Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-28T00:14:42.787Z Has data issue: false hasContentIssue false
  • English
  • Français

Performance of First Aid Trained Staff using a Modified START Triage Tool at Achieving Appropriate Triage Compared to a Physiology-Based Triage Strategy at Australian Mass Gatherings

Published online by Cambridge University Press:  27 January 2020

Ned Douglas Open the ORCID record for Ned Douglas [Opens in a new window] ,
Jacqueline Leverett ,
Joseph Paul ,
Mitchell Gibson ,
Jessica Pritchard ,
Kayla Brouwer ,
Ebony Edwards ,
James Carew ,
Jake Donovan  and
Elyssia Bourke
...Show all authors
Ned Douglas*
Affiliation:
Event Medical Services Australia, Hoppers Crossing, Victoria, Australia
Jacqueline Leverett
Affiliation:
Event Medical Services Australia, Hoppers Crossing, Victoria, Australia
Joseph Paul
Affiliation:
Event Medical Services Australia, Hoppers Crossing, Victoria, Australia
Mitchell Gibson
Affiliation:
Event Medical Services Australia, Hoppers Crossing, Victoria, Australia
Jessica Pritchard
Affiliation:
Event Medical Services Australia, Hoppers Crossing, Victoria, Australia
Kayla Brouwer
Affiliation:
Event Medical Services Australia, Hoppers Crossing, Victoria, Australia
Ebony Edwards
Affiliation:
Event Medical Services Australia, Hoppers Crossing, Victoria, Australia
James Carew
Affiliation:
Event Medical Services Australia, Hoppers Crossing, Victoria, Australia
Jake Donovan
Affiliation:
Event Medical Services Australia, Hoppers Crossing, Victoria, Australia
Elyssia Bourke
Affiliation:
Event Medical Services Australia, Hoppers Crossing, Victoria, Australia
Erin Smith
Affiliation:
Edith Cowan University, Joondalup, Western Australia, Australia
*
Correspondence: Ned Douglas, MB BS, BMedSci, FANZCA 1 Alexandra St Pascoe Vale, 3044, Victoria, Australia E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Triage at mass gatherings in Australia is commonly performed by staff members with first aid training. There have been no evaluations of the performance of first aid staff with respect to diagnostic accuracy or identification of presentations requiring ambulance transport to hospital.

Hypothesis:

It was hypothesized that triage decisions by first aid staff would be considered correct in at least 61% of presentations.

Methods:

A retrospective audit of 1,048 presentations to a single supplier of event health care services in Australia was conducted. The presentations were assessed based on the first measured set of physiological parameters, and the primary triage decision was classified as “expected” if the primary and secondary triage classifications were the same or “not expected” if they differed. The performance of the two triage systems was compared using area under the receiver operating characteristic curve (AUROC) analysis.

Results:

The expected decision was made by first aid staff in 674 (71%) of presentations. Under-triage occurred in 131 (14%) presentations and over-triage in 142 (15%) presentations. The primary triage strategy had an AUROC of 0.7644, while the secondary triage strategy had an AUROC of 0.6280, which was significantly different (P = .0199).

Conclusion:

The results support the continued use of first aid trained staff members in triage roles at Australian mass gatherings. Triage tools should be simple, and the addition of physiological variables to improve the sensitivity of triage tools is not recommended because such an approach does not improve the discriminatory capacity of the tools.

Keywords

first aidmass gatheringstriage
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 35 , Issue 2 , April 2020 , pp. 184 - 188
Copyright
© World Association for Disaster and Emergency Medicine 2020

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

Born, CT, Briggs, SM, Ciraulo, DL, et al. Disasters and mass casualties: general principles of response and management. J Am Acad Orthop Surg. 2007;15(7):388–396.CrossRefGoogle ScholarPubMed
Bullock, M, Ranse, J, Hutton, A. Impact of patients presenting with alcohol and/or drug intoxication on in-event health care services at mass-gathering events: an integrative literature review. Prehosp Disaster Med. 2018;33(5):539–542.CrossRefGoogle ScholarPubMed
Bazyar, J, Farrokhi, M, Khankeh, H. Triage systems in mass casualty incidents and disasters: a review study with a worldwide approach. Open Access Maced J Med Sci. 2019;7(3):482–494.CrossRefGoogle ScholarPubMed
Ranse, J, Hutton, A, Keene, T, et al. Health service impact from mass gatherings: a systematic literature review. Prehosp Disaster Med. 2017;32(1):71–77.10.1017/S1049023X16001199CrossRefGoogle ScholarPubMed
Zachariasse, JM, Hagen, V van der, Seiger, N, Mackway-Jones, K, Veen, M van, Moll, HA. Performance of triage systems in emergency care: a systematic review and meta-analysis. BMJ Open. 2019;9(5):e026471.CrossRefGoogle ScholarPubMed
Considine, J, LeVasseur, SA, Villanueva, E. The Australasian Triage Scale: examining emergency department nurses’ performance using computer and paper scenarios. Ann Emerg Med. 2004;44(5):516–523.CrossRefGoogle ScholarPubMed
Turris, SA, Lund, A. Triage during mass gatherings. Prehosp Disaster Med. 2012;27(6):531–535.CrossRefGoogle ScholarPubMed
Cannon, M, Roitman, R, Ranse, J, Morphet, J. Development of a mass gathering triage tool: an Australian perspective. Prehosp Disaster Med. 2017;32(S1):S140.CrossRefGoogle Scholar
Heller, AR, Salvador, N, Frank, M, Schiffner, J, Kipke, R, Kleber, C. Diagnostic quality of triage algorithms for mass casualty incidents. Anaesthesist. 2017;66(10):762–772.CrossRefGoogle ScholarPubMed
Kahn, CA, Schultz, CH, Miller, KT, Anderson, CL. Does START triage work? An outcomes assessment after a disaster. Ann Emerg Med. 2009;54(3):424–430, 430.e1.CrossRefGoogle Scholar
Timbie, JW, Ringel, JS, Fox, DS, et al. Systematic review of strategies to manage and allocate scarce resources during mass casualty events. Ann Emerg Med. 2013;61(6):677–689.e101.CrossRefGoogle ScholarPubMed
Goksuluk, D, Korkmaz, S, Zararsiz, G, Karaagaoglu, AE. EasyROC: an interactive web-tool for ROC curve analysis using R language environment. RJ. 2016;8(2):213–230.CrossRefGoogle Scholar
Agency for Healthcare Research and Quality. Emergency Severity Index (ESI): A Triage Tool for Emergency Departments. Version 4. Rockville, Maryland USA: AHRQ. https://www.ahrq.gov/professionals/systems/hospital/esi/index.html. Accessed June 2019.Google Scholar