Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-24T12:01:40.709Z Has data issue: false hasContentIssue false
  • English
  • Français

Paramedic Application of a Triage Sieve: A Paper-Based Exercise

Published online by Cambridge University Press:  14 December 2016

Glen Cuttance Open the ORCID record for Glen Cuttance [Opens in a new window] ,
Kathryn Dansie  and
Tim Rayner
Glen Cuttance*
Affiliation:
South Australia Ambulance Service, Adelaide, South Australia, Australia Paramedic Unit School of Medicine, Flinders University, Adelaide, South Australia, Australia
Kathryn Dansie
Affiliation:
Paramedic Unit School of Medicine, Flinders University, Adelaide, South Australia, Australia
Tim Rayner
Affiliation:
Paramedic Unit School of Medicine, Flinders University, Adelaide, South Australia, Australia
*
Correspondence: Glen Cuttance, MEmergMgt South Australia Ambulance Service Metro Ops GPO Box 3 Adelaide, South Australia 5001 Australia E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Triage is the systematic prioritization of casualties when there is an imbalance between the needs of these casualties and resource availability. The triage sieve is a recognized process for prioritizing casualties for treatment during mass-casualty incidents (MCIs). While the application of a triage sieve generally is well-accepted, the measurement of its accuracy has been somewhat limited. Obtaining reliable measures for triage sieve accuracy rates is viewed as a necessity for future development in this area.

Objective

The goal of this study was to investigate how theoretical knowledge acquisition and the practical application of an aide-memoir impacted triage sieve accuracy rates.

Method

Two hundred and ninety-two paramedics were allocated randomly to one of four separate sub-groups, a non-intervention control group, and three intervention groups, which involved them receiving either an educational review session and/or an aide-memoir. Participants were asked to triage sieve 20 casualties using a previously trialed questionnaire.

Results

The study showed the non-intervention control group had a correct accuracy rate of 47%, a similar proportion of casualties found to be under-triaged (37%), but a significantly lower number of casualties were over-triaged (16%). The provision of either an educational review or aide-memoir significantly increased the correct triage sieve accuracy rate to 77% and 90%, respectively. Participants who received both the educational review and aide-memoir had an overall accuracy rate of 89%. Over-triaged rates were found not to differ significantly across any of the study groups.

Conclusion

This study supports the use of an aide-memoir for maximizing MCI triage accuracy rates. A “just-in-time” educational refresher provided comparable benefits, however its practical application to the MCI setting has significant operational limitations. In addition, this study provides some guidance on triage sieve accuracy rate measures that can be applied to define acceptable performance of a triage sieve during a MCI.

CuttanceG, DansieK, RaynerT. Paramedic Application of a Triage Sieve: A Paper-Based Exercise. Prehosp Disaster Med. 2017;32(1):3–13.

Keywords

ambulance servicemass-casualty incidentparamedictriage sieve
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 32 , Issue 1 , February 2017 , pp. 3 - 13
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. Australian Government, Attorney General’s Department. Australian Emergency Management Glossary. Canberra, Australia: Commonwealth of Australia; 1998.Google Scholar
2. Lee, CW, McLeod, SL, Peddle, MB. First responder accuracy using SALT after brief initial training. Prehosp Disaster Med. 2015;30(5):1-5.CrossRefGoogle ScholarPubMed
3. Nocera, A, Garner, A. Australian disaster triage: a color maze in the Tower of Babel. Aust N Z J Surg. 1999;69(8):598-602.CrossRefGoogle ScholarPubMed
4. Castle, N. Triage and transport decisions after mass casualty incidents. Emerg Nurse. 2006;14(1):22-25.CrossRefGoogle ScholarPubMed
5. 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
6. Aitken, P, FitzGerald, G. Disaster triage: evidence, consistency, and standard practice. Emerg Med Australas. 2012;24(3):222-224.CrossRefGoogle ScholarPubMed
7. Lidal, IB, Holte, HH, Vist, GE. Triage systems for prehospital Emergency Medical Services - a systematic review. Scand J Trauma Resusc Emerg Med. 2013;21:28-33.CrossRefGoogle ScholarPubMed
8. Arshad, FH, Williams, A, Asaeda, G, et al. A modified simple triage and rapid treatment algorithm from the New York City (USA) Fire Department. Prehosp Disaster Med. 2015;30(2):199-204.CrossRefGoogle ScholarPubMed
9. Deluhery, MR, Lerner, EB, Pirrallo, RG, et al. Paramedic accuracy using SALT triage after a brief initial training. Prehosp Emerg Care. 2011;15(4):526-532.CrossRefGoogle ScholarPubMed
10. 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
11. Cross, KP, Cicero, MX. Head-to-head comparison of disaster triage methods in pediatric, adult, and geriatric patients. Ann Emerg Med. 2013;61(6):668-676.CrossRefGoogle ScholarPubMed
12. Challen, K, Walter, D. Major incident triage: comparative validation using data from 7th July bombings. Injury. 2013;44(5):629-633.CrossRefGoogle ScholarPubMed
13. Sasser, SM, Hunt, RC, Faul, M, et al. Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage, 2011. MMWR Recomm Rep. 2012;61(RR-1):1-20.Google Scholar
14. Wesson, DE, Scorpio, R. Field triage--help or hindrance? Can J Surg. 1992;35(1):19-21.Google ScholarPubMed
15. Committee on Trauma of the American College of Surgeons. Field categorization of trauma patients (field triage). Appendix F to the Hospital Resources Document. American College of Surgeons (ACS) Bulletin, 1986.Google Scholar
16. Carron, PN, Taffe, P, Ribordy, V, et al. Accuracy of prehospital triage of trauma patients by emergency physicians: a retrospective study in western Switzerland. Eur J Emerg Med. 2011;18(2):86-93.CrossRefGoogle ScholarPubMed
17. Horne, S, Vassallo, J, Read, J, et al. UK triage--an improved tool for an evolving threat. Injury. 2013;44(1):23-28.CrossRefGoogle ScholarPubMed
18. Mohan, D, Rosengart, MR, Farris, C, et al. Assessing the feasibility of the American College of Surgeons’ benchmarks for the triage of trauma patients. Arch Surg. 2011;146(7):786-792.CrossRefGoogle ScholarPubMed
19. Hammond, J. Mass-casualty incidents: planning implications for trauma care. Scand J Surg. 2005;94(4):267-271.CrossRefGoogle ScholarPubMed
20. 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
21. Hogan, DE, Brown, T. Utility of vital signs in mass-casualty disaster triage. West J Emerg Med. 2014;15(7):732-735.CrossRefGoogle ScholarPubMed
22. Lennquist, S. Management of major accidents and disasters: an important responsibility for the trauma surgeons. J Trauma. 2007;62(6):1321-1329.Google ScholarPubMed
23. Culley, JM, Effken, JA. Development and validation of a mass-casualty conceptual model. J Nurs Scholarsh. 2010;42(1):66-75.CrossRefGoogle ScholarPubMed
24. Cross, KP, Petry, MJ, Cicero, MX. A better START for low-acuity victims: data-driven refinement of mass-casualty triage. Prehosp Emerg Care. 2015;19(2):272-278.CrossRefGoogle ScholarPubMed
25. Debacker, M, Hubloue, I, Dhondt, E, et al. Utstein-style template for uniform data reporting of acute medical response in disasters. PLoS Current. 2012.CrossRefGoogle Scholar
26. Benson, M, Koenig, KL, Schultz, CH. Disaster triage: START, then SAVE--a new method of dynamic triage for victims of a catastrophic earthquake. Prehosp Disaster Med. 1996;11(2):117-124.CrossRefGoogle ScholarPubMed
27. Field, K, Norton, I. Australian triage tags: a prospective, randomized cross-over trial and evaluation of user preference. Emerg Med Australas. 2012;24(3):321-328.CrossRefGoogle ScholarPubMed
28. 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.CrossRefGoogle ScholarPubMed
29. Armstrong, JH, Frykberg, ER, Burris, DG. Toward a national standard in primary mass-casualty triage. Disaster Med Public Health Prep. 2008;2(Suppl 1):S8-10.CrossRefGoogle Scholar
30. Mackway-Jones, K. Major Incident Medical Management and Support: The Practical Approach at the Scene. 3rd edition. Oxford, United Kingdom: Wiley-Blackwell.CrossRefGoogle Scholar
31. Dethick, L. Coordinating major incident trauma care: international responses. Emerg Nurse. 1999;7(4):8-12.CrossRefGoogle ScholarPubMed
32. Hayward, M. Prehospital response to major incidents. Nurs Stand. 2003;17(30):37-40.CrossRefGoogle ScholarPubMed
33. Sapp, RF, Brice, JH, Myers, JB, et al. Triage performance of first-year medical students using a multiple-casualty scenario, paper exercise. Prehosp Disaster Med. 2010;25(3):239-245.CrossRefGoogle ScholarPubMed
34. 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
35. Navin, M, Waddell, B. Triage is broken. Emerg Med Serv. 2005;34(8):138-142.Google ScholarPubMed
36. Paramedics Australasis. Paramedicine Role Descriptions. 2012. Melbourne, Victoria, Australia.Google Scholar
37. Ersoy, N, Akpinar, A. Triage decisions of emergency physicians in Kocaeli and the principle of justice. Turkish J Trauma Emergency Surgery. 2010;16(3):203-209.Google ScholarPubMed
38. Fattah, S, Rehn, M, Reierth, E, et al. Systematic literature review of templates for reporting prehospital major incident medical management. BMJ Open. 2013;3(8).CrossRefGoogle ScholarPubMed