Incident Triage Research Articles

Evaluation of a new prehospital major incident triage tool: Informing current UK practice

During mass casualty incidents, the first Ambulance responders on scene face critical decisions about who receives medical treatment first. Effective clinical management of such incidents relies on triage, which prioritises patients based on injury severity, available resources, and the number of casualties. Various decision-making tools have been developed to assist emergency responders with triage decisions. However, there have been concerns raised about the efficacy of existing triage tools, which led to the development of a new pre-hospital triage tool for major incidents. The current study evaluated two versions of the new tool alongside the existing one used by UK emergency responders through a live exercise simulating two different major incidents. Participants offered valuable insights for the tools enhancement, notably in managing non-injured casualties and paediatric patients, and reducing cognitive load when making decisions. These findings shaped the final version of the new tool, deployed to UK Ambulance responders in Spring 2023. Findings demonstrate the importance of considering the visual presentation of triage tools as well as the inclusion of accurate physiological parameters to facilitate responder decision-making when categorising patients in mass casualty triage. Practical implications and suggestions for future research are discussed.

Don't forget the children-paediatric patients in mass casualty events and major incident planning.

Major incidents and mass casualty events can affect people of all ages. However, when planning the response to a major incident the focus is often on adult casualties rather than children. It is essential that the needs of paediatric patients are taken into account throughout major incident planning. Whether considering equipment, staffing or surgical and critical care capacity, hospitals should meet the needs of children as well as adults following a major incident and where possible, keep families together. The new Major Incident Triage Tool introduced in the National Health Service (NHS) in 2024 has a tendency to over triage paediatric casualties and so hospitals who may be receiving children following a UK major incident must be aware of this and plan for the potential implications. This article reviews the evidence and learning from previous mass casualty events and makes recommendations for hospitals to ensure that the needs of children will be met if a major incident occurs.

Utilization of an Asynchronous Online Learning Module Followed by Simulated Scenario to Train Emergency Medicine Residents in Mass-Casualty Triage.

This is a combined independent study and simulation session designed to teach and drill Mass Casualty Incident (MCI) Triage and is intended for emergency medicine residents at all levels. The training of emergency medicine residents to assume leadership roles in disaster response is important. However, lack of accepted specific educational goals on the national level leads to significant variability between residencies. The purpose of this session is to train EM residents in the use of the Simple Triage and Rapid Treatment (START) and pediatric JumpSTART algorithms for triage in mass casualty incidents (MCIs) using an asynchronous model. By the end of this small group session, learners will be able to: 1) describe START triage for adult MCI victims; 2) describe JumpSTART triage for pediatric MCI victims; 3) demonstrate the ability to apply the START and JumpSTART triage algorithms in a self-directed learning environment; 4) demonstrate the ability to apply the START and JumpSTART triage algorithms in a simulated mass casualty scenario under time constraints; and 5) demonstrate appropriate use of acute life-saving interventions as dictated by the START and JumpSTART triage algorithms in a high-pressure simulated environment. This session utilizes an online independent study module that was created de novo for this specific purpose by the authors followed by a high-pressure in-person simulation session where learners practice applying the START triage model with multiple simulated patients under time constraint. Learner feedback was collected after completion of the session. Retention of learning objectives was tested at four months via multiple-choice quiz. The session was very well received by our residents, who appreciated the opportunity to practice applying START triage under pressure. The average score on the pretest was 49%. Response rates to the post-test were low, but residents scored an average of 73%, indicating a trend towards retention of learning objectives. Overall, the utilization of a de novo online learning module followed by simulation proved to be a well-received method of teaching MCI triage to emergency medicine residents. We consider this to be an effective way to train MCI Triage with minimal in-conference time utilization. We plan to implement this training annually to provide our residents with longitudinal reinforcement of this vital skill. Mass casualty, MCI, triage, START triage, JumpSTART Triage, disaster, disaster preparedness, disaster curriculum, prehospital, EMS.

Implementation of a workshop for mass casualty incident triage training using an immersive virtual reality simulation.

We offered a workshop at the 2023 annual meeting of the Society for Academic Emergency Medicine to teach the Sort-Assess-Lifesaving Interventions-Treatment/Transport (SALT) triage protocol for responding to mass casualty incidents (MCIs) using an immersive virtual reality (VR) simulator. Here, we report workshop outcomes. After a 1-h didactic on the basics of triage protocols, workshop participants rotated through three skill stations at which learners learned how to use the VR headset and controllers, practiced applying SALT triage skills through a tabletop exercise, and then finally used our VR simulator for training responses to MCIs. During their encounter with VR, participants applied their new knowledge to triaging and treating the victims of an explosion in a virtual subway station. After a brief orientation, participants entered the scene to treat and triage virtual patients who had various life-threatening (e.g., acute arterial bleed, penetrating injury, pneumothorax, amputations) and non-life-threatening injuries (lacerations, sprains, hysteria, confusion). The simulator generated a performance report for each workshop attendee to be used for debriefing by a skilled facilitator. Participants were mostly trainees (residents), all of whom properly initiated their encounter with global sort commands (walk and wave) to identify the most critically injured. On average, participants correctly treated 92% of 18 injuries, with all bleeding injuries being properly controlled (tourniquets or wound packing). On average, participants correctly tagged 87.7% of 11 patients, but only took the pulse of 67% of the 11 patients. Learners had difficulty with cases involving embedded shrapnel and properly tagging patients who were stable after treatments. Our VR simulator provided a practical, portable, reproducible training and assessment system for preparing future emergency medical systems (EMS) medical directors to teach their EMS professionals the triage and lifesaving intervention treatment skills needed to save lives.

Prehospital mass casualty incident triage simulation builds knowledge and confidence in medical trainees.

Mass casualty incident (MCI) triage simulation is an increasingly useful tool for teaching triage systems to medical students, trainees, and hospital staff. MCI simulation in the prehospital setting has not yet been studied in this population. We aimed to assess the effectiveness of a prehospital MCI simulation in medical students, residents, and fellows. Our primary outcome was knowledge of the components of the triage algorithms used in MCI response. Our secondary outcome was each participant's confidence level if required to assist with or lead a MCI response. This was an observational study with pre-post surveys. We recruited 30 medical students, 14 emergency medicine (EM) residents, and four pediatric EM fellows to fill out a survey before and after a 3-h simulation session practicing the START and JumpSTART algorithms on two prehospital MCI scenarios. Overall, all groups demonstrated significant improvement in knowledge of triage colors, information needed to assign a triage color, pediatric airway management during a MCI, and indications for breaths-first CPR. They also demonstrated significant increase in confidence both in assisting with and in leading a MCI response. Simulated practice triaging patients in prehospital MCI scenarios improves knowledge of triage algorithms and increases confidence in assisting with or leading a MCI response in medical trainees.

Triage in major incidents: development and external validation of novel machine learning-derived primary and secondary triage tools

BackgroundMajor incidents (MIs) are an important cause of death and disability. Triage tools are crucial to identifying priority 1 (P1) patients—those needing time-critical, life-saving interventions. Existing expert opinion-derived tools have...

ChatGPT's performance before and after teaching in mass casualty incident triage

Since its initial launching, ChatGPT has gained significant attention from the media, with many claiming that ChatGPT’s arrival is a transformative milestone in the advancement of the AI revolution. Our aim was to assess the performance of ChatGPT before and after teaching the triage of mass casualty incidents by utilizing a validated questionnaire specifically designed for such scenarios. In addition, we compared the triage performance between ChatGPT and medical students. Our cross-sectional study employed a mixed-methods analysis to assess the performance of ChatGPT in mass casualty incident triage, pre- and post-teaching of Simple Triage And Rapid Treatment (START) triage. After teaching the START triage algorithm, ChatGPT scored an overall triage accuracy of 80%, with only 20% of cases being over-triaged. The mean accuracy of medical students on the same questionnaire yielded 64.3%. Qualitative analysis on pre-determined themes on ‘walking-wounded’, ‘respiration’, ‘perfusion’, and ‘mental status’ on ChatGPT showed similar performance in pre- and post-teaching of START triage. Additional themes on ‘disclaimer’, ‘prediction’, ‘management plan’, and ‘assumption’ were identified during the thematic analysis. ChatGPT exhibited promising results in effectively responding to mass casualty incident questionnaires. Nevertheless, additional research is necessary to ensure its safety and efficacy before clinical implementation.

Performance of Google bard and ChatGPT in mass casualty incidents triage

AimThe objective of our research is to evaluate and compare the performance of ChatGPT, Google Bard, and medical students in performing START triage during mass casualty situations. MethodWe conducted a cross-sectional analysis to compare ChatGPT, Google Bard, and medical students in mass casualty incident (MCI) triage using the Simple Triage And Rapid Treatment (START) method. A validated questionnaire with 15 diverse MCI scenarios was used to assess triage accuracy and content analysis in four categories: “Walking wounded,” “Respiration,” “Perfusion,” and “Mental Status.” Statistical analysis compared the results. ResultGoogle Bard demonstrated a notably higher accuracy of 60%, while ChatGPT achieved an accuracy of 26.67% (p = 0.002). Comparatively, medical students performed at an accuracy rate of 64.3% in a previous study. However, there was no significant difference observed between Google Bard and medical students (p = 0.211). Qualitative content analysis of ‘walking-wounded’, ‘respiration’, ‘perfusion’, and ‘mental status’ indicated that Google Bard outperformed ChatGPT. ConclusionGoogle Bard was found to be superior to ChatGPT in correctly performing mass casualty incident triage. Google Bard achieved an accuracy of 60%, while chatGPT only achieved an accuracy of 26.67%. This difference was statistically significant (p = 0.002).

Mass casualty triage: using virtual reality in hazardous area response teams training

Background: In recent years, virtual reality (VR) has become a pedagogic resource that complements the general training health professionals receive. VR could revolutionise hazardous area response team (HART) mass casualty incident (MCI) triage training. Aims: The study aimed to establish whether VR could improve the overall effectiveness of HART triage training and increase practitioner confidence and preparedness for an MCI. Methods: The author co-developed a VR marauding terrorist attack (MTA) triage scenario at a football stadium. The software was loaded onto Oculus Quest 2 VR headsets. HART paramedic participants completed an online survey before the exercise, which focused on demographics and experience. They were then familiarised with the VR equipment, which incorporated a tutorial on patient interaction. This was followed by a VR MTA exercise with 15 casualties, after which they completed an online survey to gauge their opinions. Results: All 36 HART paramedics recruited agreed VR would improve the effectiveness of HART paramedic training for mass casualty triage. Furthermore, 30 (83%) agreed that VR was more effective than the sand manikins currently used in training. Following the VR scenario, 31 (86%) of participants reported increased confidence in responding to an MCI and carrying out mass casualty triage. Conclusion: VR can improve the effectiveness of the HART triage training and may increase HART paramedic confidence in responding to an MCI and carrying out primary triage. Further studies with larger samples could determine if the results from this study can be generalisable across all frontline paramedic clinicians. Additionally, participant accuracy and time on task data should be evaluated.

COMPARISON OF START AND SALT TRIAGE SYSTEM IN MASS CASUALTY INCIDENTS: A STUDY OF ON-SITE TRAINING

Background: Mass casualty incident triage is essential in determining the priority of care for patients to maximize the number of survivors. This study aimed to evaluate the effectiveness of two different triage systems, SALT and START, in a simulated mass casualty event. Methods: participants were recruited and randomized into three groups: SALT-trained, START-trained, and untrained control. Participants performed triage on simulated patients pre- and post-training. Data was collected before and after implementing a training program that consist of a brief lecture and open discussion of 10 minutes for each triage system, and it was conducted in a group format. Results: A total of 60 participants were included in our analysis. The results showed that both SALT and START training significantly improved triage accuracy compared to the untrained control group. However, there was no significant difference in accuracy between the SALT and START groups. Additionally, both groups showed significant improvements in triage time post-training. Conclusion: These findings suggest that both SALT and START are effective triage systems in a simulated mass casualty event and highlight the importance of proper training for accurate and efficient triage.

An assessment of mass casualty triage systems using the Alberta trauma registry.

Triage is the process of identifying patients with both the greatest clinical need and the greatest likelihood of benefit in the setting of limited clinical resources. The primary objective of this study was to assess the ability of formal mass casualty incident triage tools to identify patients requiring urgent lifesaving interventions. Data from the Alberta Trauma Registry (ATR) was used to assess seven triage tools: START, JumpSTART, SALT, RAMP, MPTT, BCDand MITT. Clinical data captured in the ATR was used to determine which triage category each of the seven tools would have applied to each patient. These categorizations were compared to a reference standard definition based on the patients' need for specific urgent lifesaving interventions. Of the 9448 records that were captured 8652 were included in our analysis. The most sensitive triage tool was MPTT, which demonstrated a sensitivity of 0.76 (0.75, 0.78). Four of the seven triage tools evaluated had sensitivities below 0.45. JumpSTART had the lowest sensitivity and the highest under-triage rate for pediatric patients. All the triage tools evaluated had a moderate to high positive predictive value (> 0.67) for patients who had experienced penetrating trauma. There was a wide range in the sensitivity of triage tools to identify patients requiring urgent lifesaving interventions. MPTT, BCD and MITT were the most sensitive triage tools assessed. All of the triage tools assessed should be employed with caution during mass casualty incidents as they may fail to identify a large proportion of patients requiring urgent lifesaving interventions.

Triage Accuracy Rates Using the New MCI Triage System of Regione Piemonte: What’s New?

Introduction:An adequate Mass-Casualty Incident (MCI) triage system is essential to provide the best possible health care to the greatest number of affected people and to optimize the management of the available resources in the context of a MCI.Method:In February 2022, Disaster Medicine Service 118 of Regione Piemonte adopted a new 5-color code-MCI triage system and Emergency Medical System (EMS) personnel was trained through a 3-hours-distance learning course. 515 medical doctors and nurses attended the course and completed the final test (triaging of 50 computer-based simulated patients/cases). Their performance was compared to intended triage designations. We collected the data and conducted a descriptive observational study.Results:A total of 25.750 evaluations were carried out: 1.030 white cases, 6.180 green cases, 6.180 yellow cases, 9.270 red cases and 3,090 black cases. Overall triage accuracy was 89,63%. The overall errors were 2.671 (10.37%). Concerning the type of error, there were 1.415 cases under-triaged (5.5%) and 1.256 cases over- triaged (4.88%). Based on color-code, the highest rate of error was in green cases (3.48%), while black patients showed the highest accuracy rate (0.32%). Based on type, the most frequent error was under-triage of red patients, while the less frequent was over-triage of black patients.Conclusion:The results of the final test performed by EMS personnel showed the accuracy rates of triage using new 5-color code-MCI triage systems of Regione Piemonte to be in range with data reported in the literature. A study limitation is the fact that the data analyzed are derived from online testing performed in no-time limited and no-stress conditions. Another potential limitation is the distance learning which doesn’t allow a discussion with the teacher or a request for clarification. For this reason, we would plan a future study defining the efficacy of the didactic methodology in comparison with face-to-face courses.

Ten second triage: A novel and pragmatic approach to major incident triage

Triage is a key principle in the effective management of major incidents and has traditionally been performed using an assessment of a casualty's physiology. However, it has become apparent from recent experiences of major incidents that physiological triage may practically not be possible, especially in the early stages of an incident. A key factor is the speed with which it is possible to perform triage, and subsequently, the speed at which key life-saving interventions (e.g., management of external haemorrhage and airway opening manoeuvres) are able to be performed simultaneously as part of the triage process. Addressing this issue was a priority for the review of major incident triage undertaken by NHS England and culminated in the development of the Ten Second Triage (TST) tool.

Lessons From COVID-19 for the Next War: Crisis Standards of Care in the Role 3 Intensive Care Unit.

The rationing of medical resources became a common practice during the SARS-CoV-2 (COVID-19) pandemic. To cope with overwhelming patient numbers, hospitals were forced to adopt "crisis standards of care" (CSC) guidelines, which allow physicians to navigate the task of rationing health care resources in both an effective and ethically sound manner. The Military Health System currently has clinical guidelines for mass casualty incident (MCI) triage but lacks deployed Role 3 intensive care unit (ICU) CSC guidelines. In future peer and near-peer conflicts, this gap may prove detrimental when thousands of casualties following a single battle create a continuous and prolonged mass casualty event. The challenges of providing critical care in a battlefield hospital during a large conflict are unique and numerous, but lessons from COVID-19 ICUs such as transitioning to a utilitarian ethic, clear definitions, decision points, and decision authorities, as well as the establishment of clinical practice guidelines formulated from evidence-based protocols, can better prepare the U.S. expeditionary medical force for future conflicts. A battlefield CSC will allow military critical care physicians and nurses to manage overwhelmed ICUs and make better triage decisions, allowing them to provide a higher quality of care to the collective. In this commentary, we explore the need for Wartime CSC in the battlefield Role 3 ICU and the tools and methods used by civilian and military institutions to create and enact CSCs throughout the COVID-19 pandemic.

A Scoping Review of Pediatric Mass-Casualty Incident Triage Algorithms.

For the pediatric population, there is no consensus on which triage system to use for mass-casualty incidents (MCI). A scoping review was conducted to identify the most accurate triage system for pediatric patients in MCIs. MEDLINE (NLM, Bethesda, MA, USA), Embase (Elsevier Inc., Amsterdam, Netherlands), CINAHL (EBSCO Information Services, Ipswitch, MA, USA), and The Cochrane CENTRAL Register of Controlled Trials (John Wiley & Sons, Hoboken, NJ, USA), as well as Scopus (Elsevier Inc., Amsterdam, Netherlands), Global Health (Centre for Agriculture and Bioscience International, Wallingford, UK), Global Health Archive (Centre for Agriculture and Bioscience International, Wallingford, UK), and Global Index Medicus (World Health Organization, Geneva, Switzerland) were searched for relevant studies that were divided into 3 categories: accuracy of a single system, comparison of 2 or more primary triage system and comparison of secondary triage systems. Grey literature was also searched. 996 studies were identified from which 18 studies were included. Systems studied were found to have poor inter-rater reliability, had a low level of agreement between providers, had missed critically ill patients or were not externally validated. 11 studies compared pediatric MCI triage algorithms using different strategies and the most accurate algorithm was not identified. A recently developed secondary triage system, specifically for pediatric patients, was found to perform better than the comparison triage system. Although some algorithms performed better than others, no primary triage algorithm was accurate enough for the pediatric population. However, only 1 secondary triage algorithm was found to be superior to the others.

The Saunders report into the Manchester arena attack

Journal of Paramedic PracticeVol. 14, No. 12 CommentaryThe Saunders report into the Manchester arena attackTom MallinsonTom MallinsonEmail:E-mail Address: [email protected]Lecturer, College of Remote and Offshore Medicine, MaltaSearch for more papers by this authorTom MallinsonPublished Online:6 Dec 2022https://doi.org/10.12968/jpar.2022.14.12.490AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Aldington D, Jagdish S. The fentanyl ‘lozenge’ story: from books to battlefield. J R Army Med Corps. 2014;160(2):102–104. https://doi.org/10.1136/jramc-2013-000227 Crossref, Google ScholarCarenzo L, McDonald A, Grier G. Pre-hospital oral transmucosal fentanyl citrate for trauma analgesia: preliminary experience and implications for civilian mass casualty response. Br J Anaesth. 2022;128(2):e206–e208. https://doi.org/10.1016/j.bja.2021.08.017 Crossref, Google ScholarEllerton JA, Greene M, Paal P. The use of analgesia in mountain rescue casualties with moderate or severe pain. Emerg Med J. 2013;30(6):501–505. https://doi.org/10.1136/emermed-2012-202291 Crossref, Google ScholarEvents Industry Forum. The purple guide to health, safety and welfare at music and other events. 2022. https://www.thepurpleguide.co.uk (accessed 24 November 2022) Google ScholarGrassin-Delyle S, Shakur-Still H, Picetti R et al.. Pharmacokinetics of intramuscular tranexamic acid in bleeding trauma patients: a clinical trial. Br J Anaesth. 2021;126(1):201–209. https://doi.org/10.1016/j.bja.2020.07.058 Crossref, Google ScholarJESIP. Working Together, Saving Lives. 2022. https://www.jesip.org.uk/ (accessed 28 November 2022) Google ScholarManchester Arena Inquiry. Volume 2: emergency response. 2022. https://manchesterarenainquiry.org.uk/report-volume-two (accessed 24 November 2022) Google ScholarNational Ambulance Resilience Unit. National Amnulance Resilience Unit: Preparing for the future, protecting lives today.. 2022, https://naru.org.uk/ (accessed 28 November 2022) Google ScholarOakeshott JE, Griggs JE, Wareham GM, Lyon RM; Kent Surrey Sussex Air Ambulance Trust. Feasibility of prehospital freeze-dried plasma administration in a UK helicopter emergency medical service. Eur J Emerg Med. 2019;26(5):373–378. https://doi.org/10.1097/MEJ.0000000000000585 Crossref, Google ScholarPark CL, Langlois M, Smith ER et al.. How to stop the dying, as well as the killing, in a terrorist attack. BMJ. 2020;368:m298. https://doi.org/10.1136/bmj.m298 Crossref, Google ScholarVassallo J, Moran CG, Cowburn P, Smith J. New NHS prehospital major incident triage tool: from MIMMS to MITT. Emerg Med J. 2022;39(11):800–802. https://doi.org/10.1136/emermed-2022-212569 Crossref, Google Scholar FiguresReferencesRelatedDetails 2 December 2022Volume 14Issue 12ISSN (print): 1759-1376ISSN (online): 2041-9457 Metrics History Published online 6 December 2022 Published in print 2 December 2022 Information© MA Healthcare LimitedPDF download

Paediatric major incident triage: A Delphi process to determine clinicians' attitudes and beliefs within the United Kingdom and Ireland.

Triage is key to effective management of major incidents, yet there is scarce evidence surrounding the optimal method of paediatric major incident triage (MIT). This study aimed to derive consensus on key components of paediatric MIT among healthcare professionals responsible for triage during paediatric major incidents. Two-round online Delphi consensus study delivered July 2021-October 2021, including participants from pre-hospital and hospital specialities responsible for triage during paediatric major incidents. A 5-point Likert scale was used to determine consensus, set a priori at 70%. 111 clinicians completed both rounds; 13 of 17 statements reached consensus. Positive consensus was reached on rescue breaths in mechanisms associated with hypoxia or asphyxiation, mobility assessment as a crude discriminator and use of adult physiology for older children. Whilst positive consensus was reached on the benefits of a single MIT tool across all adult and paediatric age ranges, there was negative consensus in relation to clinical implementation. This Delphi study has established consensus among a large group of clinicians involved in the management of major incidents on several key elements of paediatric major incident triage. Further work is required to develop a triage tool that can be implemented based on emerging and ongoing research and which is acceptable to clinicians.

New NHS Prehospital Major Incident Triage Tool: from MIMMS to MITT

Triage is a key principle in the effective management of major incidents and is the process by which patients are prioritised on the basis of their clinical acuity. However, work...

WE7.9 Triage in Terror-Related Major Incidents

Abstract Introduction Recent major incidents (MI) in the UK have involved intentional explosions or indiscriminate attacks by perpetrators with bladed weapons. At a MI, on-scene triage vitally identifies those needing time-critical surgery and/or resuscitation (Priority 1, or P1, casualties), facilitating urgent transfer to specialist care. Currently, the National Ambulance Resilience Unit (NARU) Triage Sieve is used. We interrogated the Trauma Audit and Research Network (TARN) registry to compare performance of MI triage tools in predicting P1 status amongst adults. Methods TARN patients aged ≥16 years with penetrating and blast injury (January 2008-December 2017) were assigned triage categories (P1, P2, P3, Expectant or Dead) using pre-defined, intervention-based criteria. Ten MI triage tools were applied to patients’ first pre-hospital observations. Tool-predicted and intervention-based P1 assignments were compared. Results Of 5,660 patients, 5,635 (92%) suffered penetrating injuries, 25 (0.4%) sustained blast injuries. Mortality was 3.1% (n=171); median Injury Severity Score was 9 (IQR 9–16). 2,639 (46.6%) patients fulfilled P1 criteria: 1,170 (44.3%) required life-saving and 209 (7.9%) required limb-salvage surgery within 4 hours. The NARU Triage Sieve demonstrated sensitivity of 32.2%, over-triage 40.3% and AUC 0.566 (95%CI 0.555–0.578). The tool best-able to identify P1 casualties was the Battlefield Casualty Drills (BCD) Triage Sieve (sensitivity 68.0%, over-triage 47.3%, AUC 0.573 [95%CI 0.561–0.586]). Conclusions Terrorist attacks characteristically yield a high proportion of patients requiring urgent surgery. The current UK MI triage tool in use, the NARU Triage Sieve, exhibits unacceptably low detection of P1 casualties; we recommend it is superseded by the BCD Triage Sieve.

Sensitivity and Specificity of Spanish Prehospital Advanced Triage Method (META).

Mass-casualty incident (MCI) triage systems aim to provide the best possible health care to the greatest number of affected people with the available resources in the context of a mass-casualty event. The Spanish Prehospital Advanced Triage Method (Modelo Extrahospitalario de Triaje Avanzado; META) was designed to improved patient sorting in MCIs. The aim of this study was to estimate and compare sensitivity and specificity of META and the Manchester Triage System (MTS) in MCIs by retrospectively applying both triage algorithms to real MCI patients from the Emergency and Disaster Research Unit (Unidad de Investigación en Emergencia y Desastres; UIED) MCI database. This was a comparative study of two triage methods using sensitivity and specificity with the Revised Trauma Score (RTS) as the gold standard. A total of 134 MCI patients from the UIED database were included. An MCI in Asturias is defined as an incident that involves four or more victims that require ambulance mobilization. Patients mean age was 39.85 years (95% CI, 35.9-43.8) with an age range from one to 88 years old. In total, 54.4% of the patients were female. The most common types of MCI involved were fires (51.0%), followed by road traffic accident (43.3%) and street fight (3.7%). For MTS, the overall sensitivity was 30.6% (95% CI, 22.9-39.1) and specificity was 66.0% (95% CI, 60.0-71.7). For META triage algorithm, the overall sensitivity was 79.9% (95% CI, 72.1-86.3) and specificity was 89.9% (95% CI, 85.7-93.3). The META triage algorithm is a reliable triage system; thus, it can be recommended to be used in an MCI.