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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.

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