Primary mass casualty incident triage: evidence for the benefit of yearly brief re-training from a simulation study

Abstract

BackgroundTriage is a mainstay of early mass casualty incident (MCI) management. Standardized triage protocols aim at providing valid and reproducible results and, thus, improve triage quality. To date, there is little data supporting the extent and content of training and re-training on using such triage protocols within the Emergency Medical Services (EMS). The study objective was to assess the decline in triage skills indicating a minimum time interval for re-training. In addition, the effect of a one-hour repeating lesson on triage quality was analyzed.MethodsA dummy based trial on primary MCI triage with yearly follow-up after initial training using the ASAV algorithm (Amberg-Schwandorf Algorithm for Primary Triage) was undertaken. Triage was assessed concerning accuracy, sensitivity, specificity, over-triage, under-triage, time requirement, and a comprehensive performance measure. A subgroup analysis of professional paramedics was made.ResultsNine hundred ninety triage procedures performed by 51 providers were analyzed. At 1 year after initial training, triage accuracy and overall performance dropped significantly. Professional paramedic’s rate of correctly assigned triage categories deteriorated from 84 to 71%, and the overall performance score decreased from 95 to 90 points (maximum = 100). The observed decline in triage performance at 1 year after education made it necessary to conduct re-training. A brief didactic lecture of 45 min duration increased accuracy to 88% and the overall performance measure to 97.ConclusionsTo improve disaster preparedness, triage skills should be refreshed yearly by a brief re-education of all EMS providers.

Simulação de incidente com múltiplas vítimas: treinando profissionais e ensinando universitários.

“…The victims were classified into: red 10 The oxygen offer is one of the recommendations found in the initial treatment of trauma victims, but care should be taken regarding the harmful effects of hyperoxia 27 .…”

“…One of the most widely used methods internationally and widely known in Brazil is the START (Simple Triage And Rapid Treatment). It classifies victims by colors, red meaning immediate priority and the other colors in descending order of priority are yellow, green and black 5,8,[9][10][11] .…”

Refining mass casualty plans with simulation-based iterative learning

“…38 All processes need maintenance, and relatively small, yearly interventions can maintain and even improve response to mass casualty incident. 39 To our knowledge, this series of simulations is the largest conducted within the NHS. We achieved this without affecting ongoing clinical care and increasing engagement across many disciplines.…”

Simultaneous Casualty Admissions—Do they Affect Treatment in the Receiving Trauma Center?

“…This is essential, both in singular and multiple trauma situations. In both scenarios, well-designed institutional protocols are mandated and, in our view, these protocols should be practiced on a regular basis through simulation training of involved personnel [ 27 ]. This recommendation is based on studies showing that programs regularly utilizing inter-professional simulation of pre- and in-hospital trauma care are associated with better overall outcomes in severe trauma.…”