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Intuitive versus Algorithmic Triage

Published online by Cambridge University Press:  21 August 2018

Alexander Hart ,
Elias Nammour ,
Virginia Mangolds  and
John Broach
Alexander Hart*
Affiliation:
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MassachusettsUSA
Elias Nammour
Affiliation:
University of Massachusetts Medical School, Medical Education, Worcester, MassachusettsUSA
Virginia Mangolds
Affiliation:
Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MassachusettsUSA
John Broach
Affiliation:
Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MassachusettsUSA
*
Correspondence: Alexander Hart, MDDepartment of Emergency MedicineBeth Israel Deaconess Medical Center330 Brookline AvenueBoston, Massachusetts 02215 USA E-mail: [email protected]
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Abstract

Introduction

The most commonly used methods for triage in mass-casualty incidents (MCIs) rely upon providers to take exact counts of vital signs or other patient parameters. The acuity and volume of patients which can be present during an MCI makes this a time-consuming and potentially costly process.

Hypothesis

This study evaluates and compares the speed of the commonly used Simple Triage and Rapid Treatment (START) triage method with that of an “intuitive triage” method which relies instead upon the abilities of an experienced first responder to determine the triage category of each victim based upon their overall first-impression assessment. The research team hypothesized that intuitive triage would be faster, without loss of accuracy in assigning triage categories.

Methods

Local adult volunteers were recruited for a staged MCI simulation (active-shooter scenario) utilizing local police, Emergency Medical Services (EMS), public services, and government leadership. Using these same volunteers, a cluster randomized simulation was completed comparing START and intuitive triage. Outcomes consisted of the time and accuracy between the two methods.

Results

The overall mean speed of the triage process was found to be significantly faster with intuitive triage (72.18 seconds) when compared to START (106.57 seconds). This effect was especially dramatic for Red (94.40 vs 138.83 seconds) and Yellow (55.99 vs 91.43 seconds) patients. There were 17 episodes of disagreement between intuitive triage and START, with no statistical difference in the incidence of over- and under-triage between the two groups in a head-to-head comparison.

Conclusion:

Significant time may be saved using the intuitive triage method. Comparing START and intuitive triage groups, there was a very high degree of agreement between triage categories. More prospective research is needed to validate these results.

HartA, NammourE, MangoldsV, BroachJ. Intuitive versus Algorithmic TriagePrehosp Disaster Med.2018;33(4):355–361.

Keywords

disasterEMSmass casualtytriage
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 33 , Issue 4 , August 2018 , pp. 355 - 361
Copyright
© World Association for Disaster and Emergency Medicine 2018 

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Footnotes

Conflicts of interest: Funding for the full-scale exercise was provided by the Central Massachusetts Homeland Security Advisory Council (Worcester, Massachusetts USA). Funding for the research aspect of the project was provided by the University of Massachusetts Medical School (Worcester, Massachusetts USA). The authors declare no conflicts of interest.

References

1. Baker, MS. Creating order from chaos: Part I: triage, initial care, and tactical considerations in mass casualty and disaster response. Mil Med. 2007;172(3):232-236.Google Scholar
2. Iserson, KV, Moskop, JC. Triage in medicine, Part I: concept, history, and types. Ann Emerg Med. 2007;49(3):275-281.Google Scholar
3. Cone, DC, MacMillan, DS. Mass-casualty triage systems: a hint of science. Acad Emerg Med. 2005;12(8):739-741.Google Scholar
4. Culley, JM, Svendsen, E. A review of the literature on the validity of mass-casualty triage systems with a focus on chemical exposures. Am J Disaster Med. 2014;9(2):137-150.Google Scholar
5. Lerner, EB, Cone, DC, Weinstein, ES, et al. Mass-casualty triage: an evaluation of the science and refinement of a national guideline. Disaster Med Public Health Prep. 2011;5(2):129-137.Google Scholar
6. American Academy of Pediatrics, American College of Emergency Physicians, American College of Surgeons - Committee on Trauma, et al. Model uniform core criteria for mass casualty triage. Disaster Med Public Health Prep. 2011;5(2):125-128.Google Scholar
7. 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 Scholar
8. Hupert, N, Hollingsworth, E, Xiong, W. Is over-triage associated with increased mortality? Insights from a simulation model of mass casualty trauma care. Disaster Med Public Health Prep. 2007;1(1 Suppl):S14-24.Google Scholar
9. Jones, N, White, ML, Tofil, N, et al. Randomized trial comparing two mass-casualty triage systems (JumpSTART versus SALT) in a pediatric simulated mass-casualty event. Prehosp Emerg Care. 2014;18(3):417-423.Google Scholar
10. Armstrong, JH, Hammond, J, Hirshberg, A, Frykberg, ER. Is over-triage associated with increased mortality? The evidence says “yes.” Disaster Med Public Health Prep. 2008;2(1):4-5; author reply 5-6.Google Scholar
11. Frykberg, ER, Tepas, JJ 3rd. Terrorist bombings. Lessons learned from Belfast to Beirut. Ann Surg. 1988;208(5):569-576.Google Scholar
12. Risavi, BL, Salen, PN, Heller, MB, Arcona, S. A two-hour intervention using START improves prehospital triage of mass casualty incidents. Prehosp Emerg Care. 2001;5(2):197-199.Google Scholar
13. 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, 430 e421.Google Scholar
14. Garner, A, Lee, A, Harrison, K, Schultz, CH. Comparative analysis of multiple-casualty incident triage algorithms. Ann Emerg Med. 2001;38(5):541-548.Google Scholar
15. Frykberg, ER. Medical management of disasters and mass casualties from terrorist bombings: how can we cope? J Trauma. 2002;53(2):201-212.Google Scholar
16. Emergency Medical Services Pre-Hospital Statewide Treatment Protocols. https://www.mass.gov/files/documents/2018/04/04/treatment-protocols-2018.pdf. Boston, Massachusetts USA: Massachusetts Department of Public Health; 2018.Google Scholar