Simple Triage And Rapid Treatment Triage Research Articles

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).

Current Disaster Triage Methods in Mass Casualty Incidents

Introduction:Triage in a disaster scenario centers around doing the greatest good for the greatest number of people. There are a variety of triage systems, and to this date there is no US national endorsement of one system because triage is a dynamic procedure and there is no fixed rule for it. The Simple Triage and Rapid Treatment (START); Sort, Assess, Life-saving interventions, Treatment/Transport (SALT); Sacco; CareFlight; JumpSTART; and Pediatric Triage Tape (PTT) triage systems are discussed with emphasis on how they perform.Method:There are approximately 20 adult and two pediatric triage systems that exist for primary disaster triage. The focus is on six primary triage systems. A literature search was performed using textbooks and original research.Results:A basic assignment to immediate, delayed, minimal, or expectant can sort a large group of casualties in a matter of minutes, but improper category assignment can lead to under-triage or over-triage.When assessed by a trained paramedic arriving at a Level 1 pediatric trauma center, SALT was found to be the most accurate triage system at 59% compared to JumpSTART, CareFlight, and TriageSieve. All triage systems exhibited under-triage rates of at least 33% and SALT had the highest over-triage rate at 6%. In another study, the START triage system was found to be 85% sensitive and 86% specific in predicting critical injury in designated trauma patients.Conclusion:Mass casualty incidents are unfortunately becoming more common as the increasing numbers of violent attacks produce an overwhelming number of victims. One triage process may not work in all disasters, but first responders should be trained to evaluate for the most critical patients in a sea of evolving patient presentations. Furthermore, randomized, controlled trials in real-world conditions are nearly impossible to perform given the specific circumstances of disasters.

A Qualitative Assessment of Studies Evaluating the Classification Accuracy of Personnel Using START in Disaster Triage: A Scoping Review

BackgroundMass casualty incidents (MCIs) can occur as a consequence of a wide variety of events and often require overwhelming prehospital and emergency support and coordinated emergency response. A variety of disaster triage systems have been developed to assist health care providers in making difficult choices with regards to prioritization of victim treatment. The simple triage and rapid treatment (START) triage system is one of the most widely used triage algorithms; however, the research literature addressing real-world or simulation studies documenting the classification accuracy of personnel using START is lacking.Aims and ObjectivesTo explore the existing literature related to the current state of knowledge about studies assessing the classification accuracy of the START triage system.DesignScoping review based on Arksey and O'Malley's methodological framework and narrative synthesis based on methods described by Popay and colleagues were performed.ResultsThe literature search identified 1,820 citations, of which 32 studies met the inclusion criteria. Thirty were peer-reviewed articles and 28 published in the last 10 years (i.e., 2010 and onward). Primary research studies originated in 13 countries and included 3,706 participants conducting triaging assessments involving 2,950 victims. Included studies consisted of five randomized controlled trials, 17 non-randomized controlled studies, eight descriptive studies, and two mixed-method studies. Simulation techniques, mode of delivery, contextual features, and participants' required skills varied among studies. Overall, there was no consistent reporting of outcomes across studies and results were heterogeneous. Data were extracted from the included studies and categorized into two themes: (1) typology of simulations and (2) START system in MCIs simulations. Each theme contains sub-themes regarding the development of simulation employing START as a system for improving individuals' preparedness. These include types of simulation training, settings, and technologies. Other sub-themes include outcome measures and reference standards.ConclusionThis review demonstrates a variety of factors impacting the development and implementation of simulation to assess characteristics of the START system. To further improve simulation-based assessment of triage systems, we recommend the use of reporting guidelines specifically designed for health care simulation research. In particular, reporting of reference standards and test characteristics need to improve in future studies.

Determination of START triage skill and knowledge levels of Prehospital Emergency Medical Staff: A cross sectional study

BackgroundEmergency medical staff working in pre-hospital (PH-staff) may encounter mass casualty incident (MCI) events. In these events these medical personnel should perform triage. The objective of this study is to determine the skill and knowledge levels of PH-staff about Simple Triage and Rapid Treatment (START) triage. MethodsWith this cross-sectional, observational study we analyzed data from 127 PH-staff. Data was collected with the survey tool (response rate = 74.7%). Kruskal-Wallis H Test, Mann-Whitney U Test, and Spearman’s Correlation analyzes were used in the data analysis by means of SPSS Software. ResultsOf the participants, 63% were men, the median age was 24 years, 88 PH-staff (69.3%) intervened in MCI events, and 37 PH-staff (29.1%) applied START triage. The skill score was 60% and the knowledge score was 72.5%. There was a weak positive correlation between knowledge and skill scores (r = 0.337, p < 0.01). The knowledge level of the emergency medical technicians (EMTs) and paramedics was higher than those from the other professions. ConclusionsThe triage knowledge and skill levels of the PH-staff were not low contrary to the expectations. The triage knowledge and skill levels of professions that did not have pre-hospital training such as paramedics and EMTs were low.

Telemedicine communication using instant messaging technology improves pre-hospital triage in high mountain train disasters

Background: Differences between pre-hospital triage by an emergency medical technician and Simple Triage and Rapid Treatment triage (START) by emergency staffs often affect manpower management and aggravate the chaos condition of emergency room. Objectives: Under the assistance of instant messaging, the authors aimed to identify ways of improving triage differences between emergency medical technician triage grading and Simple Triage and Rapid Treatment triage grading by emergency staffs. Methods: Recorded photographs of all patients were reviewed by a smartphone. We categorized patients according to three triage conditions: group 1, accident scene on-site or instantaneous Simple Triage and Rapid Treatment triage by the emergency medical technician; group 2, triage under Simple Triage and Rapid Treatment grading by emergency staffs; group 3, re-triage with START grading using recorded photographs, Glasgow Coma Scale, and vital signs when these patients were arrived in emergency room. The Wilcoxon Signed-Rank test, Spearman rank correlations, and Kruskal–Wallis test are employed to test differences among the groups. We used risk estimates with odds ratios and the chi-square test to statistically analyze the differences in triage grading. Results: Statistical analysis found conflicting results among Wilcoxon Signed-Rank test, Spearman rank correlations, and Kruskal–Wallis test. The difference in triage grading between groups 2 and 1 was greater than that between groups 2 and 3 (odds ratio, 6.473; 95% confidence interval, 1.693–24.470; p-value &lt; 0.05). Conclusion: Transferred photographs combined with Glasgow Coma Scale and vital signs can help us to understand the real situations of patients. With instant messaging applications, it is possible to make more precise pre-hospital or instantaneous triage.

Simulated Mass Casualty Incident Triage Exercise for Training Medical Personnel.

The target audience is any medical professional who requires training in mass casualty incident (MCI) triage. This could apply to pre-hospital specialists, nurses, medical students, residents, and physicians. Emergency medicine specialists must be able to triage patients quickly, especially in an MCI scenario. The simple triage and rapid treatment (START) system allows providers to categorize patients according to the urgency with which patients must access limited resources. Providers should be comfortable utilizing the START triage system before an MCI or disaster so that they can be prepared to implement it if necessary. This exercise uses simulation and gamification as instructional strategies to encourage knowledge of and comfort with the START triage system for emergency providers. By the end of this exercise, learners should be able to (1) recite the basic START patient categories (2) discuss the physical exam signs associated with each START category, (3) assign roles to medical providers in a mass casualty scenario, (4) accurately categorize patients into triage categories: green, yellow, red, and black, and (5) manage limited resources when demand exceeds availability. Gamification is the use of elements of game design in non-game contexts.1 Gamification was implemented in this scenario by assigning participants to roles and teams, while creating an engaging, fun, and competitive environment. The exercise also uses low fidelity simulation (without simulation equipment) to encourage learners to practice using the START triage system in a low stakes environment.2 It is possible for the learners to be divided into two groups that each have the same patients, resources, and objectives. The team that finishes triaging all patients first would be declared the winner. However, in our implementation, we completed the exercise as a single group of learners and patients. Learners were given a survey at the end of implementation and also given the opportunity to discuss feedback with the instructors in a group discussion after completing the exercise. There was no formal assessment completed after the exercise. Informal feedback was collected at the end of the exercise. Residents and medical students all enjoyed the experience. The feedback was overwhelmingly positive. All participants providing feedback stated they would enjoy participating in the exercise again and suggested that it is implemented annually for review of triage topics. We also received informal feedback for suggested changes which we will discuss in this article. An optional, anonymous survey was given to participants at the end of the exercise. There were six responses. Of those surveyed, 100% of participants stated the effectiveness and value of the exercise was outstanding (a rating of five on a scale of one to five). Regarding the quality of the exercise, and whether the participants felt engaged, 100% of responses gave a rating of five. When asked to consider the relevance of the session, 100% of participants selected a score of five ("I loved this session"). Regarding whether the content was applicable to practice of emergency medicine, 80% of respondents stated the session was highly relevant and 20% of responses selected a score of mostly relevant. One question asked for points of improvement for the session to which there were no responses. Learners were assigned roles in the exercise by the incident commander, fulfilling objective three. The START categories were discussed at the beginning of the exercise by the lead proctor (using PowerPoint) and then utilized throughout the exercise, thus accomplishing objectives one and two. The residents/students filling the triage roles were primarily responsible for fulfilling objective four; however, all participants assisted in categorization of patients throughout the exercise. Finally, objective five was addressed through the various social situations and complications that can be implemented during the exercise. We chose not to implement the additional "radiation contamination" scenario (details available in the article text) due to time constraints; however, this is an additional option to address objective five. The implementation was effective based on informal feedback from participants and proctors as well as evidenced by the responses to the anonymous survey. Learners found the aspects of resource management, review of START triage, repetition of the START triage system, and medical management of various types of trauma informative and meaningful. We received valuable feedback from both learners and proctors, which we will discuss in this article. Mass casualty incident, disaster, START, gamification, simulation, emergency medicine, triage, triage category, contamination, teamwork, trauma, projectile trauma, penetrating injury, blunt trauma, intracranial hemorrhage, fracture, trauma in pregnancy, active shooter, radiation, radio communication.

Improving Triage Accuracy in First Responders: Measurement of Short Structured Protocols to Improve Identification of Salient Triage Features

Gaze tracking is used in biomedical teaching for situations requiring the assessment of complex visual data. We employed gaze tracking techniques to examine an adapted training protocol using simple triage and rapid treatment (START) triage principles. This study utilized a case‐control design. Both groups were presented with a series of computer images, each corresponding to four levels of injury severity. Subsequently, the experimental group underwent training using the START triage program while the control group underwent training regarding patient transportation. Participants who underwent training with the START protocol fixated upon salient features significantly earlier post‐training as evidenced by decreased post‐training entry time (ms). 1376.35 (1665.69) (p = .02, 95% confidence interval [CI] [318.02–2434.68]); circulation: 1986.57 (2268.38) (p = .01, 95% CI [545.31–3427.84]). Those who underwent training only on patient transport and not on the adapted START triage protocol demonstrated no statistically significant between‐session gaze measurement. Subjects who underwent START triage training significantly improved in their first fixation entry time, indicating a faster recognition of salient triage features. We have shown the effectiveness of a short, directed triage training tool in improving the recognition of triage features.

Presence of undertriage and overtriage in simple triage and rapid treatment.

We evaluated the use of the Simple Triage and Rapid Treatment (START) method by Emergency Medical Services (EMS) and hypothesized that EMS can categorize patients using the START algorithm accurately. Retrospective Chart Review. Inner-city Tertiary-Care Institutional Emergency Department (ED). Patients ≥ 18 years transported by EMS with a START color of Red, Yellow, or Green during the state triage tag exercise, October 9-15, 2011. EMS assigned each patient a START triage tag. Chart review of the electronic EMS run sheets was performed by investigators to determine a START color. START triage colors were re-categorized as Red = 1, Yellow = 2, and Green = 3. The difference between the investigators' color and EMS color were coded as: 0 for agreement in triage, -1 for undertriage by one category, -2 for undertriage by two categories, 1 for overtriage by one category, 2 for overtriage by two categories. Of 224 participants, START triage colors were: Red = 7.1 percent, Yellow = 19.2 percent, Green = 73.7 percent. The mean difference in triage categories was 0.228 (95% CI: 0.114-0.311, p<.001). 71.0 percent of patients were triaged to the same category, 5.8 percent undertriaged by one category, 0 percent undertriaged by two categories, 17.9 percent overtriaged by one category, and 5.4 percent overtriaged by two categories. EMS was more likely to overtriage using START. All patients who were overtriaged by two categories were ambulatory at the scene, which implies other findings not in START may affect triage.

The Effect of Start Triage Education on Knowledge and Practice of Emergency Medical Technicians in Disasters.

Introduction: Pre-hospital triage is one of the most fundamental concepts in emergency management. Limited human resource changes triage to an inevitable solution in the management of disasters. The aim of this study was to evaluate the role of education of simple triage and rapid treatment (START) in the knowledge and practice of Emergency Medical Service (EMS) employees of Eastern Azerbaijan. Methods: This is a pre-and post-intervention study conducted on two hundred and five (205) of employees of EMS sector, in the disaster and emergency management center of Eastern Azerbaijan Province, 2015. The utilized tool is a questionnaire of the knowledge and practice of individuals regarding START triage. The questionnaire was filled by the participants pre- and post-education; thereafter the data were analyzed using SPSS 13 software. Results: The total score of the participants increased from 22.02 (4.49) to 28.54 (3.47). Moreover, the score of sections related to knowledge of the triage was a necessity and the mean score of the section related to the practice increased from 11.47 (2.15) to 13.63 (1.38), and 10.73 (3.57) to 14.93 (2.78), respectively, which were statistically significant. Conclusion: In this study, it was found that holding the educational classes of pre-hospital triage before the disasters is effective in improving the knowledge and practice of employees such as EMS technicians and this resulted to decreased error in performing this process as well as reduced overload in hospitals.

K116) An Objective Comparison of the START Triage Protocols and the Sacco Triage Method

objective:The objective of this study was to compare the operational viability and performance of the Sacco Triage Method (STM) to that of the Simple Triage and Rapid Treatment (START) protocol.Methods:Following a 20-minute review of the mandated START protocol and a 20-minute training session of STM, parallel disaster exercises were conducted. Emergency responded used START in the morning and STM in the afternoon on a simulated building collapse involving 99 victims. Data were collected on the accuracy of patient assessment (START) and scoring (STM), the timeliness in clearing the scene, and me prioritization of patients leaving the scene.Results:The STM scoring was more accurate than START assessments at 91.7% and 71.0%, respectively. The time to clear the scene was 16% less using STM than START (53 minutes and 63 minutes, respectively). The 13 most seriously injured patients left the scene in the first seven ambulances using STM; while only two of the 13 most seriously injured patients left the scene in the first 13 ambulances under START, and the three most serious patients were transported by bus. Surveyed providers preferred START to STM and believed 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 as their statewide protocol, tagging was inaccurate and patient prioritization was poor. In comparison, STM was implemented after 20 minutes of introductory training, was shown to be operationally viable, and outperformed START in all objectives.

Impact of Wireless Electronic Medical Record System on the Quality of Patient Documentation by Emergency Field Responders during a Disaster Mass-Casualty Exercise

The use of wireless, electronic, medical records and communications in the prehospital and disaster field is increasing. This study examines the role of wireless, electronic, medical records and communications technologies on the quality of patient documentation by emergency field responders during a mass-casualty exercise. A controlled, side-to-side comparison of the quality of the field responder patient documentation between responders utilizing National Institutes of Health-funded, wireless, electronic, field, medical record system prototype ("Wireless Internet Information System for medicAl Response to Disasters" or WIISARD) versus those utilizing conventional, paper-based methods during a mass-casualty field exercise. Medical data, including basic victim identification information, acuity status, triage information using Simple Triage and Rapid Treatment (START), decontamination status, and disposition, were collected for simulated patients from all paper and electronic logs used during the exercise. The data were compared for quality of documentation and record completeness comparing WIISARD-enabled field responders and those using conventional paper methods. Statistical analysis was performed with Fisher's Exact Testing of Proportions with differences and 95% confidence intervals reported. One hundred simulated disaster victim volunteers participated in the exercise, 50 assigned to WIISARD and 50 to the conventional pathway. Of those victims who completed the exercise and were transported to area hospitals, medical documentation of victim START components and triage acuity were significantly better for WIISARD compared to controls (overall acuity was documented for 100% vs 89.5%, respectively, difference = 10.5% [95%CI = 0.5-24.1%]). Similarly, tracking of decontamination status also was higher for the WIISARD group (decontamination status documented for 59.0% vs 0%, respectively, difference = 9.0% [95%CI = 40.9-72.0%]). Documentation of disposition and destination of victims was not different statistically (92.3% vs. 89.5%, respectively, difference = 2.8% [95%CI = -11.3-17.3%]). In a simulated, mass-casualty field exercise, documentation and tracking of victim status including acuity was significantly improved when using a wireless, field electronic medical record system compared to the use of conventional paper methods.

Virtual Reality Triage Training Provides a Viable Solution for Disaster‐preparedness

The objective of this study was to compare the relative impact of two simulation-based methods for training emergency medicine (EM) residents in disaster triage using the Simple Triage and Rapid Treatment (START) algorithm, full-immersion virtual reality (VR), and standardized patient (SP) drill. Specifically, are there differences between the triage performances and posttest results of the two groups, and do both methods differentiate between learners of variable experience levels? Fifteen Postgraduate Year 1 (PGY1) to PGY4 EM residents were randomly assigned to two groups: VR or SP. In the VR group, the learners were effectively surrounded by a virtual mass disaster environment projected on four walls, ceiling, and floor and performed triage by interacting with virtual patients in avatar form. The second group performed likewise in a live disaster drill using SP victims. Setting and patient presentations were identical between the two modalities. Resident performance of triage during the drills and knowledge of the START triage algorithm pre/post drill completion were assessed. Analyses included descriptive statistics and measures of association (effect size). The mean pretest scores were similar between the SP and VR groups. There were no significant differences between the triage performances of the VR and SP groups, but the data showed an effect in favor of the SP group performance on the posttest. Virtual reality can provide a feasible alternative for training EM personnel in mass disaster triage, comparing favorably to SP drills. Virtual reality provides flexible, consistent, on-demand training options, using a stable, repeatable platform essential for the development of assessment protocols and performance standards.

-PLUS Prehospital Mass-Casualty Triage: A Strategy for Addressing Unusual Injury Mechanisms

Simple Triage and Rapid Treatment (START) and more recently developed prehospital casualty triage algorithms are widely used, in part because they are easy to teach and learn, and can be performed rapidly. Every rapid triage protocol has inherent, significant limitations: (1) no mechanism of injury (MOI) considerations; (2) limited assessment points; and (3) no refinement in truly mass-casualty situations where transport of "minor" or "moderate" patients may be delayed. When rapid initial triage protocols are utilized, a significant triage deficiency ("under-triage") may occur when "minor" or "moderate" casualties actually are more severely injured than initially triaged. Some MOI produce casualties with subtle or latent (i.e., hidden or delayed) signs and symptoms not considered in the commonly used prehospital triage algorithms. This research did not focus on START or other initial triage screening methods. Instead, it focuses on developing follow-on triage guidance to more specifically prioritize "delayed transport" casualties based upon signs and symptoms related to their MOI. Using expert opinion and accepted clinical criteria, triage algorithms were developed to re-evaluate patients triaged to "minor" and "moderate" cohorts. A detailed literature search produced a draft list of relevant signs and symptoms for each selected MOI. The lists then were evaluated by a multi-disciplinary panel of experts via an anonymous, mail-based Delphi method. The input shaped triage algorithms for each selected MOI, which then were subjected to a second stage Delphi process. Consensus was achieved using the Delphi method. The algorithms extend patient assessment beyond the rapid initial triage protocols and incorporate triage criteria specific to each selected injury mechanism or condition: (1) penetrating injuries; (2) unconventional MOI (burns, blast, chemical, radiation); (3) smoke and other inhalation exposure; and (4) injuries with concomitant pregnancy. The full list of triage protocols is designated by the acronym "-PLUS". "-PLUS" Prehospital Casualty Triage may supplement the strengths of already existing, widely accepted mass-casualty triage strategies. It does not displace START or other rapid initial triage protocols, but in mass-casualty situations with extensive delays in transport, it provides a method to identify under-triage of seriously injured casualties. "-PLUS" also presents a framework for capturing the triage considerations used by experienced medical providers, and so may provide a valuable teaching tool for training future triage professionals. Further research and field assessment is required.

Does START Triage Work? An Outcomes Assessment After a Disaster

The mass casualty triage system known as simple triage and rapid treatment (START) has been widely used in the United States since the 1980s. However, no outcomes assessment has been conducted after a disaster to determine whether assigned triage levels match patients' actual clinical status. Researchers hypothesize that START achieves at least 90% sensitivity and specificity for each triage level and ensures that the most critical patients are transported first to area hospitals. The performance of START was evaluated at a train crash disaster in 2003. Patient field triage categories and scene times were obtained from county reports. Patient medical records were then reviewed at all receiving hospitals. Victim arrival times were obtained and correct triage categories determined a priori using a combination of the modified Baxt criteria and hospital admission. Field and outcomes-based triage categories were compared, defining the appropriateness of each triage assignment. Investigators reviewed 148 records at 14 receiving hospitals. Field triage designations comprised 22 red (immediate), 68 yellow (delayed), and 58 green (minor) patients. Outcomes-based designations found 2 red, 26 yellow, and 120 green patients. Seventy-nine patients were overtriaged, 3 were undertriaged, and 66 patients' outcomes matched their triage level. No triage level met both the 90% sensitivity and 90% specificity requirement set forth in the hypothesis, although red was 100% sensitive (95% confidence interval [CI] 16% to 100%) and green was 89.3% specific (95% CI 72% to 98%). The Obuchowski statistic was 0.81, meaning that victims from a higher-acuity outcome group had an 81% chance of assignment to a higher-acuity triage category. The median arrival time for red patients was more than 1 hour earlier than the other patients. This analysis demonstrates poor agreement between triage levels assigned by START at a train crash and a priori outcomes criteria for each level. START ensured acceptable levels of undertriage (100% red sensitivity and 89% green specificity) but incorporated a substantial amount of overtriage. START proved useful in prioritizing transport of the most critical patients to area hospitals first.

START Triage: Does It Work?

A mass casualty incident (MCI) demands rapid and efficient triage of victims. The Simple Triage and Rapid Treatment (START) protocol has been proposed to identify salvageable victims from those with imminent mortality. This study evaluates the efficacy of START triage to predict likelihood of mortality of an MCI trauma victim. Trauma patients were randomly selected using the trauma database at a local Level II trauma center. Survival was defined as a discharge from the hospital with the primary endpoint being death. For respiratory rate <30, pulse <100, and Glasgow Coma Scale score >14, one point was given to the victim for each category. Persons who did not meet these criteria were given a score of zero. The scores were then tabulated and analyzed with respect to the primary endpoint. Of the 355 persons analyzed, 341 (96%) survived and 14 (3.9%) were categorized as deceased. For patients with a tabulated score </=1, the positive predictive value (PPV) and negative predictive value (NPV) were 0.4 and 0.98, respectively. For patients with a tabulated score of >/=2, the PPV and NPV were 0.08 and 0.99, respectively. Of the total victims, 75.77% with a respiratory rate <30, palpable radial pulse, and intact mental status survived. The deceased victims with tabulated scores of 1, 2, and 3 had mortalities of 50%, 28%, and 21%, respectively. The trend toward lower tabulated scores in the deceased victims suggests efficacy with START triage.

Casualty Collection in Mass-Casualty Incidents: A Better Method for Finding Proverbial Needles in a Haystack

Mass-casualty incidents (MCIs) are on the rise. The ability to locate, identify, and triage patients quickly and efficiently results in better patient outcomes. Poor lighting due to time of day, inclement weather, and power outages can make locating patients difficult. Efficient methods of locating patients allow for quicker transport to definitive care. The objective of this study was to evaluate the methods currently used in mass-casualty collection, and to determine whether the use of the Simple Triage and Rapid Treatment (START) triage tag system can be improved by using easily discernable tags (glow sticks) in conjunction with the standard triage tags. Numerous drills were performed utilizing the START triage method. In Trial A, patients were identified with the triage tags only. In Trial B, patients were identified using triage tags and glow sticks. Four rounds of triage drills were performed in low ambient light for each Trial, and the differences in casualty collection times were compared. Casualty relocation and collection times were considerably shorter in the trials that utilized both the glow sticks and triage tags. An average of 2.58 minutes (31.75%) were saved during the casualty collections. In addition, fewer patient errors occurred during the trials in which the glow sticks were used. Between the four rounds, an average of four patient errors occurred during the trials that utilized the triage tags. However, there was an average of only one patient error for the drills when participants utilized both the triage tags and the glow sticks. The use of the highly visible glow sticks, in conjunction with the START triage tags, allowed for more rapid and accurate casualty collection in suboptimal lighting. The use of the glow sticks made it easier to relocate previously triaged patients and arrange for expeditious transport to definitive care. In addition, the glow sticks reduced the number of patient errors. Most importantly, there was a significant reduction in the number of patients that initially were triaged via the START method, but were overlooked during casualty collection and transport.

Simple triage and rapid treatment: Does it predict transportation and referral needs in patients evaluated by disaster medical assistance teams?

Study objectives: Disaster preparedness and response has taken on a new urgency because of recent world events. Aspects of a disaster response that have not been fully evaluated or assessed for validity include triage and triage systems. A commonly used system is the modified Simple Triage and Rapid Treatment (START). In this system, patients are triaged to 1 of 4 categories: red, immediate care; yellow, delayed care; green, “walking wounded”; and black, unsalvageable. The START triage system is frequently used by disaster medical assistance teams (DMAT), and is the system used by the New Mexico DMAT (NMDMAT) during deployments. However, this model has not been assessed previously to determine whether it is a useful or appropriate tool in a DMAT deployment. Our goal is to determine whether the START system commonly used by DMATs is a useful predictor of patient referral and transportation needs in disasters. To our knowledge, this is the first evaluation of this triage tool in DMAT deployments.Methods: This is a retrospective cohort review of all patients treated by the NMDMAT after Hurricane Andrew (Florida, August 1992), Hurricane Iniki (Hawaii, September 1992), the Northridge Earthquake (California, January 1994), and the Houston flood caused by Tropical Storm Allison (Texas, June 2001). Medical records were reviewed for triage category, disposition, and mode of transportation. Patients were assigned 1 of 4 triage categories according to urgency for medical care: green, yellow, red, or black. Disposition was assigned to 1 of 2 categories: home or referral to additional medical care. Transportation was also assigned to 1 of 2 categories: private vehicle or emergency medical services (EMS). Data were compared for statistical significance using a χ2 test for trend.Results: One thousand six hundred fifty-eight patients treated during these disaster events were assigned the following triage categories: green 1,363 (82.2%), yellow 236 (14.2%), red 55 (3.3%), and black 0. A total of 226 (13.6%) patients required disposition to additional medical care: green 123 (9.0% of category, 7.4% of total), yellow 236 (31.4% of category, 4.5% of total), and red 29 (52.7% of category, 1.7% of total). Of these patients with a reported method of transportation, a total of 66 (46.2%) were transported by EMS: green 13 (20.3% of category), yellow 30 (55.6% of category), and red 23 (92.0% of category). All categories were statistically different (P<.005).Conclusion: A relatively low percentage of disaster patients treated by a DMAT team at 4 major deployments required referral for additional medical care. Compared with the green triage category, patients assigned a red triage category were 5 times more likely to require referral for additional medical care and nearly 5 times more likely to require EMS transportation. In this first-of-its-kind examination of the START system, a higher-acuity START category was associated with an increased likelihood of transfer to a hospital and may continue to be a useful tool in this respect in future DMAT deployments.