SALT Triage Research Articles

SALT triage training and virtual reality demonstration.

SALT triage training and virtual reality demonstration.

START Triage Sebagai Istrumen Penanganan Korban dalam Setting Bencana

Unexpected incidents that result in significant loss or destruction are called disasters. In general, this event is closely associated with natural phenomena. Ultimately, though, this is frequently linked to incidents brought about by human intervention that entail drastic lifestyle modifications and significant harm. Since it is vital to allocate comparatively few resources to specific, urgent medical needs, triage is a crucial component of contemporary medical treatment. When a patient's medical demands and the resources that are available are not met in a timely or convenient manner, this task becomes critical. The foundation of Simple Triage and Rapid Treatment (START) is a quick evaluation of mental status, breathing, and perfusion (RPM). This work was written using a literature study methodology. Reference books (textbooks), scientific journals, and other pertinent sources provide the literature that is used. According to calibration and discrimination data, RPM (STARt triage) is a more reliable indicator of the blunt trauma survival rate than the Trauma Severity Score and the Revised Trauma Score. SALT triage is inferior to START (SMART) triage. On the other hand, employing START triage has been shown to increase time efficiency. It has been scientifically demonstrated that using START triage can result in suitable assessments for disaster management. Through the development of the Mass Casualty Triage Pack (SMART Triage Pack), STRAT triage has been used to enhance its efficacy.

Proof of principle: An animal field triage protocol for livestock and horses caught in natural disasters and major incidents

Field triage systems are available to address mass casualty incidents involving humans, but lack for animals caught in disasters. This study aimed to develop, as a proof of principle, an animal field triage protocol for livestock, horses and wildlife based on an existing human triage system. A literature review was completed, resulting in choosing the human SALT triage algorithm as a starting point, followed by an expert consultation using a two-round Delphi study to evaluate and create the final version of the triage protocol. Finally, a group of first responders were familiarized with the protocol and triage injured animals in a simulated disaster environment using a purpose-built training game and provide written feedback. For livestock and horses, consensus was reached on the use of global sorting based on the criteria ‘autonomously mobile without obvious major injuries’, and on five of six appropriate physiological criteria applied for individual health state assessment. Triaged animals were placed in one of four categories developed for applicable veterinary care, being beyond saving (black), immediate/urgent (red), delayed (yellow) and minor (green). The expert panel agreed that the veterinary triage model is probably workable for livestock and horses but not for wildlife, and has added value in natural disasters and mass casualty incidents involving animals. Validation of the protocol with first responders on the usability of the triage protocol as a proof of principle warrants a careful introduction for practical use and further evaluation during disasters affecting livestock and horses in the field.

Comparative Analysis of META and SALT Disaster Triage in an Adult Trauma Population: A Retrospective Observational Study.

Medical professionals can use mass-casualty triage systems to assist them in prioritizing patients from mass-casualty incidents (MCIs). Correct triaging of victims will increase their chances of survival. Determining the triage system that has the best performance has proven to be a difficult question to answer. The Advanced Prehospital Triage Model (Modelo Extrahospitalario de Triaje Avanzado; META) and Sort, Assess, Lifesaving Interventions, Treatment/Transport (SALT) algorithms are the most recent triage techniques to be published. The present study aimed to evaluate the META and SALT algorithms' performance and statistical agreement with various standards. The secondary objective was to determine whether these two MCI triage systems predicted patient outcomes, such as mortality, length-of-stay, and intensive care unit (ICU) admission. This retrospective study used patient data from the trauma registry of an American College of Surgeons Level 1 trauma center, from January 1, 2018 through December 31, 2020. The sensitivity, specificity, and statistical agreement of the META and SALT triage systems to various standards (Revised Trauma Score [RTS]/Sort Triage, Injury Severity Score [ISS], and Lerner criteria) when applied using trauma patients. Statistical analysis was used to assess the relationship between each triage category and the secondary outcomes. A total of 3,097 cases were included in the study. Using Sort triage as the standard, SALT and META showed much higher sensitivity and specificity in the Immediate category than for Delayed (Immediate sensitivity META 91.5%, SALT 94.9%; specificity 60.8%, 72.7% versus Delayed sensitivity 28.9%, 1.3%; specificity 42.4%, 28.9%). With the Lerner criteria, in the Immediate category, META had higher sensitivity (77.1%, SALT 68.6%) but lower specificity (61.1%) than SALT (71.8%). For the Delayed category, SALT showed higher sensitivity (META 61.4%, SALT 72.2%), but lower specificity (META 75.1%, SALT 67.2%). Both systems showed a positive, though modest, correlation with ISS. For SALT and META, triaged Immediate patients tended to have higher mortality and longer ICU and hospital lengths-of-stay. Both META and SALT triage appear to be more accurate with Immediate category patients, as opposed to Delayed category patients. With both systems, patients triaged as Immediate have higher mortality and longer lengths-of-stay when compared to Delayed patients. Further research can help refine MCI triage systems and improve accuracy.

An Education and Training Program on Disaster Triage for Nurses and Nursing Students: Literature Review

Natural disasters continue to increase globally yearly. Over 1.6 billion people live in disaster-prone areas, conflict zones, and displacement areas. The impacts of disasters highlight the importance of disaster preparedness to minimize errors in disaster triage management. However, nurses' knowledge and skills in implementing initial triage procedures are still adequate. This scooping review aims to find an overview of implementing disaster triage education and training programs. This research is a scooping review using the Prisma flow chart in its implementation. This study showed significant results in all articles (n = 14) in increasing knowledge, attitudes, skills, awareness, preparedness, accuracy, and learning motivation in conducting disaster triage. The methods used are simulation methods (live, virtual reality, and screen-based) and training and education methods (lectures, discussions, videos, roleplay, and games) with material on disaster triage, START triage, and SALT triage concepts. This study concluded that disaster triage education for nurses and nursing students is very important to be provided by carrying out the latest methods so that the results are more effective.

“That was cool!” Participant Response to a Mass Casualty Incident Virtual Reality Simulator

Abstract Objective To minimize loss of life, mass casualty response requires swift identification, efficient triage categorization, and rapid hemorrhage control. Current training methods remain suboptimal. Our objective was to train first responders to triage a mass casualty incident using Virtual Reality (VR) simulation and obtain their impressions of the training’s quality and effectiveness. Methods We trained subjects in SALT Triage then had them respond to a terrorist bombing of a subway station using a fully immersive VR simulation. We gathered learner reactions to their VR experience and post-encounter debriefing with a custom electronic survey. Results Nearly 400 subjects experienced the VR encounter and completed evaluation surveys. Most participants (95%) recommended the experience for other first responders and rated the simulation (95%) and virtual patients (91%) as realistic. Ninety-four percent of participants rated the VR simulator as “excellent” or “good.” We observed no differences between those who owned a personal VR system and those who did not. Conclusions Our VR simulator (go.osu.edu/firstresponder) is an automated, customizable, fully immersive virtual reality system for training and assessing personnel in the proper response to a mass casualty incident. Participants perceived the encounter as effective for training, regardless of their prior experience with virtual reality.

Virtual Reality Simulation for Assessment of Hemorrhage Control and SALT Triage Accuracy in First Responders

Abstract Objective Hemorrhage control, triage efficiency, and triage accuracy are essential skills for optimal outcomes in mass casualty incidents. This study evaluated user application of skills through a Virtual Reality (VR) simulation of a subway bombing. Methods EMS clinicians and healthcare professionals engaged in a VR simulation of a bomb/blast scenario utilizing VRFirstResponder, a high-fidelity, fully immersive, automated, customizable, and programmable VR simulation platform. Metrics including time to control life-threatening hemorrhage and triage efficacy were analyzed using median and interquartile ranges (IQR). Results 389 EMS responders engaged in this high-fidelity VR simulation encountering 11 virtual patients with varying injury severity. The median time to triage the scene was 7:38 minutes (SD = 2:27, IQR = 6:13, 8:59). A robust 93% of participants successfully implemented all required hemorrhage control, with a median time of 3:51 minutes for life-threatening hemorrhage control (SD = 1:44, IQR = 2:41, 4:52). Hemorrhage control per patient took a median of 11 seconds (SD = 0:47, IQR = 0:06, 0:20). Participants accurately tagged 73% of patients and 17% effectively utilized the SALT sort commands for optimal patient evaluation. Conclusion The VRFirstResponder simulation, currently under validation, aims to enhance realism by incorporating distractors and refining assessment tools.

Table Top Salt Triage In Improving Pre Hospital Triage Capacity And Disaster Victim Handling Preparedness

Disasters have broad and complex impacts, both on humans and the surrounding environment. One of the challenges often faced in health management efforts in disaster areas is the lack of skills of nurses and other health workers in disaster victim preparedness and the ability to carry out pre hospital triage which will ultimately hamper health services. The knowledge and skills of nurses in handling disaster victims including conducting triage on victims are still in the sufficient category at 60%. In pre hospital situations, the correctness of officers in making triage decisions in handling victims has a very important role. The research objective was to determine the effect of the SALT triage table top in improving pre hospital triage capabilities and disaster victim handling preparedness. The research design used was a quasi experiment with a pre-post test with a control group. Sampling using purposive sampling technique. The number of respondents obtained was 78 people. The results of the Wilcoxon test showed a value of p = 0.000, which means that there is an influence of the SALT triage table top in increasing the ability of pre hospital triage and preparedness for handling disaster victims. Keywords: disaster; preparedness; pre hospital; table tops; triageTable Top Salt Triage Dalam Meningkatkan Kemampuan Triage Pre Hospital Dan Kesiapsiagaan Penanganan Korban BencanaABSTRAK Bencana memiliki dampak yang luas dan kompleks, baik terhadap manusia maupun lingkungan sekitarnya. Salah satu tantangan yang sering dihadapi dalam upaya penanggulangan kesehatan di daerah bencana adalah kekurangan ketrampilan perawat dan tenaga kesehatan lainnya dalam kesiapsiagaan penanganan korban bencana maupun kemampuan melakukan triage pre hospital yang akhirnya akan menghambat pelayanan kesehatan. Pengetahuan dan ketrampilan perawat dalam penanganan korban bencana termasuk melakukan triage terhadap korban masih berada pada kategori cukup sebesar 60%. Pada situasi pre hospital, kebenaran petugas dalam membuat keputusan triage dalam penanganan korban memiliki peran yang sangat penting. Tujuan penelitian untuk mengetahui pengaruh table top SALT triage dalam meningkatkan kemampuan triage pre hospital dan kesiapsiagaan penanganan korban bencana. Desain penelitian yang digunakan adalah quasi eksperiment dengan pre-post test with control group. Pengambilan sampel dengan menggunakan tehnik purposive sampling. Responden yang didapatkan berjumlah 78 orang. Hasil uji Wilcoxon menunjukkan nilai p = 0,000 yang artinya ada pengaruh table top SALT triage dalam meningkatkan kemampuan triage pre hospital dan kesiapsiagaan penanganan korban bencana. Kata Kunci : bencana; kesiapsiagaan; pre hospital; table top; triage

Mass Casualty Triage: What Works and Who Does it Best?

Introduction:There is a consensus that there lacks a standard for primary triage during mass casualty incidents. This is further compounded by a dearth of high quality research on the topic. Some studies suggest the superiority of SALT triage versus other triage systems, however, findings have not widely transitioned to clinical practice. We believe that despite specialized training including that in emergency medicine or emergency medical services (EMS), there will be significant variability amongst triage determination and use of triage methods. This study intends to analyze various provider skill levels and their accuracy of triage determination.Method:In a disaster exercise, a group of providers trained to use START triage were expected to triage, treat and determine transport order of the patients from a scenario of a simulated intentional radiological dispersal device (RDD) detonation with multiple casualties. Another group of providers trained to use SALT triage were expected to triage, treat, and determine transport order of patients from a scenario of a building collapse after a hurricane to assess SALT triage with the participating officers. Additional cohorts of EMS clinicians will be given the same case scenarios and asked to triage, treat when necessary, and determine transport order of the patients.Results:The initial data from the RDD exercise includes 102 patient case scenarios with 27 minimal (green), 40 delayed (yellow), and 35 immediate (red) patients. The providers involved in the exercise are trained at minimum to NREMT EMT level. Results showed an under-triage rate of 7.8%, an over-triage rate of 20.6% and overall accuracy of 71.6% when using START triage.Conclusion:The undertriage rate with START is 7.8% is higher than the generally acceptable rate of less than 5%. Our research is ongoing and we anticipate completion in 2023. We hope that our research provides future direction to improve triage in disaster scenarios.

Exploring Augmented Reality Triage Tools to Support Mass Casualty Incidents

ARTTS is a head-worn Augmented Reality (AR) Triage Tool Suite containing an initial sorting tool, virtual assessment tool, and virtual triage tag to assist first responders in mass casualty incidents. The initial sorting tool prompts stunned responders through first-wave tasks to aid recalibration from shock to triage. The virtual assessment tool provides novice responders, potentially confused by the chaos, with a walkthrough of the SALT triage flowchart. Finally, current emergency medical triage processes leverage static paper tags susceptible to loss or illegible damage. ARTTS’ virtual triage tags are dynamic, can be updated automatically with vital sensors or manually through responder interaction, and employ user interface emergent features based on individual patient conditions. This paper describes the UX process used to develop ARTTS.

The SALT and START Triage System for Classifying Patient Acuity Level: A Systematic Review

Background: Two common triage systems have been widely used in mass casualty incidents (MCIs) and disaster situations, namely START (simple triage algorithm and rapid treatment) and SALT (sort, assess, lifesaving, intervention, and treatment/transport). There is currently controversy regarding the effectiveness of SALT over the START triage system.Purpose: This systematic review aims to compare the accuracy of the SALT and START triage systems in disaster and MCI settings.Methods: The literature was searched using a systematic search strategy for articles published from 2009 to 2020 in the Medline, CINAHL, Web of Science, Scopus, PubMed, ProQuest databases, and the grey literature. This review included simulation-based and medical record-based studies investigating the accuracy and applicability of the SALT and START triage systems in adult and child populations during MCIs and disasters. All types of studies were included. The PRISMA flowchart was used to retain the articles, and the Joanna Briggs Institute critical appraisal tools were used to assess the quality of the reviewed studies.Results: Of 1,450 articles identified in the search, 10 articles were included. It was found that the START triage system had a wide range and inconsistent levels of accuracy (44% to 94.2%) compared to the SALT triage system (70% to 83%). The under-triage error of the START triage system ranged from 2.73% to 20%, which was slightly lower than the SALT triage system (7.6% to 23.3%). The over-triage error of the START triage system (2% to 53%) was slightly higher than the SALT triage system (2% to 22%). However, the time taken to apply START triage system (70 to 72.18 seconds) was faster than for the SALT triage system (78 seconds).Conclusion: The START triage system was simpler and faster than SALT. Conversely, the SALT triage system appeared to be slightly more accurate, more consistent, and had a lower rate of under- and over-triage error than START. It appears that neither the SALT nor the START triage system is superior to the other. Further research is needed to establish the most appropriate disaster and MCI triage system, especially for the Indonesian context.

Sort, Assess, Life-Saving Intervention, Triage With Drone Assistance in Mass Casualty Simulation: Analysis of Educational Efficacy.

IntroductionMass casualty incident (MCI) simulation and triage are educational methods used to provide high fidelity training to first response teams. Simulation and triage need to be as effective as possible to train professionals for true emergencies involving mass casualty. Although MCI simulation and triage have been used in the pre-professional setting (i.e. medical school, nursing school, etc.), more data is required regarding quality improvement of these simulations. This study focuses on quality improvement of MCI simulation and triage in the pre-professional training. In order to evaluate simulation quality to optimize future triage simulations, this study had three specific aims: (1) assess participant accuracy of triage after training in Sort, Assess, Life-Saving Interventions, Triage/Transport (SALT); (2) evaluate the role of stress and confidence in participants of triage simulation; (3) determine trainees’ perception of unmanned aerial vehicles (drones) in the setting of mass casualty simulation.MethodsA total of 44 attendees of the University of Central Florida (UCF) College of Medicine Global Health Conference participated in this study across three groups. Each group was provided a 15-minute lecture on SALT protocol. After the training, the participants continued to a 30-minute simulation in which they were asked to accurately triage up to 46 patient-actors. Each participants’ triage designations were compared to the previously assigned designations of each patient-actor. Pre- and post-simulation surveys were collected and analyzed using Statistical Package for the Social Sciences (SPSS) (IBM Corp., Chicago, IL). All other data were analyzed using descriptive statistics. ResultsQualitative and Likert data for the simulation were collected from 44 participants. Given a total of 1,113 triage scores (average of 25.29 triage designations per person), there was data to support that novice learners in this study tended to under-triage using the SALT protocol after 15-minute SALT training, with an overall accuracy of 52.43%. Survey data showed that confidence in mass casualty triage improved post-simulation, improving from median 3/10 to 5/10. Most participants were unaware of the use of unmanned aerial vehicles in MCI but most had positive opinions of their usefulness in MCI after the simulation, with a median score of 8/10.ConclusionsParticipant accuracy of triage after undergoing a 15-minute training in SALT triage was 52.43%, with a non-statistically significant tendency to under-triage. This accuracy level is consistent with other studies of SALT triage in MCI, but the tendency to undertriage requires further study for validation. Stress levels during the simulation were significantly elevated, while post-simulation confidence increased significantly from pre-simulation. The perception of drone utility in MCI was favorable among participants in this study, indicating drones may be useful for first response teams in future mass casualty simulations.

Nurses Assessment Accuracy And Self Confidence In Performing SALT Triage

Introduction: The nurses' assessment accuracy and confidence in the handling of mass victims of traffic accidents in the prehospital phase was an important success key of subsequent handling of victims when taken to the hospital, and vice versa if there was an error in providing help could be fatal for victims. The purpose of this study was to determine the comparison of face-to-face and watch video simulations of the assessment accuracy and nurses’ confidence in conducting prehospital disaster triage of victims of land traffic accidents using the SALT Triage model.Research Methods: Quasi experimental research with nonequivalent control group design. The sample size was 32 nurses who were divided into 2 groups, namely the face-to-face simulation group and the watch video SALT Triage simulation group. The samples were taken by non-random sampling with purposive sampling technique. Data analysis used was Paired t test and Independent t-testResults: There was no difference in the average nurses’ assessment accuracy and confidence in the face-to-face group with the group watching the simulation video. Statistical test results obtained p value> α = 0.05Conclusion: The sorting mass victims of the SALT Triage model can teach nurses by providing face-to-face or watching a simulation video about SALT Triage. Both ways were equally good at conveying information

Tabletop Application of SALT Triage to 10, 100, and 1000 Pediatric Victims.

The Sort, Access, Life-saving interventions, Treatment and/or Triage (SALT) mass-casualty incident (MCI) algorithm is unique in that it includes two subjective questions during the triage process: "Is the victim likely to survive given the resources?" and "Is the injury minor?" Given this subjectivity, it was hypothesized that as casualties increase, the inter-rater reliability (IRR) of the tool would decline, due to an increase in the number of patients triaged as Minor and Expectant. A pre-collected dataset of pediatric trauma patients age <14 years from a single Level 1 trauma center was used to generate "patients." Three trained raters triaged each patient using SALT as if they were in each of the following scenarios: 10, 100, and 1,000 victim MCIs. Cohen's kappa test was used to evaluate IRR between the raters in each of the scenarios. A total of 247 patients were available for triage. The kappas were consistently "poor" to "fair:" 0.37 to 0.59 in the 10-victim scenario; 0.13 to 0.36 in the 100-victim scenario; and 0.05 to 0.36 in the 1,000-victim scenario. There was an increasing percentage of subjects triaged Minor as the number of estimated victims increased: 27.8% increase from 10- to 100-victim scenario and 7.0% increase from 100- to 1,000-victim scenario. Expectant triage categorization of patients remained stable as victim numbers increased. Overall, SALT demonstrated poor IRR in this study of increasing casualty counts while triaging pediatric patients. Increased casualty counts in the scenarios did lead to increased Minor but not Expectant categorizations.

Triage Performance of School Personnel Using the SALT System.

The aim of this study was to determine if school personnel can understand and apply the Sort, Assess, Life-saving interventions, Treat/Transport (SALT) triage methods after a brief training. The investigators predicted that subjects can learn to triage with accuracy similar to that of medically trained personnel, and that subjects can pass an objective-structured clinical exam (OSCE) evaluating hemorrhage control. School personnel were eligible to participate in this prospective observational study. Investigators recorded subject demographic information and prior medical experience. Participants received a 30-minute lecture on SALT triage and a brief lecture and demonstration of hemorrhage control and tourniquet application. A test with brief descriptions of mass-casualty victims was administered immediately after training. Participants independently categorized the victims as dead, expectant, immediate, delayed, or minimal. They also completed an OSCE to evaluate hemorrhage control and tourniquet application using a mannequin arm. Subjects from two schools completed the study. Fifty-nine were from a private school that enrolls early childhood through grade eight, and 45 from a public school that enrolls grades seven and eight (n=104). The average subject age was 45 years and 68% were female. Approximately 81% were teachers and 87% had prior cardiopulmonary resuscitation (CPR) training. Overall triage accuracy was 79.2% (SD=10.7%). Ninety-six (92.3%) of the subjects passed the hemorrhage control OSCE. After two brief lectures and a short demonstration, school personnel were able to triage descriptions of mass-casualty victims with an overall accuracy similar to medically trained personnel, and most were able to apply a tourniquet correctly. Opportunities for future study include integrating high-fidelity simulation and mock disasters, evaluating for knowledge retention, and exploring the study population's baseline knowledge of medical care, among others.

Comparing the Accuracy of Mass Casualty Triage Systems When Used in an Adult Population

Objective: To use a previously published criterion standard to compare the accuracy of 4 different mass casualty triage systems (Sort, Assess, Lifesaving Interventions, Treatment/Transport [SALT], Simple Triage and Rapid Treatment [START], Triage Sieve, and CareFlight) when used in an emergency department-based adult population. Methods: We performed a prospective, observational study of a convenience sample of adults aged 18 years or older presenting to a single tertiary care hospital emergency department. A co-investigator with prior emergency medical services (EMS) experience observed each subject’s initial triage in the emergency department and recorded all data points necessary to assign a triage category using each of the 4 mass casualty triage systems being studied. Subjects’ medical records were reviewed after their discharge from the hospital to assign the “correct” triage category using the criterion standard. The 4 mass casualty triage system assignments were then compared to the “correct” assignment. Descriptive statistics were used to compare accuracy and over- and under-triage rates for each triage system. Results: A total of 125 subjects were included in the study. Of those, 53% were male and 59% were transported by private vehicle. When compared to the criterion standard definitions, SALT was found to have the highest accuracy rate (52%; 95% CI 43–60) compared to START (36%; 95% CI 28–44), CareFlight (36%; 95% CI 28–44), and TriageSieve (37%; 95% CI 28–45). SALT also had the lowest under-triage rate (26%; 95% CI 19–34) compared to START (57%; 95% CI 48–66), CareFlight (58%; 95% CI 49–66), and TriageSieve (58%; 95% CI 49–66). SALT had the highest over-triage rate (22%; 95% CI 14–29) compared to START (7%; 95% CI 3–12), CareFlight (6%; 95% CI 2–11) and TriageSieve (6%; 95% CI 2–11). Conclusion: We found that SALT triage most often correctly triaged adult emergency department patients when compared to a previously published criterion standard. While there are no target under- and over-triage rates that have been published for mass casualty triage, all 4 systems had relatively high rates of under-triage.

Chemical and Radiation Training for Public Health and Nursing Students: An Under-Utilized Disaster Response Demographic

Introduction:Public health (PH) and nursing students are an underutilized demographic in disaster response. Knowledge of the disaster response phase may enhance student understanding of preparedness, and provide response capabilities.Aim:A single four-hour simulation-based training session, with toxicologists as instructors, can effectively improve PH and nursing student knowledge and skills in chemical and radiation response, despite minimal prior experience.Methods:A convenience sample was used to test PH and nursing students in a response training program. An introductory lecture and simulation training reviewed: mass casualty care, triage, personal protective equipment, decontamination, and chemical and radiation exposure toxidromes. An examination was administered pre-training, and then post-training, to evaluate relevant training, knowledge, risk perception, and comfort in response capabilities to chemical and radiation incidents.Results:Forty-two students attended the course; 39 were included in the study. Seventy-two percent (n=28) of participants had no prior disaster training. Overall, there were significant differences between the pre-test and post-test scores for all students [95% CI: 5.4 (4.7-6.1); p&lt;0.0001, paired t-test]; maximum score 15/15. Comparing scores of nursing and PH students, despite statistical difference in pre-test scores (median, IQR: 9.0 (7.5-10±2.0); 7.0 (5.7-9.0) respectively; p=0.048, Mann Whitney U-test), there were no statistical differences in post-test scores (median, IQR: 14.0 (13.0-14.0); 13.0 (12.0-14.0), respectively, Mann Whitney U-test). All students recognized nerve agent toxidrome and performed SALT triage after the training (p &lt;0.0001, McNemar test). Subjectively, participant comfort level in responding to a chemical or radiological incident improved (p &lt;0.0001, McNemar test). Individual risk perception for chemical or radiological disasters did not improve after training.Discussion:Improvement of knowledge and comfort was demonstrated, irrespective of previous experience. Simulation-based training of chemical and radiation disaster preparedness, led by medical toxicologists, is an effective means of educating PH and nursing students, with minimal prior fluency.

Unexpected Lessons from a Mass Casualty Simulation: Strategies for Management of the Minimally Injured Can Increase Efficiency and Decrease Chaos

Introduction:The SALT Triage system has been advocated as an easy-to-use sorting and treatment system for mass casualty incidents (MCI). Minimally injured (GREEN) patients tend to be in the majority and may cause impediments to access and treatment of the most critically injured (RED). By identifying flaws in MCI communications that impair effective patient care, responders can be more effective.Aim:To discover strategies that effectively manage the minimally injured and leverage their help, increasing triage efficiency and treatment of the immediate casualties.Methods:Direct observation, after-action debriefing, and literature search.Results:The literature was vague regarding recommendations on a bystander and trained provider communication best practices. Feedback from standardized patients (actors) and participants during a structured debriefing following a 2018 American Society of Anesthesiology MCI exercise suggested that triaging providers under stress may communicate poorly, contributing to increased patient anxiety, disruptive behavior, and less effective team dynamics during a disaster. Strategies suggested include: eye contact; therapeutic touch (culturally appropriate); using slow, clear, reassuring speech; clearly explaining what is happening and why (sickest (RED and YELLOW) first priority, minimal (GREEN) next, expectant (BLACK) last); acknowledging their emotional state and their grief (not ignoring them); assigning nontechnical tasks to those capable of helping (putting pressure on a wound, moving casualties, or comforting the injured, dying, and the emotionally distraught).Discussion:Bystander engagement has been repeatedly identified as a means to increase the capacity of first responders to provide care to patients during an MCI. Utilization and management of the minimally injured and any uninjured bystanders and responders can become a force multiplier for the triage/treating responders. Developing a best practice dialogue to be used in training first responders could help improve many of these issues and augment current MCI training programs.

START versus SALT Triage: Which is Preferred by the 21st Century Health Care Student?

A convenience sample of 218 interprofessional, disaster-naïve health care students received just-in-time, unbiased education on both START and SALT triage systems. Students then completed a survey asking them to decide which triage system they believe would be most effective in their community. A total of 123 health care students (56.4%) preferred SALT while 95 (43.6%) preferred START; however, only the physician assistant students showed a statistically significantly preference (28 versus six, respectively; P=.042). Interestingly, there was also a statistically significant difference in preference by gender (Chi-square=5.02; P=.025) of the observed distribution versus expected distribution in SALT and START. The females preferred SALT (61.0%) while the males preferred START (55.9%).Among those who preferred START, START being easier to learn was the most important reason cited. Among those who preferred SALT, the most important reason cited was that the number of patient triage categories seemed more logical, comprehensible, and consistent with traditional medical care. While SALT's preference among females and physician assistant students was based on the addition of medical interventions and the provision of palliative care, START's preference was related to expediency. Based on this research, incorporating disaster concepts into US health care students' curricula encourages thoughtful consideration among the future health care leaders about the most effective approach to triage care. It is critical that further research be completed to determine, without reservation, which triage system will not only save the most lives but provide the most humane care to victims.Fink BN, Rega PP, Sexton ME, Wishner C. START versus SALT triage: which is preferred by the 21st century health care student? Prehosp Disaster Med. 2018;33(4):381-386.

MP01: Use of an unmanned aerial vehicle to provide situational awareness in a simulated mass casualty incident

Introduction: Situational awareness (SA) is essential for maintenance of scene safety and effective resource allocation in mass casualty incidents (MCI). Unmanned aerial vehicles (UAV) can potentially enhance SA with real-time visual feedback during chaotic and evolving or inaccessible events. The purpose of this study was to test the ability of paramedics to use UAV video from a simulated MCI to identify scene hazards, initiate patient triage, and designate key operational locations. Methods: A simulated MCI, including fifteen patients of varying acuity (blast type injuries), plus four hazards, was created on a college campus. The scene was surveyed by UAV capturing video of all patients, hazards, surrounding buildings and streets. Attendees of a provincial paramedic meeting were invited to participate. Participants received a lecture on SALT Triage and the principles of MCI scene management. Next, they watched the UAV video footage. Participants were directed to sort patients according to SALT Triage step one, identify injuries, and localize the patients within the campus. Additionally, they were asked to select a start point for SALT Triage step two, identify and locate hazards, and designate locations for an Incident Command Post, Treatment Area, Transport Area and Access/Egress routes. Summary statistics were performed and a linear regression model was used to assess relationships between demographic variables and both patient triage and localization. Results: Ninety-six individuals participated. Mean age was 35 years (SD 11), 46% (44) were female, and 49% (47) were Primary Care Paramedics. Most participants (80 (84%)) correctly sorted at least 12 of 15 patients. Increased age was associated with decreased triage accuracy [-0.04(-0.07,-0.01);p=0.031]. Fifty-two (54%) were able to localize 12 or more of the 15 patients to a 27x 20m grid area. Advanced paramedic certification, and local residency were associated with improved patient localization [2.47(0.23,4.72);p=0.031], [-3.36(-5.61,-1.1);p=0.004]. The majority of participants (78 (81%)) chose an acceptable location to start SALT triage step two and 84% (80) identified at least three of four hazards. Approximately half (53 (55%)) of participants designated four or more of five key operational areas in appropriate locations. Conclusion: This study demonstrates the potential of UAV technology to remotely provide emergency responders with SA in a MCI. Additional research is required to further investigate optimal strategies to deploy UAVs in this context.