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

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.

A Qualitative Assessment of Studies Evaluating the Classification Accuracy of Personnel Using START in Disaster Triage: A Scoping Review

“…Following an initial search to identify publications on the topic, a health sciences librarian (SC) developed a search of nine electronic databases including OVID Medline, OVID EMBASE, OVID Global Health, EBSCO CINAHL, Compendex (Engineering Village), SCOPUS, Proquest Dissertations and Theses Global, Cochrane Library, and PROSPERO. The search strings for each database was adjusted appropriately for different databases and included controlled vocabulary and keywords for three concepts: ( 1 ) START, ( 2 ) triage and ( 3 ) mass casualty. The search was conducted in March 2020 and databases searches were limited from 1983 to present.…”

“…Created in the 1980s, the Simple Triage and Rapid Treatment ( START ) triage system was developed to be used in the event of a MCI ( 2 ), allowing responders to triage a patient in fewer than 60 seconds (s). ( 3 ).…”

Do Physiological Variables Predict the Need for Transport to Hospital From Music Festivals? An Analysis of Australian Festival Data

“…The data entry methods and abstraction from the database have previously been reported. 17 Raw data were the patient care records of the organization. The database recorded the first set of observations taken after presentation.…”

“…Measurement of variables was standardized over the study period. 17 The physiological variables were measured either with standard clinical approaches, or using the Philips M3001A Multi-Measurement Server (Philips GMBH; Amsterdam, The Netherlands) for HR, blood pressure, and oxygen saturation.…”

“…Previous evidence has shown that first aid staff can appropriately triage patients requiring hospital transport using either a formalized process, 16 or gestalt-based decision-making. 17 Most of these systems are designed for the disaster-medicine context, rather than music festivals. The role of solely physiology-based systems at music festivals has not been examined previously.…”