Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-26T02:54:01.717Z Has data issue: false hasContentIssue false
  • English
  • Français

Triage Performance of School Personnel Using the SALT System

Published online by Cambridge University Press:  07 August 2019

Daniel H. Celik ,
Francis R. Mencl ,
Michel Debacker ,
Lisa Kurland ,
Scott T. Wilber  and
Jennifer A. Frey
Daniel H. Celik*
Affiliation:
Academic and Community Emergency Specialists, Uniontown, OhioUSA Summa Health System, Akron, OhioUSA
Francis R. Mencl
Affiliation:
Academic and Community Emergency Specialists, Uniontown, OhioUSA Summa Health System, Akron, OhioUSA
Michel Debacker
Affiliation:
Research Group on Emergency and Disaster Medicine (ReGEDiM), Vrije Universiteit Brussel, Brussels, Belgium
Lisa Kurland
Affiliation:
Department of Medical Sciences, Örebro University and Department of Emergency Medicine, Örebro University Hospital, Örebro, Sweden
Scott T. Wilber
Affiliation:
Summa Health System, Akron, OhioUSA
Jennifer A. Frey
Affiliation:
Summa Health System, Akron, OhioUSA The Ohio State University, Columbus, OhioUSA
*
Correspondence: Daniel H. Celik, MD Academic and Community Emergency Specialists 3730 Tabs Drive Uniontown, Ohio 44685 USA E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

The aim of this study was to determine if school personnel can understand and apply the Sort, Assess, Life-saving interventions, Treat/Transport (SALT) triage methods after a brief training. The investigators predicted that subjects can learn to triage with accuracy similar to that of medically trained personnel, and that subjects can pass an objective-structured clinical exam (OSCE) evaluating hemorrhage control.

Methods:

School personnel were eligible to participate in this prospective observational study. Investigators recorded subject demographic information and prior medical experience. Participants received a 30-minute lecture on SALT triage and a brief lecture and demonstration of hemorrhage control and tourniquet application. A test with brief descriptions of mass-casualty victims was administered immediately after training. Participants independently categorized the victims as dead, expectant, immediate, delayed, or minimal. They also completed an OSCE to evaluate hemorrhage control and tourniquet application using a mannequin arm.

Results:

Subjects from two schools completed the study. Fifty-nine were from a private school that enrolls early childhood through grade eight, and 45 from a public school that enrolls grades seven and eight (n = 104). The average subject age was 45 years and 68% were female. Approximately 81% were teachers and 87% had prior cardiopulmonary resuscitation (CPR) training. Overall triage accuracy was 79.2% (SD = 10.7%). Ninety-six (92.3%) of the subjects passed the hemorrhage control OSCE.

Conclusions:

After two brief lectures and a short demonstration, school personnel were able to triage descriptions of mass-casualty victims with an overall accuracy similar to medically trained personnel, and most were able to apply a tourniquet correctly. Opportunities for future study include integrating high-fidelity simulation and mock disasters, evaluating for knowledge retention, and exploring the study population’s baseline knowledge of medical care, among others.

Keywords

disaster medicineEmergency Medical Servicesmass-casualty incidentstourniquetstriage
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 34 , Issue 4 , August 2019 , pp. 401 - 406
Copyright
© World Association for Disaster and Emergency Medicine 2019 

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

Debacker, M. “Some considerations on triage in disasters.” In: de Boer, J, Dubouloz, M (eds). Handbook of Disaster Medicine. Van der Wees, Utrecht, The Netherlands: CRC Press; 2000:329–335.Google Scholar
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
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.CrossRefGoogle ScholarPubMed
SALT Triage Training PowerPoint (Download). NDLSF Web site. www.salttriage.org. Accessed March 7, 2013.Google Scholar
Byrum, S, Lerner, EB, Coule, PL. SALT triage drill. Disaster Med Public Health Prep. 2009;3(3):129.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Lerner, EB, Schwartz, RB, Coule, PL, Pirrallo, RG. Use of SALT triage in simulated mass-casualty incident. Prehosp Emerg Care. 2010;14(1):21–25.CrossRefGoogle ScholarPubMed
Heffernan, RW, Lerner, EB, McKee, CH, et al. Comparing the accuracy of mass casualty triage systems in a pediatric population. Prehosp Emergency Care. 2018.CrossRefGoogle Scholar
Nilsson, A, Aslund, K, Lampi, M, Nilsson, H, Jonson, CO. Improved and sustained triage skills in firemen after a short training intervention. Scand J Trauma Resusc Emerg Med. 2015;23:81.CrossRefGoogle ScholarPubMed
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
Cicero, MX, Auerbach, MA, Zigmont, J, Riera, A, Ching, K, Baum, CR. Simulation training with structured debriefing improves residents’ pediatric disaster triage performance. Prehosp Disaster Med. 2012;27(3):239–244.CrossRefGoogle 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.CrossRefGoogle ScholarPubMed
Lee, CW, McLeod, SL, Van Aarsen, K, Klingel, M, Franc, JM, Peddle, MB. First responder accuracy using SALT during mass-casualty incident simulation. Prehosp Disaster Med. 2016;31(2):150–154.CrossRefGoogle ScholarPubMed
Lee, CW, McLeod, SL, Peddle, MB. First responder accuracy using SALT after brief initial training. Prehosp Disaster Med. 2015;30(5):447–451.CrossRefGoogle ScholarPubMed
Jones, N, White, ML, Tofil, N, Pickens, M, Youngblood, A, Zinkan, L, Baker, MD. 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.CrossRefGoogle Scholar
Kaplan, BG, Connor, A, Ferranti, EP, Holmes, L, Spencer, L. Use of emergency preparedness disaster simulation with undergraduate nursing students. Public Health Nursing. 2011;29(1):44–51.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Kilner, T. Triage decisions of prehospital emergency health care providers, using a multiple casualty scenario paper exercise. Emerg Med J. 2002;19(4):348–353.CrossRefGoogle ScholarPubMed
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
Mabry, RL, Holcomb, JB, Baker, AM, et al. United States Army Rangers in Somalia: an analysis of combat casualties on an urban battlefield. J Trauma. 2000;49(3):515–528.CrossRefGoogle ScholarPubMed
Butler, FK Jr, Hagmann, J, Butler, EG. Tactical combat casualty care in Special Operations. Mil Med. 1996;161(Suppl):3–16.CrossRefGoogle ScholarPubMed
Rasmussen, TE, Clouse, WD, Jenkins, DH, Peck, MA, Eliason, JL, Smith, DL. Echelons of care and the management of wartime vascular injury: a report from the 332nd EMDG/Air Force Theater Hospital, Balad Air Base, Iraq. Perspect Vasc Surg Endovasc Ther. 2006;18(2):91–99.CrossRefGoogle ScholarPubMed
Beekley, AC, Sebesta, JA, Blackbourne, LH, et al; 31st Combat Support Hospital Research Group. Prehospital tourniquet use in Operation Iraqi Freedom: effect on hemorrhage control and outcomes. J Trauma. 2008;64(2 Suppl):S28–37.CrossRefGoogle ScholarPubMed
Welling, DR, Burris, DG, Hutton, JE, Minken, SL, Rich, NM. A balanced approach to tourniquet use: lessons learned and relearned. J Am Coll Surg. 2006;203(1):106–115.CrossRefGoogle ScholarPubMed
NAEMT. PHTLS: Prehospital Trauma Life Support. 7th edition. St. Louis, Missouri USA: Elsevier Mosby; 2010.Google Scholar
Goralnick, E, Chaudhary, MA, McCarty, JC, et al. Effectiveness of instructional interventions for hemorrhage control readiness for laypersons in the public access and tourniquet training study (PATTS): a randomized clinical trial. JAMA Surg. 2018;153(9):791–799.CrossRefGoogle ScholarPubMed
Teaching Bleeding Control. Bleeding Control Web site. https://www.bleedingcontrol.org/~/media/bleedingcontrol/files/private/bleeding%20control%20basic%20course%20guidelines.ashx. Accessed November 18, 2018.Google Scholar
Ross, EM, Redman, TT, Mapp, JG, et al. Stop the Bleed: the effects of hemorrhage control education on laypersons’ willingness to respond during a traumatic medical emergency. Prehosp Disaster Med. 2018;33(2):127–132.CrossRefGoogle Scholar
Ross, EM, Mapp, JG, Redman, TT, Brown, DJ, Kharod, CU, Wampler, DA. The tourniquet gap: a pilot study of the intuitive placement of three tourniquet types by laypersons. J Emerg Med. 2018;54(3):307–314.CrossRefGoogle ScholarPubMed