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Triage Performance of First-Year Medical Students Using a Multiple-Casualty Scenario, Paper Exercise

Published online by Cambridge University Press:  28 June 2012

Robert F. Sapp ,
Jane H. Brice ,
J. Brent Myers  and
Paul Hinchey
Robert F. Sapp
Affiliation:
Resident Physician, Oregon Health and Science University, Portland, Oregon, USA
Jane H. Brice*
Affiliation:
Medical Director, Orange County EMS System, Hillsborough, North Carolina USA; Associate Professor, Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
J. Brent Myers
Affiliation:
Medical Director, Wake County EMS System, Raleigh, North Carolina USA; Adjunct Assistant Professor, Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
Paul Hinchey
Affiliation:
Assistant Medical Director, Wake County EMS System, Raleigh, North Carolina, USA
*
Department of Emergency Medicine, CB# 7594, University of North Carolina Hospitals 101 Manning Dr., Chapel Hill, North Carolina 27599-7594, USA E-mail: [email protected]
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Abstract

Introduction:

Large-scale events may overwhelm the capacity of even the most advanced emergency medical systems. When patient volume outweighs the number of available emergency medical services (EMS) providers, a mass-casualty incident may require the aid of non-medical volunteers. These individuals may be utilized to perform field disaster triage, lessening the burden on EMS personnel.

Objective:

The purpose of this study was to evaluate the accuracy of triage decisions made by newly enrolled first-year medical students after receiving a brief educational intervention.

Methods:

A total of 315 first-year medical students from two successive classes participated in START triage training and completed a paper-based triage exercise as part of orientation. This questionnaire consisted of 15 clinical scenarios providing brief but sufficient details for prioritization. Subjects assigned each scenario a triage category of Red, Yellow, Green, or Black, based on the START protocol and were allowed four minutes to complete the exercise. Participants from the Class of 2009 were provided with printed START reference cards, while those from the Class of 2008 were not. Two test types varying in the order of patient age values were created to determine whether patient age was a factor in triage assessment.

Results:

The mean accuracy score of triage assignment by medical student volunteers after a brief START training session was 64.3%. The overall rate of over-triage was 17.8%, compared to an under-triage rate of 12.6%. There were no significant differences in triage accuracy between subjects with and without printed materials (63.9% vs. 64.6%, p = 0.729) or those completing the age-variant test types (64.4% vs. 64.1%, p = 0.889).

Conclusions:

First-year medical students who received brief START training achieved triage accuracy scores similar to those of emergency physicians, registered nurses, and paramedics in previous studies. Observed rates of underand over-triage suggest that a need exists for improving the accuracy of triage decisions made by medical and non-medical personnel. This study did not find that printed materials significantly improved triage accuracy, nor did it find that patient age affected the ability of participants to correctly assign triage categories. Future research might further evaluate disaster triage by non-medical volunteers.

Keywords

disasterdisaster triageexercisemass-casualty incidentmedical studenttriagetriage accuracytriage performancevolunteervolunteer triage
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 25 , Issue 3 , June 2010 , pp. 239 - 245
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2010

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