Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-09T08:27:01.420Z Has data issue: false hasContentIssue false

Developing a Context-Bound Model for Hospital Triage in Disasters and Mass Casualty Incidents in the Health System of Iran

Published online by Cambridge University Press:  08 June 2021

Jafar Bazyar
Affiliation:
Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
Mehrdad Farrokhi
Affiliation:
Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
Amir Salari
Affiliation:
Department of Health in Emergencies and Disasters, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Mehdi Noroozi
Affiliation:
Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
Hamidreza Khankeh*
Affiliation:
Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
*
Corresponding author: Hamid Reza Khankeh, Email: [email protected].

Abstract

Objective:

The aim of this study was to develop a context-bound model of hospital triage in disasters and mass casualty incidents in the health system of Iran.

Methods:

This study was done using a sequential mixed method. Data were analyzed using Expert Choice software program.

Results:

In the qualitative phase, 27 specialists were interviewed. Walking and purposeful movement, airway and respiration, circulatory status, and mental indices were included in the finalized model. In the quantitative phase, 21 participants responded to a questionnaire for weighting and ranking the final indices based on 3 competing options, including clinical importance of the index, lack of complexity and simplicity in implementation, and speed of implementation. The index of walking and purposeful movements weighing 0.300 and ranking 1, airway and respiration weighing 0.276 and ranking 2, blood circulatory status weighing 0.245 and ranking 3, and finally mental status weighing 0.179 and ranking 4 were obtained.

Conclusions:

This is the first attempt to design and develop a new context-bound model of hospital triage in disasters and mass casualties in Iran. The development of new triage models is a dynamic and continuous process, and changes will be applied to them, in case further developments and improvements are required.

Type
Original Research
Copyright
© Society for Disaster Medicine and Public Health, Inc. 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Safarpour, H, Khorasani-Zavareh, D. The fourth epidemiological transition: the need for worldwide focus on reducing morbidity and mortality rates of disasters and emergencies. Shiraz E Med J. 2019;20(9):e86746.Google Scholar
Safarpour, H, Sohrabizadeh, S, Malekyan, L, et al. Suicide death rate after disasters: a meta-analysis study. Arch Suicide Res. 2020;epub, 1-14.Google Scholar
CRED. Natural Disasters 2017. Brussels: CRED. 2018; EM-DAT file dated February 7, 2018. http://cred.be/sites/default/files/adsr_2017.pdf.Google Scholar
Ghomian, Z, Yousefian, S. Natural disasters in the Middle-East and North Africa with a focus on Iran: 1900 to 2015. Health Emerg Disasters. 2017;2(2):53-62.Google Scholar
Jenkins, JL, McCarthy, ML, Sauer, LM, et al. Mass-casualty triage: time for an evidence-based approach. Prehosp Disaster Med. 2008;23(1):3-8.Google ScholarPubMed
Ciottone, GR, Biddinger, PD, Darling, RG, et al. Ciottone’s disaster medicine. 2nd ed. Philadelphia: Elsevier Health Sciences; 2015.Google Scholar
Vassallo, J, Beavis, J, Smith, JE, Wallis, LA. Major incident triage: derivation and comparative analysis of the Modified Physiological Triage Tool (MPTT). Injury. 2017;48(5):992-999.CrossRefGoogle ScholarPubMed
Gerdtz, MF, Bucknall, TK. Triage nurses’ clinical decision making. An observational study of urgency assessment. J Adv Nurs. 2001;35(4):550-561.CrossRefGoogle ScholarPubMed
Croskerry, P. Achieving quality in clinical decision making: cognitive strategies and detection of bias. Acad Emerg Med. 2002;9(11):1184-1204.CrossRefGoogle ScholarPubMed
Koenig, KL, Schultz, CH. Koenig and Schultz’s disaster medicine: comprehensive principles and practices. New York: Cambridge University Press; 2010.Google Scholar
Rådestad, M, Montán, KL, Rüter, A, et al. Attitudes towards and experience of the use of triage tags in major incidents: a mixed method study. Prehosp Disaster Med. 2016;31(4):376-385.CrossRefGoogle ScholarPubMed
Lerner, EB, Schwartz, RB. Principles of disaster triage. Health care emergency management. Principles Practice. 2011:341-51.Google Scholar
TRACIE. Mass casualty trauma triage paradigms and pitfalls. 2019. https://files.asprtracie.hhs.gov/documents/aspr-tracie-mass-casualty-triage-final-508.pdf. Accessed April 25, 2020.Google Scholar
Benson, M, Koenig, KL, Schultz, CH. Disaster triage: START, then SAVE – a new method of dynamic triage for victims of a catastrophic earthquake. Prehosp Disaster Med. 1996;11(2):117-124.CrossRefGoogle Scholar
Gaul, A. Mass casualty triage: an in-depth analysis of various systems and their implications for future considerations. University of Pittsburgh; 2016.Google Scholar
Ranse, J, Zeitz, K. Disaster triage. In: Powers, R, Daily, E, Libby, P, eds. International Disaster Nursing. Melbourne: Cambridge; 2010:57-80.Google Scholar
Zhong, S, Clark, M, Hou, X-Y, et al. Development of hospital disaster resilience: conceptual framework and potential measurement. Emerg Med J. 2014;31(11):930-938.Google ScholarPubMed
Safarpour, H, Safi-Keykaleh, M, Eskandari, Z, et al. Hospital’s preparedness in road traffic injuries with mass casualties: exploring a valid and reliable checklist. HK J Emerg Med. 2019;epub, https://doi.org/10.1177/1024907919870662.CrossRefGoogle Scholar
Bazyar, J, Pourvakhshoori, N, Safarpour, H, et al. Hospital disaster preparedness in Iran: a systematic review and meta-analysis. Iran J Public Health. 2020;49(5):837-850.Google ScholarPubMed
Cross, KP, Cicero, MX. Head-to-head comparison of disaster triage methods in pediatric, adult, and geriatric patients. Ann Emerg Med. 2013;61(6):668-676.e7.CrossRefGoogle ScholarPubMed
Cross, KP, Petry, MJ, Cicero, MX. A better START for low-acuity victims: data-driven refinement of mass casualty triage. Prehosp Emerg Care. 2015;19(2):272-278.CrossRefGoogle ScholarPubMed
Horne, S, Vassallo, J, Read, J, Ball, S. UK triage – an improved tool for an evolving threat. Injury. 2013;44(1):23-28.Google ScholarPubMed
Abbasi Dolat Abadi, Z, Hosseini, SMR, Atighechian, G, et al. Triage in disaster. Iran J Cardiovasc Nurs. 2013;2(2):58-68.Google Scholar
Bazyar, J, Farrokhi, M, Khankeh, H. Triage systems in mass casualty incidents and disasters: a review study with a worldwide approach. Open Access Maced J Med Sci. 2019;7(3):482.CrossRefGoogle ScholarPubMed
Jannat, F, Ardalan, A, Masoumi, G, et al. Simple and advanced triage in occurrence of natural disasters and examine the role of volunteers. Int J Curr Life Sci. 2014;4(5):2169-2171.Google Scholar
Zhong, S, Clark, M, Hou, X-Y, et al. Development of key indicators of hospital resilience: a modified Delphi study. J Health Serv Res Policy. 2015;20(2):74-82.CrossRefGoogle ScholarPubMed
Tzeng, G-H, Huang, J-J. Multiple attribute decision making: methods and applications. New York: CRC Press; 2011.Google Scholar
Bazyar, J, Farrokhi, M, Salari, A, Khankeh, HR. The principles of triage in emergencies and disasters: a systematic review. Prehosp Disaster Med. 2020;35(3):305-313.CrossRefGoogle ScholarPubMed
Pediatrics; AAo, Physicians; ACoE, Trauma; ACoS-Co. Model uniform core criteria for mass casualty triage. Disaster Med Public Health Prep. 2011;5(2):125-128. doi: 10.1001/dmp.2011.41.Google Scholar
Saaty, TL. How to make a decision: the analytic hierarchy process. Eur J Operat Res. 1990;48(1):9-26.CrossRefGoogle Scholar
Amini, E, Baniasadi, M, Vahidi, H, et al. Affecting factors of knowledge-based companies using fuzzy AHP model, case study Tehran University Enterprise Park. J Knowl Econ. 2018;epub, 1-19.Google Scholar
Bhalla, MC, Frey, J, Rider, C, et al. Simple triage algorithm and rapid treatment and sort, assess, lifesaving, interventions, treatment, and transportation mass casualty triage methods for sensitivity, specificity, and predictive values. Am J Emerg Med. 2015;33(11):1687-1691.CrossRefGoogle ScholarPubMed
Garner, A, Lee, A, Harrison, K, Schultz, CH. Comparative analysis of multiple-casualty incident triage algorithms. Ann Emerg Med. 2001;38(5):541-548.CrossRefGoogle ScholarPubMed
Smith, W. Triage in mass casualty situations. Cont Med Educ. 2012;30(11):413-415.Google Scholar
Wolf, P, Bigalke, M, Graf, BM, et al. Evaluation of a novel algorithm for primary mass casualty triage by paramedics in a physician manned EMS system: a dummy based trial. Scand J Trauma Resusc Emerg Med. 2014;22(1):50.CrossRefGoogle Scholar
Hodgetts, T, Hall, J, Maconochie, I, Smart, C. Paediatric triage tape. Prehosp Immed Care. 1998;2:155-159.Google Scholar
Coule, PL, Horner, JA. National disaster life support programs: a platform for multi-disciplinary disaster response. Dent Clin North Am. 2007;51(4):819-825.Google ScholarPubMed
Kleber, C, Cwojdzinski, D, Strehl, M, et al. Results of in-hospital triage in 17 mass casualty trainings: underestimation of life-threatening injuries and need for re-triage. Am J Disaster Med. 2013;8(1):5-11.CrossRefGoogle ScholarPubMed
Romig, LE. Pediatric triage. A system to JumpSTART your triage of young patients at MCIs. J Emerg Med Serv. 2002;27(7):52-58, 60-63.Google ScholarPubMed
Cone, DC, Serra, J, Kurland, L. Comparison of the SALT and Smart triage systems using a virtual reality simulator with paramedic students. Eur J Emerg Med. 2011;18(6):314-321.Google ScholarPubMed
Gottschalk, S, Wood, D, DeVries, S, et al. The cape triage score: a new triage system South Africa. Proposal from the Cape Triage Group. Emerg Med J. 2006;23(2):149-153.CrossRefGoogle Scholar
Cannon, M, Roitman, R, Ranse, J, Morphet, J. Development of a mass-gathering triage tool: an Australian perspective. Prehosp Disaster Med. 2017;32(1):101-105.CrossRefGoogle ScholarPubMed
Marx, J, Walls, R, Hockberger, R. Rosen’s emergency medicine-concepts and clinical practice. Philadelphia: Elsevier Health Sciences; 2013.Google Scholar
Lerner, EB, McKee, CH, Cady, CE, et al. A consensus-based gold standard for the evaluation of mass casualty triage systems. Prehosp Emerg Care. 2015;19(2):267-271.CrossRefGoogle ScholarPubMed
Nocera, A, Garner, A. An Australian mass casualty incident triage system for the future based upon triage mistakes of the past: the Homebush Triage Standard. ANZ J Surg. 1999;69(8):603-608.Google ScholarPubMed
Lerner, EB, Schwartz, RB, Coule, PL, et al. Mass casualty triage: an evaluation of the data and development of a proposed national guideline. Disaster Med Public Health Prep. 2008;2(S1):S25-S34.CrossRefGoogle ScholarPubMed