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Comparison of Electronic Versus Manual Mass-Casualty Incident Triage

Published online by Cambridge University Press:  17 April 2018

Claudie Bolduc ,
Nisreen Maghraby ,
Patrick Fok ,
The Minh Luong  and
Valerie Homier
Claudie Bolduc*
Affiliation:
McGill University Health Center, Emergency Medicine, Montreal, Quebec, Canada
Nisreen Maghraby
Affiliation:
McGill University Health Center, Emergency Medicine, Montreal, Quebec, Canada
Patrick Fok
Affiliation:
McGill University Health Center, Emergency Medicine, Montreal, Quebec, Canada
The Minh Luong
Affiliation:
McGill University Health Center, Emergency Medicine, Montreal, Quebec, Canada
Valerie Homier
Affiliation:
McGill University Health Center, Emergency Medicine, Montreal, Quebec, Canada
*
Correspondence: Claudie Bolduc, MD, MPH McGill University Health Center Montreal, Quebec, Canada E-mail: [email protected]
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Abstract

Introduction

Mass-casualty incidents (MCIs) easily overwhelm a health care facility’s human and material resources through the extraordinary influx of casualties. Efficient and accurate triage of incoming casualties is a critical step in the hospital disaster response.

Hypothesis/Problem

Traditionally, triage during MCIs has been manually performed using paper cards. This study investigated the use of electronic Simple Triage and Rapid Treatment (START) triage as compared to the manual method.

Methods

This observational, crossover study was performed during a live MCI simulation at an urban, Canadian, Level 1 trauma center on May 26, 2016. Health care providers (two medical doctors [MDs], two paramedics [PMs], and two registered nurses [RNs]) each triaged a total of 30 simulated patients - 15 by manual (paper-based) and 15 by electronic (computer-based) START triage. Accuracy of triage categories and time of triage were analyzed. Post-simulation, patients and participating health care providers also completed a feedback form.

Results

There was no difference in accuracy of triage between the electronic and manual methods overall, 83% and 80% (P=1.0), between providers or between triage categories. On average, triage time using the manual method was estimated to be 8.4 seconds faster (P<.001) for PMs; and while small differences in triage times were observed for MDs and RNs, they were not significant. Data from the participant feedback survey showed that the electronic method was preferred by most health care providers. Patients had no preference for either method. However, patients perceived the computer-based method as “less personal” than the manual triage method, but they also perceived the former as “better organized.”

Conclusion

Hospital-based electronic START triage had the same accuracy as hospital-based manual START triage, regardless of triage provider type or acuity of patient presentations. Time of triage results suggest that speed may be related to provider familiarity with a modality rather than the modality itself. Finally, according to patient and provider perceptions, electronic triage is a feasible modality for hospital triage of mass casualties. Further studies are required to assess the performance of electronic hospital triage, in the context of a rapid surge of patients, and should consider additional efficiencies built in to electronic triage systems. This study presents a framework for assessing the accuracy, triage time, and feasibility of digital technologies in live simulation training or actual MCIs.

BolducC, MaghrabyN, FokP, LuongTM, HomierV. Comparison of Electronic Versus Manual Mass-Casualty Incident Triage. Prehosp Disaster Med. 2018;33(3):273–278.

Keywords

disaster medicineelectronic triagehealth care technologymass-casualty incidentstriage
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 33 , Issue 3 , June 2018 , pp. 273 - 278
Copyright
© World Association for Disaster and Emergency Medicine 2018 

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Footnotes

Conflicts of interest: none

References

1. Medicare and Medicaid Programs. Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers; Proposed Rule, 78 Fed. Reg. 79082. https://www.federalregister.gov/documents/2013/12/27/2013-30724/medicare-and-medicaid-programs-emergency-preparedness-requirements-for-medicare-and-medicaid. Accessed November 22, 2016.Google Scholar
2. 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.CrossRefGoogle ScholarPubMed
3. Kahn, CA, Schultz, CH, Miller, KT, Anderson, CL. Does START triage work? An outcomes assessment after a disaster. Ann Emerg Med. 2009;54(3):424-430.CrossRefGoogle Scholar
4. Shah, AA, Rehman, A, Sayyed, RH, et al. Impact of a predefined hospital mass-casualty response plan in a limited resource setting with no pre-hospital care system. Injury. 2015;46(1):156-161.CrossRefGoogle Scholar
5. Lee, JS, Franc, JM. Impact of a two-step emergency department triage model with START, then CTAS, on patient flow during a simulated mass casualty incident. Prehosp Disaster Med. 2015;30(4):390-396.CrossRefGoogle ScholarPubMed
6. Schell, CL, Wohl, R, Rathe, R, Schell, WJ. Automated vs manual triage for bioterrorist disaster: a blinded crossover feasibility study comparing personal digital assistant to paper-based triage. Am J Emerg Med. 2006;24(7):843-846.CrossRefGoogle ScholarPubMed