Evaluating preparedness of emergency trainees to triage victims of mass casualty incidents

Abstract

Background: Triage of victims in mass casualty incidents (MCI) is crucial in prioritizing care and allocating resources1. Triage skills are important to be evaluated for training and better preparedness. Using clinical vignettes is a well-known approach to evaluate clinicians’ knowledge and decision-making2. This study aims to evaluate preparedness of emergency residents and fellows to triage victims of MCI. Methods: Emergency Medicine (EM) residents and fellows at Hamad General Hospital, Emergency Department (HGH-ED) were invited to the study. Each participant filled a questionnaire followed by triaging of 15 vignette-based victims of MCI. Descriptive statistics elaborated on participants’ training and relevant exposures (Table 1). It also showed the degree of agreement in their triage results and rates of under-triage and over-triage. Cohen's kappa coefficient showed inter-rater agreement and internal consistency in triage results. Results: Participants included 63 emergency trainees, 27 residents, and 36 fellows. Only 28.3% (n = 17) of them participated in an MCI drill over the past two years. 51.7% (n = 31) attended training on triage in MCI. 73.3% (n = 44) indicated that they have rarely or never triaged victims in a real MCI or a drill. Only 3.3% (n = 2) perceived themselves as highly confident in triaging victims of MCI. A total of 904 triage outcomes resulted from this exercise (Table 2). The overall rate of agreement among the triage outcomes is 73% (660 times in 904 triage outcomes). The rate of over-triage was 36.8% and 23% under-triage. Conclusion: Better triage results was associated with previous triage training. The rate of over-triage was as the literature recommends. However, the rate of under triage was alarmingly higher than the literature recommendation as < 5%3. The higher rate of under-triage imposes a risk of missing seriously injured victims, which may lead to higher mortality or poor patients’ outcomes. Further training and exercises may be the key to saving more lives and resources.