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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

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Open Access 01-12-2017 | Original research

Pre-hospital triage performance after standardized trauma courses

Authors: Maria Lampi, Johan Junker, Peter Berggren, Carl-Oscar Jonson, Tore Vikström

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2017

Abstract

Background

The pre-hospital triage process aims at identifying and prioritizing patients in the need of prompt intervention and/or evacuation. The objective of the present study was to evaluate triage decision skills in a Mass Casualty Incident drill. The study compares two groups of participants in Advanced Trauma Life Support and Pre-Hospital Trauma Life Support courses.

Methods

A questionnaire was used to deal with three components of triage of victims in a Mass Casualty Incident: decision-making; prioritization of 15 hypothetical casualties involved in a bus crash; and prioritization for evacuation. Swedish Advanced Trauma Life Support and Pre-Hospital Trauma Life Support course participants filled in the same triage skills questionnaire just before and after their respective course.

Results

One hundred fifty-three advanced Trauma Life Support course participants were compared to 175 Pre-Hospital Trauma Life Support course participants. The response rates were 90% and 95%, respectively. A significant improvement was found between pre-test and post-test for the Pre-Hospital Trauma Life Support group in regards to decision-making. This difference was only noticeable among the participants who had previously participated in Mass Casualty Incident drills or had experience of a real event (pre-test mean ± standard deviation 2.4 ± 0.68, post-test mean ± standard deviation 2.60 ± 0.59, P = 0.04). No improvement was found between pre-test and post-test for either group regarding prioritization of the bus crash casualties or the correct identification of the most injured patients for immediate evacuation.

Conclusions

Neither Advanced Trauma Life Support nor Pre-Hospital Trauma Life Support participants showed general improvement in their tested triage skills. However, participation in Mass Casualty Incident drills or experience of real events prior to the test performed here, were shown to be advantageous for Pre-Hospital Trauma Life Support participants. These courses should be modified in order to assure proper training in triage skills.

Frykberg ER. Triage: principles and practice. Scand J Surg. 2005;94:272–8.CrossRefPubMed

Risavi BL, Terrell MA, Lee W, Holsten Jr DL. Prehospital mass-casualty triage training-written versus moulage scenarios: how much do EMS providers retain? Prehosp Disaster Med. 2013;28:251–6. doi:10.1017/S1049023X13000241.CrossRefPubMed

Debacker M, Hubloue I, Dhondt E, Rockenschaub G, Rüter A, Codreanu T, et al. Utstein-style template for uniform data reporting of acute medical response in disasters. PLoS Currents. 2012;4:e4f6cf3e8df15a. doi:10.1371/4f6cf3e8df15a.PubMedPubMedCentral

Aylwin CJ, Konig TC, Brennan NW, Shirley PJ, Davies G, Walsh MS, et al. Reduction in critical mortality in urban mass casualty incidents: analysis of triage, surge, and resource use after the London bombings on July 7, 2005. Lancet. 2006;368:2219–25. doi:10.1016/S0140-6736(06)69896-6.CrossRefPubMed

Redwood-Campbell L, Abrahams J. Primary health care and disasters-the current state of the literature: what we know, gaps and next steps. Prehosp Disaster Med. 2011;26:184–91. doi:10.1017/S1049023X11006388.CrossRefPubMed

Ashkenazi I, Olsha O, Schecter WP, Kessel B, Khashan T, Alfici R. Inadequate mass-casualty knowledge base adversely affects treatment decisions by trauma care providers: survey on hospital response following a terrorist bombing. Prehosp Disaster Med. 2009;24:342–7.CrossRefPubMed

Yin H, He H, Arbon P, Zhu J. A survey of the practice of nurses’ skills in Wenchuan earthquake disaster sites: implications for disaster training. J Adv Nurs. 2011;67:2231–8. doi:10.1111/j.1365-2648.2011.05699.x.CrossRefPubMed

Lerner EB, Schwartz RB, Coule PL, Weinstein ES, Cone DC, Hunt RC, 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:S25–34. doi:10.1097/DMP.0b013e318182194e.CrossRefPubMed

Walsh DP, Lammert GR, Devoll J. The effectiveness of the advanced trauma life support system in a mass casualty situation by non-trauma-experienced physicians: Grenada 1983. Journal of Emergency Medicine. 1989;7:175–80.CrossRefPubMed

10.

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;30:390–6.CrossRefPubMed

11.

Jenkins JL, McCarthy ML, Sauer LM, Green GB, Stuart S, Thomas TL, et al. Mass-casualty triage: time for an evidence-based approach. Prehosp Disaster Med. 2008;23:3–8.CrossRefPubMed

12.

Kilner TM, Brace SJ, Cooke MW, Stallard N, Bleetman A, Perkins GD. In ‘big bang’ major incidents do triage tools accurately predict clinical priority? A systematic review of the literature. Injury. 2011;42:460–8. doi:10.1016/j.injury.2010.11.005.CrossRefPubMed

13.

Wolf S, Partenheimer A, Voigt C, Kunze R, Adams HA, Lill H. Primary care hospital for a mass disaster MANV IV. Experience from a mock disaster exercise. Unfallchirurg. 2009;112:565–74. doi:10.1007/s00113-008-1559-9 (in German).CrossRefPubMed

14.

Sollid SJ, Rimstad R, Rehn M, Nakstad AR, Tomlinson AE, Strand T, et al. Oslo government district bombing and Utoya island shooting July 22, 2011: the immediate prehospital emergency medical service response. Scand J Trauma Resusc Emerg Med. 2012;20:3. doi:10.1186/1757-7241-20-3.CrossRefPubMedPubMedCentral

15.

Botker MT, Bakke SA, Christensen EF. A systematic review of controlled studies: do physicians increase survival with prehospital treatment? Scandinavian Journal of Trauma Resuscitation and Emergency Medicine. 2009;17:12. doi:10.1186/1757-7241-17-12.CrossRef

16.

Hyde P, Mackenzie R, Ng G, Reid C, Pearson G. Availability and utilisation of physician-based pre-hospital critical care support to the NHS ambulance service in England, Wales and Northern Ireland. Emerg Med J. 2012;29:177–81. doi:10.1136/emj.2010.106963.CrossRefPubMed

17.

Rådestad M. Evaluation of medical response in disaster preparedness. Stockholm: Karolinska Institutet; 2013.

18.

Maeder MB, Germann S, Banz VM, Amsler F, Driscoll P, Zimmermann H, et al. Swiss multidisciplinary and multilingual experience of the Advanced Trauma Life Support course: lessons for Europe. Eur J Emerg Med. 2012;19:220–5. doi:10.1097/MEJ.0b013e32834b0098.CrossRefPubMed

19.

Thies K, Gwinnutt C, Driscoll P, Carneiro A, Gomes E, Araújo R, et al. The European Trauma Course--from concept to course. Resuscitation. 2007;74:135–41. doi:10.1016/j.resuscitation.2007.02.011.CrossRefPubMed

20.

American College of Surgeons. Advanced trauma life support for doctors ATLS. Chicago, IL: ATLS; 2012.

21.

Wolfl CG, Gliwitzky B, Wentzensen A. Standardised primary care of multiple trauma patients. Prehospital Trauma Life Support und Advanced Trauma Life Support. Unfallchirurg. 2009;112:846–53. doi:10.1007/s00113-009-1685-z (in German).CrossRefPubMed

22.

Deluhery MR, Lerner EB, Pirrallo RG, Schwartz RB. Paramedic accuracy using SALT triage after a brief initial training. Prehosp Emerg Care. 2011;15:526–32. doi:10.3109/10903127.2011.569852.CrossRefPubMed

23.

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;25:239–45.CrossRefPubMed

24.

Lampi M, Vikström T, Jonson CO. Triage performance of Swedish physicians using the ATLS algorithm in a simulated mass casualty incident: a prospective cross-sectional survey. Scand J Trauma Resusc Emerg Med. 2013;21:90. doi:10.1186/1757-7241-21-90.CrossRefPubMedPubMedCentral

25.

Rådestad M, Lennquist Montán K, Rüter A, Castrén M, Svensson L, Gryth D, Fossum B. Attitudes Towards and Experience of the Use of Triage Tags in Major Incidents: A Mixed Method Study. Prehosp and Disaster Med. 2016;31:376-85. doi:10.1017/S1049023X16000480.

26.

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;18:314–21. doi:10.1097/MEJ.0b013e328345d6fd.CrossRefPubMed

27.

Lerner EB, Schwartz RB, Coule PL, Pirrallo RG. Use of SALT triage in a simulated mass-casualty incident. Prehosp Emerg Care. 2010;14:21–5. doi:10.3109/10903120903349812.CrossRefPubMed

Title: Pre-hospital triage performance after standardized trauma courses
Authors: Maria Lampi
Johan Junker
Peter Berggren
Carl-Oscar Jonson
Tore Vikström
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine / Issue 1/2017
Electronic ISSN: 1757-7241
DOI: https://doi.org/10.1186/s13049-017-0395-8

At a glance: The STEP trials

Springer Medicine

Pre-hospital triage performance after standardized trauma courses

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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