Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-22T21:20:42.389Z Has data issue: false hasContentIssue false
  • English
  • Français

First Responder Accuracy Using SALT during Mass-casualty Incident Simulation

Published online by Cambridge University Press:  09 February 2016

Christopher W.C. Lee ,
Shelley L. McLeod ,
Kristine Van Aarsen ,
Michelle Klingel ,
Jeffrey M. Franc  and
Michael B. Peddle
Christopher W.C. Lee*
Affiliation:
Division of Emergency Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
Shelley L. McLeod
Affiliation:
Division of Emergency Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
Kristine Van Aarsen
Affiliation:
Division of Emergency Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
Michelle Klingel
Affiliation:
Division of Emergency Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
Jeffrey M. Franc
Affiliation:
Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada Centro di Ricerca e Formazione in Medicina dell’Emergenza e dei Disastri, Università degli Studi del Piemonte Orientale “Amedeo Avogadro,” Novara, Piedmont, Italy
Michael B. Peddle
Affiliation:
Division of Emergency Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada Southwestern Ontario Regional Base Hospital Program, Central Region, London, Ontario, Canada
*
Correspondence: Christopher Lee, MD, BASc Division of Emergency Medicine Department of Medicine Schulich School of Medicine and Dentistry Western University London, Ontario, Canada, N6A 5W9 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

During mass-casualty incidents (MCIs), patient volume often overwhelms available Emergency Medical Services (EMS) personnel. First responders are expected to triage, treat, and transport patients in a timely fashion. If other responders could triage accurately, prehospital EMS resources could be focused more directly on patients that require immediate medical attention and transport.

Hypothesis

Triage accuracy, error patterns, and time to triage completion are similar between second-year primary care paramedic (PCP) and fire science (FS) students participating in a simulated MCI using the Sort, Assess, Life-saving interventions, Treatment/Transport (SALT) triage algorithm.

Methods

All students in the second-year PCP program and FS program at two separate community colleges were invited to participate in this study. Immediately following a 30-minute didactic session on SALT, participants were given a standardized briefing and asked to triage an eight-victim, mock MCI using SALT. The scenario consisted of a four-car motor vehicle collision with each victim portrayed by volunteer actors given appropriate moulage and symptom coaching for their pattern of injury. The total number and acuity of victims were unknown to participants prior to arrival to the mock scenario.

Results

Thirty-eight PCP and 29 FS students completed the simulation. Overall triage accuracy was 79.9% for PCP and 72.0% for FS (∆ 7.9%; 95% CI, 1.2-14.7) students. No significant difference was found between the groups regarding types of triage errors. Over-triage, under-triage, and critical errors occurred in 10.2%, 7.6%, and 2.3% of PCP triage assignments, respectively. Fire science students had a similar pattern with 15.2% over-triaged, 8.7% under-triaged, and 4.3% critical errors. The median [IQR] time to triage completion for PCPs and FSs were 142.1 [52.6] seconds and 159.0 [40.5] seconds, respectively (P=.19; Mann-Whitney Test).

Conclusions

Primary care paramedics performed MCI triage more accurately than FS students after brief SALT training, but no difference was found regarding types of error or time to triage completion. The clinical importance of this difference in triage accuracy likely is minimal, suggesting that fire services personnel could be considered for MCI triage depending on the availability of prehospital medical resources and appropriate training.

LeeCWC , McLeodSL , Van AarsenK , KlingelM , FrancJM , PeddleMB . First Responder Accuracy Using SALT during Mass-casualty Incident Simulation. Prehosp Disaster Med. 2016;31(2):150–154.

Keywords

Emergency Medical Servicesfire and rescue personnelmass-casualty incidentstriage
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 31 , Issue 2 , April 2016 , pp. 150 - 154
Copyright
© World Association for Disaster and Emergency Medicine 2016 

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

1. Frykberg, ER. Medical management of disasters and mass casualties from terrorist bombings: how can we cope? J Trauma. 2002;53(2):201-212.CrossRefGoogle ScholarPubMed
2. Pesik, N, Keim, ME, Iserson, KV. Terrorism and the ethics of emergency medical care. Ann Emerg Med. 2001;37(6):642-646.CrossRefGoogle ScholarPubMed
3. 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
4. Schultz, CH. Comparing disaster triage algorithms: selecting the right metric. Ann Emerg Med. 2013;62(6):642-643.CrossRefGoogle ScholarPubMed
5. 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
6. 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.e1.CrossRefGoogle Scholar
7. 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.CrossRefGoogle ScholarPubMed
8. Schenker, JD, Goldstein, S, Braun, J, et al. Triage accuracy at a multiple casualty incident disaster drill: the Emergency Medical Service, Fire Department of New York City experience. J Burn Care Res. 2006;27(5):570-575.Google Scholar
9. Cone, DC, Serra, J, Burns, K, MacMillan, DS, Kurland, L, Van Gelder, C. Pilot test of the SALT mass casualty triage system. Prehosp Emerg Care. 2009;13(4):536-540.Google Scholar
10. Sapp, RF, Brice, JH, Myers, JB, Hinchey, P. Triage performance of first-year medical students using a multiple-casualty scenario, paper exercise. Prehosp Disaster Med. 2010;25(3):239-245.Google Scholar
11. Lerner, EB, Schwartz, RB, Coule, PL, Pirrallo, RG. Use of SALT triage in a simulated mass-casualty incident. Prehosp Emerg Care. 2010;14(1):21-25.CrossRefGoogle Scholar
12. Deluhery, MR, Lerner, EB, Pirrallo, RG, Schwartz, RB. Paramedic accuracy using SALT triage after a brief initial training. Prehosp Emerg Care. 2011;15(4):526-532.Google Scholar
13. 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.CrossRefGoogle ScholarPubMed
14. Risavi, BL, Terrell, MA, Lee, W, Holsten, DL. Prehospital mass-casualty triage training-written versus moulage scenarios: how much do EMS providers retain? Prehosp Disaster Med. 2013;28(3):251-256.Google Scholar
15. 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
16. 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(Suppl 1):S25-S34.CrossRefGoogle ScholarPubMed
17. Andreatta, PB, Maslowski, E, Petty, S, et al. Virtual reality triage training provides a viable solution for disaster-preparedness. Acad Emerg Med. 2010;17(8):870-876.CrossRefGoogle ScholarPubMed
18. Kilner, T, Hall, FJ. Triage decisions of United Kingdom police firearms officers using a multiple-casualty scenario paper exercise. Prehosp Disaster Med. 2005;20(1):40-46.CrossRefGoogle ScholarPubMed
19. Lee, CW, McLeod, S, Peddle, MB. First responder accuracy using SALT after brief initial training. Acad Emerg Med. 2014;21(Supplement 1):S80.Google Scholar