Operational Comparison of the Simple Triage and Rapid Treatment Method and the Sacco Triage Method in Mass Casualty Exercises

Abstract

Background: The operational viability of the Sacco Triage Method (STM) was assessed, and the performance of STMs was compared with the Simple Triage and Rapid Treatment (START) method. Methods: Parallel disaster exercises were conducted. Emergency responders used START in the morning and STM in the afternoon on a 99-victim simulated building collapse. Data were collected on the accuracy of patient assessment, the timeliness in clearing the scene, and the prioritization of patients. Attitudinal data were surveyed from responders. Results: STM scoring was more accurate at 91.7% than START assessments at 71.0%. The time to clear the scene was 16% less under STM (53 minutes) than START (63 minutes), although results were artificially better because physiologic assessments were not measured but read from patient profile cards. Twelve of the 13 most serious patients left the scene in the first 6 ambulances using STM. Under START, only 2 of the 13 most serious left in the first 13 ambulances and the 3 most serious were transported by bus nearly an hour later. Surveyed providers preferred START to STM falsely believing it to be more accurate, faster, and better able to identify the most serious patients. Conclusions: Emergency responders did not implement START successfully. Despite refresher training and 12 years of using START in Maryland, tagging was inaccurate and patient prioritization was poor. STM was implemented accurately after 20 minutes of introductory training, was shown to be operationally viable, and outperformed START in all objectives, most significantly in clearing the scene of the highest priority patients.