Accuracy of prehospital triage systems for mass casualty incidents in trauma register studies - A systematic review and meta-analysis of diagnostic test accuracy studies

Marcussen, Christian Elleby; Bräuner, Karoline Bendix; Alstrøm, Henrik; Møller, Ann Merete

doi:10.1016/j.injury.2022.05.006

Cited by 7 publications

(6 citation statements)

References 35 publications

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“…In this study, no triage system seems to be better than the other, emphasizing the lack of consensus in using a specific triage system, especially in MCIs and when vulnerable patients are concerned [ 7 , 27 , 28 ]. Ultimately, the choice of triage system will depend on the specific context and the availability of the resources.…”

Section: Discussionmentioning

confidence: 99%

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The implication of a translational triage tool in mass casualty incidents: part three: a multinational study, using validated patient cards

Khorram-Manesh,

Carlström,

Burkle

et al. 2023

Scand J Trauma Resusc Emerg Med

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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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Section: Discussionmentioning

confidence: 99%

“…One difficulty expressed by some participants in this study was the lack of a blue tag. Compared to the Sieve triage, neither START nor the new NHS Major Incident Triage Tool (MITT) has a blue tag [ 27 , 29 , 34 ]. Utilizing blue tags may simplify the decision-making between salvageable and non-salvageable RED patients.…”

Section: Discussionmentioning

confidence: 99%

The implication of a translational triage tool in mass casualty incidents: part three: a multinational study, using validated patient cards

Khorram-Manesh,

Carlström,

Burkle

et al. 2023

Scand J Trauma Resusc Emerg Med

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“…In penetrating trauma, a load and go principle, with treatment en route is recommended. In MI situations in the Capital Region, the Triage Sieve [ 35 ] is advocated as a supplement to anatomical localization of injuries/involved organ systems with regard to decision making.…”

Section: Discussionmentioning

confidence: 99%

“…Triage Sieve [ 35 ] is one of many triage systems used in MI [ 36 ] and until recently, no triage system has been proven to be significantly superior to another [ 37 ]. However, research by Malik et al [ 38 ] found the Battlefield Casualty Drills (BCD) Triage Sieve to outperform all existing MI triage tools and is the preferred triage system in United Kingdom.…”

Section: Discussionmentioning

confidence: 99%

The Field’s mass shooting: emergency medical services response

Hansen,

Mikkelsen,

Alstrøm

et al. 2023

Scand J Trauma Resusc Emerg Med

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Background Major incidents (MI) happen infrequently in Scandinavia and mass shootings are even less frequently occurring. Case reports and research are called for, as literature is scarce. On 3rd July 2022, a mass shooting took place at the shopping mall Field’s in Copenhagen, Denmark. Three people were killed and seven injured by a gunman, firing a rifle inside the mall. A further 21 people suffered minor injuries during the evacuation of the mall. In this case report, we describe the emergency medical services (EMS) incident response and evaluate the EMS´ adherence to the MI management guidelines to identify possible areas of improvement. Case presentation Forty-eight EMS units including five Tactical Emergency Medical Service teams were dispatched to the incident. Four critically injured patients were taken to two trauma hospitals. The deceased patients were declared dead at the scene and remained there for the sake of the investigation. A total of 24 patients with less severe and minor injuries were treated at four different hospitals in connection with the attack. The ambulance resources were inherently limited in the initial phase of the MI, mandating improvisation in medical incident command. Though challenged, Command and Control, Safety, Communication, Assessment, Triage, Treatment, Transport (CSCATTT) principles were followed. Conclusions The EMS response generally adhered to national guidelines for MI. The activation of EMS and the hospital preparedness program was relevant. Important findings were communication shortcomings; inherent lack of readily available ambulance resources in the initial critical phase; uncertainty regarding the number of perpetrators; uncertainty regarding number of casualties and social media rumors that unnecessarily hampered and prolonged the response. The incident command had to use non-standard measures to mitigate potential challenges.

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“…Major incident triage tools typically begin with the binary assessment of catastrophic haemorrhage 5 ; acknowledging that the distribution at an incident is typically skewed to the walking wounded, 6 the TST begins with 'walking' prior to the assessment of 'severe bleeding'. This enables responders to rapidly deprioritise a large volume of casualties, allowing for efforts to focus on non-ambulant casualties.…”

Section: Walking Before Bleedingmentioning

confidence: 99%

Ten second triage: A novel and pragmatic approach to major incident triage

Vassallo

Cowburn

Park

et al. 2023

Trauma

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Triage is a key principle in the effective management of major incidents and has traditionally been performed using an assessment of a casualty's physiology. However, it has become apparent from recent experiences of major incidents that physiological triage may practically not be possible, especially in the early stages of an incident. A key factor is the speed with which it is possible to perform triage, and subsequently, the speed at which key life-saving interventions (e.g., management of external haemorrhage and airway opening manoeuvres) are able to be performed simultaneously as part of the triage process. Addressing this issue was a priority for the review of major incident triage undertaken by NHS England and culminated in the development of the Ten Second Triage (TST) tool.

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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

Cited by 7 publications

References 35 publications

The implication of a translational triage tool in mass casualty incidents: part three: a multinational study, using validated patient cards

The implication of a translational triage tool in mass casualty incidents: part three: a multinational study, using validated patient cards

The Field’s mass shooting: emergency medical services response

Ten second triage: A novel and pragmatic approach to major incident triage

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