Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-17T01:18:28.156Z Has data issue: false hasContentIssue false
  • English
  • Français

Testing the START Triage Protocol: Can It Improve the Ability of Nonmedical Personnel to Better Triage Patients During Disasters and Mass Casualties Incidents ?

Published online by Cambridge University Press:  09 January 2017

Stefano Badiali ,
Aimone Giugni  and
Lucia Marcis
Stefano Badiali*
Affiliation:
Bologna NHS Emergency Department, Bologna, Italy
Aimone Giugni
Affiliation:
Bologna NHS Emergency Department, Bologna, Italy
Lucia Marcis
Affiliation:
Italian Red Cross Bologna Committee - Rizzoli Orthopedic Institute of Bologna, Bologna, Italy
*
Correspondence and reprint requests to Stefano Badiali MD, via Aldo Cividali 12, 40133 Bologna BO, Italy (e-mail [email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

START (Simple Triage and Rapid Treatment) triage is a tool that is available even to nonmedical rescue personnel in case of a disaster or mass casualty incident (MCI). In Italy, no data are available on whether application of the START protocol could improve patient outcomes during a disaster or MCI. We aimed to address whether “last-minute” START training of nonmedical personnel during a disaster or MCI would result in more effective triage of patients.

Methods

In this case-control study, 400 nonmedical ambulance crew members were randomly assigned to a non-START or a START group (200 per group). The START group received last-minute START training. Each group examined 6000 patients, obtained from the Emergo Train System (ETS Italy, Bologna, Italy) victims database, and assigned patients a triage code (black-red-yellow-green) along with a reason for the assignment. Each rescuer triaged 30 patients within a 30-minute time frame. Results were analyzed according to Fisher’s exact test for a P value<0.01. Under- and over-triage ratios were analyzed as well.

Results

The START group completed the evaluations in 15 minutes, whereas the non-START group took 30 minutes. The START group correctly triaged 94.2% of their patients, as opposed to 59.83% of the non-START group (P<0.01). Under- and over-triage were, respectively, 2.73% and 3.08% for the START group versus 13.67% and 26.5% for the non-START group. The non-START group had 458 “preventable deaths” on 6000 cases because of incorrect triage, whereas the START group had 91.

Conclusions

Even a “last-minute” training on the START triage protocol allows nonmedical personnel to better identify and triage the victims of a disaster or MCI, resulting in more effective and efficient medical intervention. (Disaster Med Public Health Preparedness. 2017;11:305–309)

Keywords

START triagetriage effectivenessnonmedical first responderstriage accuracy
Type
Brief Reports
Information
Disaster Medicine and Public Health Preparedness , Volume 11 , Issue 3 , June 2017 , pp. 305 - 309
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2017 

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. START Adult Triage Algorithm. US Department of Health and Human Services, Radiation Emergency Medical Management website. https://www.remm.nlm.gov/startadult.htm. Last updated November 13, 2016. Accessed December 5, 2016.Google Scholar
2. Guérisse, P. Mass Emergency Management 2000. European Conference on Triage. Presented at Belgian Federal Ministry of Health; October 2000; Bruxelles, Belgium.Google Scholar
3. Motola, I, Burns, WA, Brotons, AA, et al. Just-in-time learning is effective in helping first responders manage weapons of mass destruction events. J Trauma Acute Care Surg. 2015;79(4 suppl 2):S152-S156. doi: 10.1097/TA.0000000000000570.Google Scholar
4. Lee, CW, McLeod, SL, Van Aarsen, K, et al. First responder accuracy using SALT during mass-casualty incident simulation. Prehosp Disaster Med. 2016;31(2):150-154. https://doi.org/10.1017/S1049023X16000091.Google Scholar
5. Emergo Train System website. http://www.emergotrain.com/index.php?option=com_content&view=article&id=107&Itemid=804.Google Scholar
6. Nilsson, H, Jonson, CO, Vikström, T, et al. Simulation assisted burn disaster planning. Burns. 2013;39(6):1122-1130. doi: 10.1016/j.burns.2013.01.018.CrossRefGoogle ScholarPubMed
7. Badiali, S. Pre-hospital care. In: De Boer J, Dubouloz M, eds. Handbook of Disaster Medicine. Utrecht: Van der Wees; 2000:289-309.Google Scholar
8. Russo, RM, Galante, JM, Jacoby, RC, et al. Mass casualty disasters: who should run the show? J Emerg Med. 2015;48(6):685-692. doi: 10.1016/j.jemermed.2014.12.069.Google Scholar