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    Intuitive versus Algorithmic Triage

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    Authors
    Hart, Alexander
    Nammour, Elias
    Mangolds, Virginia B.
    Broach, John
    UMass Chan Affiliations
    Graduate School of Nursing
    Department of Emergency Medicine
    School of Medicine
    Document Type
    Journal Article
    Publication Date
    2018-08-01
    Keywords
    EMS Emergency Medical Services
    FSE full-scale exercise
    MCI mass-casualty incident
    START Simple Triage and Rapid Treatment
    EMS
    disaster
    mass casualty
    triage
    Emergency Medicine
    Health Services Administration
    
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    Link to Full Text
    https://doi.org/10.1017/S1049023X18000626
    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.
    Source

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

    DOI
    10.1017/S1049023X18000626
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/28477
    PubMed ID
    30129913
    Notes

    Virginia B. Mangolds participated in this study as a doctoral student in the Graduate School of Nursing at UMass Medical School.

    Related Resources

    Link to Article in PubMed

    ae974a485f413a2113503eed53cd6c53
    10.1017/S1049023X18000626
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    T.H. Chan School of Medicine Student Publications
    UMass Chan Faculty and Researcher Publications
    Tan Chingfen Graduate School of Nursing Scholarly Publications
    Emergency Medicine Publications

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