TRIAGE : Management of the trauma patient

Abstract

Triage, derived from the French word for sorting, aims to assess and prioritize injured patients, regardless of whether the injuries are sustained from everyday road traffic accident with few injured or a mass casualty incident. Triage seeks to provide the greatest benefit to the largest number of casualties in order to minimize morbidity and mortality. Triage in a pre-hospital setting entails management and sorting of patients according to an assessment of medical need, prioritization, and evacuation. In-hospital triage aims to rapidly identify the most injured and ensure timely and appropriate treatment according to the patient's clinical urgency. A number of different systems for performing triage have been established and implemented globally. The methodology is recognized and utilized but there is still a need for an evidence-based strategy to optimize training and the efficacy of the different systems.The main aim of this thesis was to determine triage performance among prehospital personnel and investigate the potential advantage of a triage system for trauma patients. The papers included in this thesis evaluated the triage skills of physicians, pre-hospital personnel, and rescue services personnel by testing their performance before and after an educational intervention. The last paper evaluated potential benefits of using a triage system for trauma patients admitted to the emergency department at MOI Teaching and Referral Hospital in Eldoret, Kenya.The results presented in this thesis illustrate that triage skills are lacking among physicians. Experienced pre-hospital personnel are more skilled in performing triage than physicians. The triage skills of the rescue services personnel improved significantly after the educational intervention. Moreover, the potential benefit to trauma patients of implementing an in-hospital triage system in a resource-poor environment was shown. In conclusion, health care personnel, especially physicians without experience but highly involved in trauma patient management, seem to be in need of triage training. How to train, how to implement, and how to evaluate triage skills must be considered in order to develop effective training. POPULÄRVETENSKAPLIG SAMMANFATTNINGOrdet triage kommer från franskans "sortera" och är ett av det första stegen i omhändertagandet av skadade när det råder resursbrist. Från 1800-talets blodiga slagfält, till dagens skadeplats och akutmottagningar har sättet att triagera patienter utvecklats. Men då, som nu, är grundtanken den samma, att sortera och prioritera de skadade utifrån tillgängliga resurser och patienternas vårdbehov. Följaktligen har begreppet kommit att bli centralt inom ämnet katastrofmedicin. Att avlida till följd av skador i samband med allvarliga händelser men också skador i till exempel vardagstrafiken är ett globalt hälsoproblem. Tiden från olycka till sjukhusbehandling är en viktig och ofta avgörande överlevnadsfaktor för en patient. I det här sammanhanget talas det om "den gyllene timmen", som påvisar vikten av att få ...

Time-efficiency factors in road tunnel rescue as perceived by Swedish operative personnel – an interview study

“…The participants in the present study also described that no common method of triage was used. This finding is in line with others who described that a lack of a common method of triage could create confusion among emergency service personnel and delay essential treatment (Lampi, 2017; Advanced Life Support Group, 2012). A potential countermeasure is described by Nilsson et al.…”

Association between Pre-Hospital Prioritization and Outcome of Injuries from Road Traffic Accidents in Makueni County, Kenya

“…A study in Moi Teaching and Referral Hospital in Kenya found that triage skills were lacking even among the physicians and that experienced pre-hospital personnel are more skilled than specialists in hospital settings [17]. This is because of the working environment in the pre-hospital set up which is not as organized as in the health facility set up.…”

Pemberdayaan Masyarakat Pelatihan GEPID (Triage and Rapid Treatment) Terhadap Kesiapsiagaan Evakuasi Korban Bencana Alam Gempa

“…Pemberian pendidikan kesehatan dapat meningkatkan pengetahuan atau wawasan tentang bencana dan tindakan saat pada fase pra bencana, saat bencana dan pasca bencana gempa bumi khususnya pasa fase pra bencana pencegahan dan mitigasi untuk mengurangi dampak dari bencana (Febriawati et al, 2020). Pemberian pelatihan berupa pemberdayaan yang bisa di lakukan untuk mengatasi dampak yang akan ditimbulkan apabila gempa susulan terjadi lagi maka tim pengabdian mengadakan penyuluhan dan pelatihan yaitu Pelatihan GEPID (Triage dan Rapid Treatment) (Lampi, 2017). GEPID (Triage dan Rapid Treatment) adalah tindakan penyelamatan pasien yang tengah mengalami gangguan medikal ataupun trauma.…”