemical exposures efficiently. The surge of patients into a hospital emergency department during a mass casualty incident creates additional stress on an already overburdened system, potentially placing patients at risk and challenging staff to process patients for appropriate care and treatment efficacy. Traditional emergency department triage models are oversimplified during highly stressed mass casualty incident scenarios in which there is little margin for error. Emerging mobile technology could alleviate the burden placed on nurses by allowing the freedom to move about the emergency department and stay connected to a decision support system. OBJECTIVE This study aims to present and evaluate a new mobile tool for assisting emergency department personnel in patient management and triage during a chemical mass casualty incident. METHODS Over 500 volunteer nurses, students, and first responders were recruited for a study involving a simulated chemical mass casualty incident. During the exercise, a mobile application was used to collect patient data through a kiosk system. Nurses also received tablets where they could review patient information and choose recommendations from a decision support system. Data collected was analyzed on the efficiency of the app to obtain patient data and on nurse agreement with the decision support system. RESULTS Of the 296 participants, 96.3% (288/296) of the patients completed the kiosk system with an average time of 3 minutes, 22 seconds. Average time to complete the entire triage process was 5 minutes, 34 seconds. Analysis of the data also showed strong agreement among nurses regarding the app's decision support system. Overall, nurses agreed with the system 91.6% (262/286) of the time when it came to choose an exposure level and 84.3% (241/286) of the time when selecting an action. CONCLUSIONS The app reliably demonstrated the ability to collect patient data through a self-service kiosk system thus reducing the burden on hospital resources. Also, the mobile technology allowed nurses the freedom to triage patients on the go while staying connected to a decision support system in which they felt would give reliable recommendations.
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Affiliation(s)
- Nicholas Boltin
- Department of Computer Science and Engineering, University of South Carolina, Columbia, SC, United States
| | - Diego Valdes
- Department of Computer Science and Engineering, University of South Carolina, Columbia, SC, United States
| | - Joan M Culley
- College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Homayoun Valafar
- Department of Computer Science and Engineering, University of South Carolina, Columbia, SC, United States
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Abstract
IntroductionMass-casualty incidents (MCIs) easily overwhelm a health care facility's human and material resources through the extraordinary influx of casualties. Efficient and accurate triage of incoming casualties is a critical step in the hospital disaster response.Hypothesis/ProblemTraditionally, triage during MCIs has been manually performed using paper cards. This study investigated the use of electronic Simple Triage and Rapid Treatment (START) triage as compared to the manual method. METHODS This observational, crossover study was performed during a live MCI simulation at an urban, Canadian, Level 1 trauma center on May 26, 2016. Health care providers (two medical doctors [MDs], two paramedics [PMs], and two registered nurses [RNs]) each triaged a total of 30 simulated patients - 15 by manual (paper-based) and 15 by electronic (computer-based) START triage. Accuracy of triage categories and time of triage were analyzed. Post-simulation, patients and participating health care providers also completed a feedback form. RESULTS There was no difference in accuracy of triage between the electronic and manual methods overall, 83% and 80% (P=1.0), between providers or between triage categories. On average, triage time using the manual method was estimated to be 8.4 seconds faster (P<.001) for PMs; and while small differences in triage times were observed for MDs and RNs, they were not significant. Data from the participant feedback survey showed that the electronic method was preferred by most health care providers. Patients had no preference for either method. However, patients perceived the computer-based method as "less personal" than the manual triage method, but they also perceived the former as "better organized." CONCLUSION Hospital-based electronic START triage had the same accuracy as hospital-based manual START triage, regardless of triage provider type or acuity of patient presentations. Time of triage results suggest that speed may be related to provider familiarity with a modality rather than the modality itself. Finally, according to patient and provider perceptions, electronic triage is a feasible modality for hospital triage of mass casualties. Further studies are required to assess the performance of electronic hospital triage, in the context of a rapid surge of patients, and should consider additional efficiencies built in to electronic triage systems. This study presents a framework for assessing the accuracy, triage time, and feasibility of digital technologies in live simulation training or actual MCIs. BolducC, MaghrabyN, FokP, LuongTM, HomierV. Comparison of electronic versus manual mass-casualty incident triage. Prehosp Disaster Med. 2018;33(3):273-278.
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Vassallo J, Smith J, Bouamra O, Lecky F, Wallis LA. The civilian validation of the Modified Physiological Triage Tool (MPTT): an evidence-based approach to primary major incident triage. Emerg Med J 2017; 34:810-815. [DOI: 10.1136/emermed-2017-206647] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/11/2017] [Accepted: 07/22/2017] [Indexed: 11/04/2022]
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Diagnostic precision of triage algorithms for mass casualty incidents. English version. Anaesthesist 2017; 68:15-24. [PMID: 28798972 DOI: 10.1007/s00101-017-0352-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 03/30/2017] [Accepted: 06/07/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Regarding survival and quality of life recent mass casualty incidents again emphasize the importance of early identification of the correct degree of injury/illness to enable prioritization of treatment amongst patients and their transportation to an appropriate hospital. The present study investigated existing triage algorithms in terms of sensitivity (SE) and specificity (SP) as well as its process duration in a relevant emergency patient cohort. METHODS In this study 500 consecutive air rescue missions were evaluated by means of standardized patient records. Classification of patients was accomplished by 19 emergency physicians. Every case was independently classified by at least 3 physicians without considering any triage algorithm. Existing triage algorithms Primary Ranking for Initial Orientation in Emergency Medical Services (PRIOR), modified Simple Triage and Rapid Treatment (mSTaRT), Field Triage Score (FTS), Amberg-Schwandorf Algorithm for Triage (ASAV), Simple Triage and Rapid Treatment (STaRT), Care Flight, and Triage Sieve were additionally carried out computer based on each case, to enable calculation of quality criteria. RESULTS The analyzed cohort had an age of (mean ± SD) 59 ± 25 years, a NACA score of 3.5 ± 1.1 and consisted of 57% men. On arrival 8 patients were deceased. Consequently, 492 patients were included in the analysis. The distribution of triage categories T1/T2/T3 were 10%/47%/43%, respectively. The highest diagnostic quality was achieved with START, mSTaRT, and ASAV yielding a SE of 78% and a SP ranging from 80-83%. The subgroup of surgical patients reached a SE of 95% and a SP between 85-91%. The newly established algorithm PRIOR exerted a SE of 90% but merely a SP of 54% in the overall cohort thereby consuming the longest time for overall decision. CONCLUSION Triage procedures with acceptable diagnostic quality exist to identify the most severely injured. Due to its high rate of false positive results (over-triage) the recently developed PRIOR algorithm will cause overload of available resources for the severely injured within mass casualty incident missions. Non-surgical patients still are poorly identified by the available algorithms.
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[Diagnostic quality of triage algorithms for mass casualty incidents]. Anaesthesist 2017; 66:762-772. [PMID: 28710612 DOI: 10.1007/s00101-017-0336-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 03/30/2017] [Accepted: 06/07/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Regarding survival and quality of life, recent mass casualty incidents have once more emphasized the importance of early identification of the correct degree of injury or illness, to enable prioritizing treatment of patients and transportation to an appropriate hospital. The present study investigated international triage algorithms in terms of sensitivity (SE) and specificity (SP) as well as the process duration in a relevant emergency patient cohort. METHODS A total of 500 consecutive air rescue missions were evaluated by means of standardized patient records. Interdisciplinary classification of patients was accomplished by 19 emergency physicians. Every case was independently classified according to the triage category by at least three physicians without considering any triage algorithm. The available triage algorithms PRIOR (Primary Ranking for Initial Orientation in Emergency Medical Services), mSTaRT (modified Simple Triage and Rapid Treatment), FTS (Field Triage Score), ASAV (Amberg-Schwandorf Algorithm for Triage), STaRT (Simple Triage and Rapid Treatment), CareFlight triage and Triage Sieve were additionally carried out for each patient in a computer-based procedure, to enable calculation of test quality criteria for all procedures. RESULTS The analyzed cohort had a mean age of 59 ± 25 years (±SD), a National Advisory Committee for Aeronautics (NACA) score of 3.5 ± 1.1 and consisted of 57% men. On arrival 8 patients were already deceased, consequently 492 patients were included in the analysis. The distributions of triage categories I/II/III were 10%/47%/43%, respectively. The highest diagnostic quality was achieved with START, mSTaRT, and ASAV with 78% SE and 80-83% SP. The subgroup of surgical patients achieved 95% SE and 85-91% SP. The newly established algorithm PRIOR exerted an SE of 90% but an SP of only 54% in the overall cohort thereby taking the longest overall time for decisions. CONCLUSION Triage procedures with acceptable diagnostic quality exist to identify the most severely injured. Due to its high rate of false positive results (overtriage) in this study, the recently developed PRIOR algorithm could result in exhaustion of available resources for the severely injured and therefore to undertreatment of correctly assigned triage category I cases within mass casualty incidents. Non-surgical patients are still poorly allocated by the available algorithms. Contribution available free of charge by "Free Access".
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Abstract
BACKGROUND Mass-casualty incidents (MCIs) present a unique challenge with regards to triage as patient volume often outweighs the number of available Emergency Medical Services (EMS) providers. A possible strategy to optimize existing triage systems includes the use of other first responder groups, namely fire and police, to decrease the triage time during MCIs, allowing for more rapid initiation of life-saving treatment and prioritization of patient transport. Hypothesis First-year primary care paramedic (PCP), fire, and police trainees can apply with similar accuracy an internationally recognized MCI triage tool, Sort, Assess, Life-saving interventions, Treatment/transport (SALT), immediately following a brief training session, and again three months later. METHODS All students enrolled in the PCP, fire, and police foundation programs at two community colleges were invited to participate in a 30-minute didactic session on SALT. Immediately following this session, a 17-item, paper-based test was administered to assess the students' ability to understand and apply SALT. Three months later, the same test was given to assess knowledge retention. RESULTS Of the 464 trainees who completed the initial test, 364 (78.4%) completed the three month follow-up test. Initial test scores were higher (P<.05) for PCPs (87.0%) compared to fire (80.2%) and police (68.0%) trainees. The mean test score for all respondents was higher following the initial didactic session compared to the three month follow-up test (75% vs 64.7%; Δ 10.3%; 95% CI, 8.0%-12.6%). Three month test scores for PCPs (75.4%) were similar to fire (71.4%) students (Δ 4.0%; 95% CI, -2.1% to 10.1%). Both PCP and fire trainees significantly outperformed police (57.8%) trainees. Over-triage errors were the most common, followed by under-triage and then critical errors, for both the initial and follow-up tests. CONCLUSIONS Amongst first responder trainees, PCPs were able to apply the SALT triage tool with the most accuracy, followed by fire, then police. Over-triage was the most frequent error, while critical errors were rare.
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Future Developments in the Management of Explosive Incidents. Ann Emerg Med 2016; 69:S46-S51. [PMID: 27955763 DOI: 10.1016/j.annemergmed.2016.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kouliev T. Objective triage in the disaster setting: will children and expecting mothers be treated like others? Open Access Emerg Med 2016; 8:77-86. [PMID: 27822127 PMCID: PMC5089824 DOI: 10.2147/oaem.s96913] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The study of disaster triage is made difficult by the complex emotional response of potentially lifesaving intervention that a triage officer must make basing decisions on a succinct and efficient algorithm. A survey of triage professionals in international settings was designed to identify possible emotionally led bias that affects objective decision making in identifying victims most likely to benefit from immediate life support intervention. This survey suggests a lack of correlation between triage priority and predictable clinical outcomes as predicted by the Revised Trauma Score tool. Among the subjects, it was observed that a pediatric victim is uniformly overtriaged when compared to less injured victims.
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Affiliation(s)
- Timur Kouliev
- Beijing United Family Hospital, Beijing, People's Republic of China
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49
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Turner CDA, Lockey DJ, Rehn M. Pre-hospital management of mass casualty civilian shootings: a systematic literature review. Crit Care 2016; 20:362. [PMID: 27825363 PMCID: PMC5101656 DOI: 10.1186/s13054-016-1543-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mass casualty civilian shootings present an uncommon but recurring challenge to emergency services around the world and produce unique management demands. On the background of a rising threat of transnational terrorism worldwide, emergency response strategies are of critical importance. This study aims to systematically identify, describe and appraise the quality of indexed and non-indexed literature on the pre-hospital management of modern civilian mass shootings to guide future practice. METHODS Systematic literature searches of PubMed, Cochrane Database of Systematic Reviews and Scopus were conducted in conjunction with simple searches of non-indexed databases; Web of Science, OpenDOAR and Evidence Search. The searches were last carried out on 20 April 2016 and only identified those papers published after the 1 January 1980. Included documents had to contain descriptions, discussions or experiences of the pre-hospital management of civilian mass shootings. RESULTS From the 494 identified manuscripts, 73 were selected on abstract and title and after full text reading 47 were selected for inclusion in analysis. The search yielded reports of 17 mass shooting events, the majority from the USA with additions from France, Norway, the UK and Kenya. Between 1994 and 2015 the shooting of 1649 people with 578 deaths at 17 separate events are described. Quality appraisal demonstrated considerable heterogeneity in reporting and revealed limited data on mass shootings globally. CONCLUSION Key themes were identified to improve future practice: tactical emergency medical support may harmonise inner cordon interventions, a need for inter-service education on effective haemorrhage control, the value of senior triage operators and the need for regular mass casualty incident simulation.
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Affiliation(s)
- Conor D. A. Turner
- Barts and The London School of Medicine and Dentistry, Queen Mary University London, Garrod Building, Turner Street, Whitechapel, London, E1 2AD UK
| | - David J. Lockey
- Barts and The London School of Medicine and Dentistry, Queen Mary University London, Garrod Building, Turner Street, Whitechapel, London, E1 2AD UK
- London’s Air Ambulance, Barts Health Trust, London, UK
- The Norwegian Air Ambulance Foundation, Drøbak, Norway
| | - Marius Rehn
- London’s Air Ambulance, Barts Health Trust, London, UK
- The Norwegian Air Ambulance Foundation, Drøbak, Norway
- Department of Health Studies, University of Stavanger, Stavanger, Norway
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Achkoski J, Koceski S, Bogatinov D, Temelkovski B, Stevanovski G, Kocev I. Remote triage support algorithm based on fuzzy logic. J ROY ARMY MED CORPS 2016; 163:164-170. [DOI: 10.1136/jramc-2015-000616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 06/06/2016] [Accepted: 06/14/2016] [Indexed: 11/04/2022]
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