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. 2010 Aug 11:10:17.
doi: 10.1186/1471-227X-10-17.

A concept for major incident triage: full-scaled simulation feasibility study

Marius Rehn  1 , Jan E Andersen, Trond Vigerust, Andreas J Krüger, Hans M Lossius
Affiliations

A concept for major incident triage: full-scaled simulation feasibility study

Marius Rehn et al. BMC Emerg Med. .

Abstract

Background: Efficient management of major incidents involves triage, treatment and transport. In the absence of a standardised interdisciplinary major incident management approach, the Norwegian Air Ambulance Foundation developed Interdisciplinary Emergency Service Cooperation Course (TAS). The TAS-program was established in 1998 and by 2009, approximately 15 500 emergency service professionals have participated in one of more than 500 no-cost courses. The TAS-triage concept is based on the established triage Sieve and Paediatric Triage Tape models but modified with slap-wrap reflective triage tags and paediatric triage stretchers. We evaluated the feasibility and accuracy of the TAS-triage concept in full-scale simulated major incidents.

Methods: The learners participated in two standardised bus crash simulations: without and with competence of TAS-triage and access to TAS-triage equipment. The instructors calculated triage accuracy and measured time consumption while the learners participated in a self-reported before-after study. Each question was scored on a 7-point Likert scale with points labelled "Did not work" (1) through "Worked excellent" (7).

Results: Among the 93 (85%) participating emergency service professionals, 48% confirmed the existence of a major incident triage system in their service, whereas 27% had access to triage tags. The simulations without TAS-triage resulted in a mean over- and undertriage of 12%. When TAS-Triage was used, no mistriage was found. The average time from "scene secured to all patients triaged" was 22 minutes (range 15-32) without TAS-triage vs. 10 minutes (range 5-21) with TAS-triage. The participants replied to "How did interdisciplinary cooperation of triage work?" with mean 4,9 (95% CI 4,7-5,2) before the course vs. mean 5,8 (95% CI 5,6-6,0) after the course, p < 0,001.

Conclusions: Our modified triage Sieve tool is feasible, time-efficient and accurate in allocating priority during simulated bus accidents and may serve as a candidate for a future national standard for major incident triage.

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Figures

Figure 1
Figure 1
Modified triage sieve action card. Adult (>140 cm) triage sieve.
Figure 2
Figure 2
Reflective slap wrap triage tags. (P1) immediate (red); (P2) urgent (yellow); (P3) delayed (green) and deceased (white/black).
Figure 3
Figure 3
Paediatric triage tape stretcher. Details: paediatric vital signs reference values.
Figure 4
Figure 4
Study design. LEQ = Learners Evaluation Questionnaire.
See this image and copyright information in PMC

References

    1. Advanced Life Support Group (Ed.) Major Incident Medical Management and Support, the Practical Approach at the scene. Second. Plymouth, UK: BMJ Publishing Group; 2002.
    1. Aylwin CJ, Konig TC, Brennan NW, Shirley PJ, Davies G, Walsh MS, Brohi K. Reduction in critical mortality in urban mass casualty incidents: analysis of triage, surge, and resource use after the London bombings on July 7, 2005.[see comment] Lancet. 2006;368:2219–2225. doi: 10.1016/S0140-6736(06)69896-6. - DOI - PubMed
    1. Seynaeve G, Archer F, Fisher J, Lueger-Schuster B, Rowlands A, Sellwood P, Vandevelde K, Zigoura A. International standards and guidelines on education and training for the multi-disciplinary health response to major events that threaten the health status of a community. Prehosp Disaster Med. 2004;19:S17–30. - PubMed
    1. Pesik N, Keim ME, Iserson KV. Terrorism and the ethics of emergency medical care. Ann Emerg Med. 2001;37:642–646. doi: 10.1067/mem.2001.114316. - DOI - PubMed
    1. Hodgetts T, Hall J, Maconochie I, Smart C. Paediatric triage tape. Pre-Hospital Immediate Care. 1998;2:155–159.

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