Abstract
BackgroundThe Amberg-Schwandorf Algorithm for Primary Triage (ASAV) is a novel primary triage concept specifically for physician manned emergency medical services (EMS) systems. In this study, we determined the diagnostic reliability and the time requirements of ASAV triage.MethodsSeven hundred eighty triage runs performed by 76 trained EMS providers of varying professional qualification were included into the study. Patients were simulated using human dummies with written vital signs sheets. Triage results were compared to a standard solution, which was developed in a modified Delphi procedure. Test performance parameters (e.g. sensitivity, specificity, likelihood ratios (LR), under-triage, and over-triage) were calculated. Time measurements comprised the complete triage and tagging process and included the time span for walking to the subsequent patient. Results were compared to those published for mSTaRT. Additionally, a subgroup analysis was performed for employment status (career/volunteer), team qualification, and previous triage training.ResultsFor red patients, ASAV sensitivity was 87%, specificity 91%, positive LR 9.7, negative LR 0.139, over-triage 6%, and under-triage 10%. There were no significant differences related to mSTaRT. Per patient, ASAV triage required a mean of 35.4 sec (75th percentile 46 sec, 90th percentile 58 sec). Volunteers needed slightly more time to perform triage than EMS professionals. Previous mSTaRT training of the provider reduced under-triage significantly. There were significant differences in time requirements for triage depending on the expected triage category.ConclusionsThe ASAV is a specific concept for primary triage in physician governed EMS systems. It may detect red patients reliably. The test performance criteria are comparable to that of mSTaRT, whereas ASAV triage might be accomplished slightly faster. From the data, there was no evidence for a clinically significant reliability difference between typical staffing of mobile intensive care units, patient transport ambulances, or disaster response volunteers. Up to now, there is no clinical validation of either triage concept. Therefore, reality based evaluation studies are needed.
Highlights
The global incidence of natural and technological disaster has been on a steady rise until around the year 2000
In this study we report the evaluation of Amberg-Schwandorf-Algorithmus für die Vorsichtung (ASAV) concerning its accuracy, reliability, and time requirements
Study participant demographics In six training and certification sessions performed in the year 2013, 82 emergency medical services (EMS) providers (60 professional and 22 volunteer EMS providers) were trained to perform ASAV, including the complete EMS career staff of the district
Summary
The global incidence of natural and technological disaster has been on a steady rise until around the year 2000. Triage algorithms provide a standardized and preliminary patient assessment and classification In this context, many triage algorithms for mass casualty incidents (MCI) require the decision on withholding lifesaving interventions for presumably unsalvageable patients, as it is the case for START [5], Triage Sieve [6,7], jumpSTaRT [8], mSTaRT [9], or SALT [10,11]. Simplified algorithmic decision making and avoidance of withholding lifesaving interventions are core requirements for primary triage by non-physician EMS personnel. Taking this into account, we adapted the mSTaRT primary triage algorithm [9] for the use in our physician based EMS system, resulting in the Amberg-Schwandorf Algorithm for Primary Triage (Amberg-Schwandorf-Algorithmus für die Vorsichtung, ASAV) [12]. We determined the diagnostic reliability and the time requirements of ASAV triage
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