Testing the START Triage Protocol: Can It Improve the Ability of Nonmedical Personnel to Better Triage Patients During Disasters and Mass Casualties Incidents ?

2017 ◽  
Vol 11 (3) ◽  
pp. 305-309 ◽  
Author(s):  
Stefano Badiali ◽  
Aimone Giugni ◽  
Lucia Marcis
Keyword(s):  
Group Versus ◽  
Time Frame ◽  
Mass Casualty Incident ◽  
Medical Intervention ◽  
Mass Casualty ◽  
Mass Casualties ◽  
Exact Test ◽  
Triage Protocol ◽  
Train System ◽  
Improve Patient

AbstractObjectiveSTART (Simple Triage and Rapid Treatment) triage is a tool that is available even to nonmedical rescue personnel in case of a disaster or mass casualty incident (MCI). In Italy, no data are available on whether application of the START protocol could improve patient outcomes during a disaster or MCI. We aimed to address whether “last-minute” START training of nonmedical personnel during a disaster or MCI would result in more effective triage of patients.MethodsIn this case-control study, 400 nonmedical ambulance crew members were randomly assigned to a non-START or a START group (200 per group). The START group received last-minute START training. Each group examined 6000 patients, obtained from the Emergo Train System (ETS Italy, Bologna, Italy) victims database, and assigned patients a triage code (black-red-yellow-green) along with a reason for the assignment. Each rescuer triaged 30 patients within a 30-minute time frame. Results were analyzed according to Fisher’s exact test for a P value<0.01. Under- and over-triage ratios were analyzed as well.ResultsThe START group completed the evaluations in 15 minutes, whereas the non-START group took 30 minutes. The START group correctly triaged 94.2% of their patients, as opposed to 59.83% of the non-START group (P<0.01). Under- and over-triage were, respectively, 2.73% and 3.08% for the START group versus 13.67% and 26.5% for the non-START group. The non-START group had 458 “preventable deaths” on 6000 cases because of incorrect triage, whereas the START group had 91.ConclusionsEven a “last-minute” training on the START triage protocol allows nonmedical personnel to better identify and triage the victims of a disaster or MCI, resulting in more effective and efficient medical intervention. (Disaster Med Public Health Preparedness. 2017;11:305–309)

scholarly journals Actionable, Revised (v.3), and Amplified American Burn Association Triage Tables for Mass Casualties: A Civilian Defense Guideline

2020 ◽  
Vol 41 (4) ◽  
pp. 770-779
Author(s):  
Randy D Kearns ◽  
Amanda P Bettencourt ◽  
William L Hickerson ◽  
Tina L Palmieri ◽  
Paul D Biddinger ◽  
...  
Keyword(s):  
Healthcare System ◽  
Burn Injury ◽  
Standard Of Care ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Standards Of Care ◽  
Mass Casualties ◽  
Institute Of Medicine ◽  
Burn Care ◽  
Civilian Defense

Abstract Burn care remains among the most complex of the time-sensitive treatment interventions in medicine today. An enormous quantity of specialized resources are required to support the critical and complex modalities needed to meet the conventional standard of care for each patient with a critical burn injury. Because of these dependencies, a sudden surge of patients with critical burn injuries requiring immediate and prolonged care following a burn mass casualty incident (BMCI) will place immense stress on healthcare system assets, including supplies, space, and an experienced workforce (staff). Therefore, careful planning to maximize the efficient mobilization and rational use of burn care resources is essential to limit morbidity and mortality following a BMCI. The U.S. burn care profession is represented by the American Burn Association (ABA). This paper has been written by clinical experts and led by the ABA to provide further clarity regarding the capacity of the American healthcare system to absorb a surge of burn-injured patients. Furthermore, this paper intends to offer responders and clinicians evidence-based tools to guide their response and care efforts to maximize burn care capabilities based on realistic assumptions when confronted with a BMCI. This effort also aims to align recommendations in part with those of the Committee on Crisis Standards of Care for the Institute of Medicine, National Academies of Sciences. Their publication guided the work in this report, identified here as “conventional, contingency, and crisis standards of care.” This paper also includes an update to the burn Triage Tables- Seriously Resource-Strained Situations (v.2).

The Importance of Preparedness for Emergency Response to Railway Incidents

2017 ◽  
Author(s):  
John Cockle ◽  
Larry Day
Keyword(s):  
Public Transportation ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Mass Casualties ◽  
Shared Resources ◽  
Use Of Time ◽  
Mass Casualty Events ◽  
Large Numbers ◽  
Time And Energy ◽  
Large Groups

Public transportation provides opportunities for people to share a common platform or mode of transportation as they move from place to place, often amassing persons in large groups or quantities. Rail transportation in particular has the benefit of accommodating very large numbers of people in one movement, often upwards of 1000 persons. The benefits to society are considerable: shared resources, lower impacts on the environment, and more efficient use of time and energy. The consequence when something goes wrong, however, can also be considerable: mass casualties (fatalities and/or injuries) from a single event, disrupted supply chains, and environmental damages to name a few. Even if persons are not physically harmed, the effects of an incident can be felt by a far greater number of persons. Adequate preparation can play a key role in minimizing the effects of mass casualty events such as railway collisions or derailments. Indeed, lives can be saved or lost depending on the resources, training, and organization that are employed when responding to a mass casualty incident.

scholarly journals (A281) Protecting and Preparing Critical Hospital Infrastructure — Redundancy, Security, and Disaster Response

2011 ◽  
Vol 26 (S1) ◽  
pp. s78-s78
Author(s):  
A.G. Robertson ◽  
M.G. Leclercq ◽  
C. Wilkinson
Keyword(s):  
Disaster Response ◽  
Capital Investment ◽  
Critical Infrastructure ◽  
Early Stage ◽  
Tertiary Hospital ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Medium Size ◽  
Mass Casualties ◽  
Health Infrastructure

Western Australia (WA) currently is undergoing a major rebuild of its key metropolitan and regional hospitals, with the planned construction of a major tertiary hospital, pediatric hospital, and several large general hospitals in the metropolitan area, and a range of small and medium size hospitals in WA over the next five years. Protecting these hospitals from major internal failure and external assault, while preparing them to cope with mass casualties, has been a major focus of the WA Department of Health over the last five years. This program has involved capital investment in current infrastructure, including critical asset protection, and detailed planning to ensure that the new health infrastructure will have both the redundant systems, to allow for continued operations in a range of infrastructure failure and disaster scenarios, and the facilities to deal with a mass-casualty incident. This presentation will review the implementation of this critical infrastructure program, the evolving issues facing hospitals working to ensure their continued operations in a range of scenarios, the security and infrastructure threats facing major hospitals, and the planning required to ensure that these threats are addressed at an early stage of hospital development. Issues as diverse as the placement of underground garages to minimize bomb threats, the location of helicopter landing pads, and the consideration of how to lock down hospitals to prevent the uncontrolled access of contaminated patients, are some of the challenges that need measured consideration and a planned response. The preparations and planning for such contingencies, and the infrastructure to facilitate continued operations and an appropriate disaster response, are key elements in protecting critical health infrastructure.

Comparison of Electronic Versus Manual Mass-Casualty Incident Triage

2018 ◽  
Vol 33 (3) ◽  
pp. 273-278 ◽  
Author(s):  
Claudie Bolduc ◽  
Nisreen Maghraby ◽  
Patrick Fok ◽  
The Minh Luong ◽  
Valerie Homier
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Simulated Patients ◽  
Mass Casualties ◽  
Care Providers ◽  
Manual Method ◽  
Computer Based ◽  
Triage Time

AbstractIntroductionMass-casualty incidents (MCIs) easily overwhelm a health care facility’s human and material resources through the extraordinary influx of casualties. Efficient and accurate triage of incoming casualties is a critical step in the hospital disaster response.Hypothesis/ProblemTraditionally, triage during MCIs has been manually performed using paper cards. This study investigated the use of electronic Simple Triage and Rapid Treatment (START) triage as compared to the manual method.MethodsThis observational, crossover study was performed during a live MCI simulation at an urban, Canadian, Level 1 trauma center on May 26, 2016. Health care providers (two medical doctors [MDs], two paramedics [PMs], and two registered nurses [RNs]) each triaged a total of 30 simulated patients - 15 by manual (paper-based) and 15 by electronic (computer-based) START triage. Accuracy of triage categories and time of triage were analyzed. Post-simulation, patients and participating health care providers also completed a feedback form.ResultsThere was no difference in accuracy of triage between the electronic and manual methods overall, 83% and 80% (P=1.0), between providers or between triage categories. On average, triage time using the manual method was estimated to be 8.4 seconds faster (P<.001) for PMs; and while small differences in triage times were observed for MDs and RNs, they were not significant. Data from the participant feedback survey showed that the electronic method was preferred by most health care providers. Patients had no preference for either method. However, patients perceived the computer-based method as “less personal” than the manual triage method, but they also perceived the former as “better organized.”ConclusionHospital-based electronic START triage had the same accuracy as hospital-based manual START triage, regardless of triage provider type or acuity of patient presentations. Time of triage results suggest that speed may be related to provider familiarity with a modality rather than the modality itself. Finally, according to patient and provider perceptions, electronic triage is a feasible modality for hospital triage of mass casualties. Further studies are required to assess the performance of electronic hospital triage, in the context of a rapid surge of patients, and should consider additional efficiencies built in to electronic triage systems. This study presents a framework for assessing the accuracy, triage time, and feasibility of digital technologies in live simulation training or actual MCIs.BolducC, MaghrabyN, FokP, LuongTM, HomierV. Comparison of electronic versus manual mass-casualty incident triage. Prehosp Disaster Med. 2018;33(3):273–278.

scholarly journals Seven First Minutes - Community Emergency Response Training

2019 ◽  
Vol 34 (s1) ◽  
pp. s18-s18
Author(s):  
Raphael Herbst ◽  
Eli Jaffe
Keyword(s):  
General Public ◽  
Emergency Services ◽  
Medical Training ◽  
Study Groups ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Emergency Responders ◽  
Accurate Picture ◽  
Unique Experience ◽  
Improve Patient

Introduction:Following a mass casualty incident (MCI), it can take several minutes for emergency medical services (EMS) to arrive. The course was developed by Magen David Adom (MDA) based on unique experience in dealing with MCIs, and the time between alerting emergency services to such an incident until they arrive. The course is focused on teaching the general public to channel their desire to help in such a situation into useful skills which can potentially improve patient outcomes. The seminar focuses on key principles such as safety, calling for help, providing an accurate picture of the scene, and initiating basic treatment with an emphasis on hemorrhage control.Aim:MDA examined the ability of the general public with no previous medical training to perform a basic triage and treatment in an MCI situation. Additionally, the study examined the abilities of the study groups to manage a scene until the arrival of EMS based on the principles taught in the course.Methods:MDA has sent teams of instructors around the world to teach over 1,000 participants. Upon completing the course, the participants partake in a drill that assesses their ability to manage a scene of 20 patients. Their ability to initiate the call for help, provide an accurate picture, initiate treatment, and give an accurate report to arriving emergency responders are examined.Results:The average times were recorded. Within 38 seconds, dispatch was alerted to the situation. Within 2:30 minutes, treatment was initiated for all patients. Within 4:37 minutes, the scene was fully under control, and within 6:37 minutes, an accurate report was transferred to EMS on the scene.Discussion:The participants demonstrated an unexpected willingness to learn, practice, and partake in the drills, and the results were unexpected.

scholarly journals Preparing for Mass Casualties: Improving Staff Preparedness and Hospital Operations through Multidisciplinary Simulation Training in Disaster Management

2019 ◽  
Vol 34 (s1) ◽  
pp. s81-s82
Author(s):  
Nathan Watkins ◽  
Amy NB Johnston ◽  
Peter McNamee ◽  
Naomi Muter ◽  
Cindy Huang ◽  
...  
Keyword(s):  
Mass Casualty ◽  
Mass Casualties ◽  
Post Exercise ◽  
Self Confidence ◽  
Hospital Operations ◽  
Large Teaching Hospital ◽  
Perceived Preparedness ◽  
Multidisciplinary Simulation ◽  
Train System ◽  
Real Patients

Introduction:World events continue to compel hospitals to have agile and scalable response arrangements for managing natural and instigated disasters. While many hospitals have disaster plans, few exercise these plans or test their staff under realistic scenarios.Aim:This study explores changes in perceived preparedness of multidisciplinary hospital-wide teams to manage mass casualty incidents.Methods:Two Emergo Train System (ETS) mass casualty exercises involving 80 and 86 “victims,” respectively, were run at two southeast Queensland hospitals: one large teaching hospital and one smaller regional hospital. Pre- and post-exercise surveys were administered, capturing participants’ confidence, skills, and process knowledge anonymously on 5-point Likert scales. A waiver of ethics review was obtained. Changes in individuals’ pre- and post-scores were analyzed using paired t-tests. Open-ended questions and a “hot debrief” occurring immediately post-exercise allowed for capture of improvement ideas.Results:Nearly 200 unique healthcare staff (n=193) participated in one exercise. At least one survey was returned by 159 staff (82.4%). Pre- and post- surveys were available for 89 staff; two-thirds (n=59) were nurses or doctors, and 46% overall were emergency department clinicians. Ninety-seven percent reported the exercise was valuable, also recommending additional simulations. Analysis of the 89 matched-pairs showed significant (p<.001) increases in self-confidence, skills, and knowledge (point increases on a five-point Likert scale (95% confidence intervals): 0.8 (0.6-0.9) for confidence and 0.4 (0.2-0.5) for both skills and knowledge. The exercise was critically appraised and a summary of operational learnings was developed. The most common criticism of ETS was its lack of real patients.Discussion:Involvement in simulated exercises (e.g. ETS) can increase confidence, knowledge, and skills of staff to manage disasters, with the biggest improvement in confidence. Whilst validating and testing plans, simulations can also uncover opportunities to improve processes and systems.

Beta-Blockade in Intraseptal Anomalous Coronary Artery With Reversible Myocardial Ischemia

2021 ◽  
Vol 12 (1) ◽  
pp. 145-148
Author(s):  
Tam T. Doan ◽  
Athar M. Qureshi ◽  
Shagun Sachdeva ◽  
Cory V. Noel ◽  
Dana Reaves-O’Neal ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Dobutamine Stress ◽  
Medical Intervention ◽  
Beta Blockade ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Reversible Ischemia ◽  
Improve Patient

Anomalous aortic origin of a left coronary artery (L-AAOCA) with an intraseptal course is a rare anomaly and can be associated with myocardial ischemia and sudden cardiac death. No surgical or medical intervention is known to improve patient outcomes. A 7-year-old boy with intraseptal L-AAOCA presented with nonexertional chest pain, syncope, and had reversible myocardial ischemia on provocative testing. The patient was started on β-blockade, following which his symptoms improved and resolved over a period of six years. A follow-up dobutamine stress magnetic resonance imaging no longer showed reversible ischemia, and cardiac catheterization with fractional flow reserve did not show coronary flow compromise.

scholarly journals Prehospital Triage by Lay Person First Responders: A Scoping Review and Proposal for a new Prehospital Triage Tool

2021 ◽  
pp. 1-11
Author(s):  
Wesley D Jetten ◽  
Jeroen Seesink ◽  
Markus Klimek
Keyword(s):  
Scoping Review ◽  
Life Support ◽  
First Responders ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Mass Casualty Incidents ◽  
Lay People ◽  
Online Databases ◽  
Healthcare Experience ◽  
Prehospital Triage

Abstract Objective: The primary aim of this study is to review the available tools for prehospital triage in case of mass casualty incidents and secondly, to develop a tool which enables lay person first responders (LPFRs) to perform triage and start basic life support in mass casualty incidents. Methods: In July 2019, online databases were consulted. Studies addressing prehospital triage methods for lay people were analyzed. Secondly, a new prehospital triage tool for LPFRs was developed. Therefore, a search for prehospital triage models available in literature was conducted and triage actions were extracted. Results: The search resulted in 6188 articles, and after screening, a scoping review of 4 articles was conducted. All articles stated that there is great potential to provide accurate prehospital triage by people with no healthcare experience. Based on these findings, and combined with the pre-existing prehospital triage tools, we developed a, not-yet validated, prehospital triage tool for lay people, which may improve disaster awareness and preparedness and might positively contribute to community resilience. Conclusion: The prehospital triage tool for lay person first responders may be useful and may help professional medical first responders to determine faster, which casualties most urgently need help in a mass casualty incident.

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