Title

Intuitive versus Algorithmic Triage

UMMS Affiliation

School of Medicine; Department of Emergency Medicine

Publication Date

2018-08-01

Document Type

Article

Disciplines

Emergency Medicine | Health Services Administration

Abstract

Introduction. The most commonly used methods for triage in mass-casualty incidents (MCIs) rely upon providers to take exact counts of vital signs or other patient parameters. The acuity and volume of patients which can be present during an MCI makes this a time-consuming and potentially costly process.

Hypothesis. This study evaluates and compares the speed of the commonly used Simple Triage and Rapid Treatment (START) triage method with that of an "intuitive triage" method which relies instead upon the abilities of an experienced first responder to determine the triage category of each victim based upon their overall first-impression assessment. The research team hypothesized that intuitive triage would be faster, without loss of accuracy in assigning triage categories.

METHODS: Local adult volunteers were recruited for a staged MCI simulation (active-shooter scenario) utilizing local police, Emergency Medical Services (EMS), public services, and government leadership. Using these same volunteers, a cluster randomized simulation was completed comparing START and intuitive triage. Outcomes consisted of the time and accuracy between the two methods.

RESULTS: The overall mean speed of the triage process was found to be significantly faster with intuitive triage (72.18 seconds) when compared to START (106.57 seconds). This effect was especially dramatic for Red (94.40 vs 138.83 seconds) and Yellow (55.99 vs 91.43 seconds) patients. There were 17 episodes of disagreement between intuitive triage and START, with no statistical difference in the incidence of over- and under-triage between the two groups in a head-to-head comparison.

CONCLUSION: Significant time may be saved using the intuitive triage method. Comparing START and intuitive triage groups, there was a very high degree of agreement between triage categories. More prospective research is needed to validate these results.

Keywords

EMS Emergency Medical Services, FSE full-scale exercise, MCI mass-casualty incident, START Simple Triage and Rapid Treatment, EMS, disaster, mass casualty, triage

DOI of Published Version

10.1017/S1049023X18000626

Source

Prehosp Disaster Med. 2018 Aug;33(4):355-361. doi: 10.1017/S1049023X18000626. Link to article on publisher's site

Journal/Book/Conference Title

Prehospital and disaster medicine

Related Resources

Link to Article in PubMed

PubMed ID

30129913

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