Triage Performance of School Personnel Using the SALT System

2019 ◽  
Vol 34 (04) ◽  
pp. 401-406
Author(s):  
Daniel H. Celik ◽  
Francis R. Mencl ◽  
Michel Debacker ◽  
Lisa Kurland ◽  
Scott T. Wilber ◽  
...  
Keyword(s):  
Private School ◽  
School Personnel ◽  
Knowledge Retention ◽  
Mass Casualty ◽  
Hemorrhage Control ◽  
Brief Training ◽  
Life Saving ◽  
Trained Personnel ◽  
Objective Structured Clinical Exam ◽  
Cpr Training

AbstractIntroduction:The aim of this study was to determine if school personnel can understand and apply the Sort, Assess, Life-saving interventions, Treat/Transport (SALT) triage methods after a brief training. The investigators predicted that subjects can learn to triage with accuracy similar to that of medically trained personnel, and that subjects can pass an objective-structured clinical exam (OSCE) evaluating hemorrhage control.Methods:School personnel were eligible to participate in this prospective observational study. Investigators recorded subject demographic information and prior medical experience. Participants received a 30-minute lecture on SALT triage and a brief lecture and demonstration of hemorrhage control and tourniquet application. A test with brief descriptions of mass-casualty victims was administered immediately after training. Participants independently categorized the victims as dead, expectant, immediate, delayed, or minimal. They also completed an OSCE to evaluate hemorrhage control and tourniquet application using a mannequin arm.Results:Subjects from two schools completed the study. Fifty-nine were from a private school that enrolls early childhood through grade eight, and 45 from a public school that enrolls grades seven and eight (n = 104). The average subject age was 45 years and 68% were female. Approximately 81% were teachers and 87% had prior cardiopulmonary resuscitation (CPR) training. Overall triage accuracy was 79.2% (SD = 10.7%). Ninety-six (92.3%) of the subjects passed the hemorrhage control OSCE.Conclusions:After two brief lectures and a short demonstration, school personnel were able to triage descriptions of mass-casualty victims with an overall accuracy similar to medically trained personnel, and most were able to apply a tourniquet correctly. Opportunities for future study include integrating high-fidelity simulation and mock disasters, evaluating for knowledge retention, and exploring the study population’s baseline knowledge of medical care, among others.

scholarly journals World trauma education: hemorrhage control training for healthcare providers in India

2019 ◽  
Vol 4 (1) ◽  
pp. e000263 ◽  
Author(s):  
Lindsay Andrea Smith ◽  
Sarah Caughey ◽  
Susan Liu ◽  
Cassandra Villegas ◽  
Mohan Kilaru ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Trauma Patients ◽  
Bleeding Control ◽  
Cross Sectional Survey ◽  
Hemorrhage Control ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Life Saving ◽  
Poor Outcomes ◽  
Trauma Education

BackgroundHemorrhage remains a major cause of death around the world. Eighty percent of trauma patients in India do not receive medical care within the first hour. The etiology of these poor outcomes is multifactorial. We describe findings from the first Stop the Bleed (StB) course recently offered to a group of medical providers in southern India.MethodsA cross-sectional survey of 101 participants who attended StB trainings in India was performed. Pre-training and post-training questionnaires were collected from each participant. In total, 88 healthcare providers’ responses were analyzed. Three bleeding control skills were presented: wound compression, wound packing, and tourniquet application.ResultsAmong participants, only 23.9% had received prior bleeding control training. Participants who reported feeling ‘extremely confident’ responding to an emergency medical situation rose from 68.2% prior to StB training to 94.3% post-training. Regarding hemorrhage control abilities, 37.5% felt extremely confident before the training, compared with 95.5% after the training. For wound packing and tourniquet application, 44.3% and 53.4%, respectively, felt extremely confident pre-training, followed by 97.7% for both skills post-training. Importantly, 90.9% of StB trainees felt comfortable teaching newly acquired hemorrhage control skills. A significant majority of participants said that confidence in their wound packing and tourniquet skills would improve with more realistic mannequins.ConclusionTo our knowledge, this is the first StB training in India. Disparities in access to care, long transport times, and insufficient numbers of prehospital personnel contribute to its significant trauma burden. Dissemination of these critical life-saving skills into this region and the resulting civilian interventions will increase the number of trauma patients who survive long enough to reach a trauma center. Additionally, considerations should be given to translating the course into local languages to increase program reach.Level of EvidenceLevel IV.

scholarly journals Assessing the Current Generation of Tourniquets

2020 ◽  
Vol 185 (3-4) ◽  
pp. e377-e382
Author(s):  
Shimon Katsnelson ◽  
Jessie Oppenheimer ◽  
Rafi Gerrasi ◽  
Ariel Furer ◽  
Linn Wagnert-Avraham ◽  
...  
Keyword(s):  
Applied Pressure ◽  
Military Medicine ◽  
Pressure Profile ◽  
Strongly Correlated ◽  
Hemorrhage Control ◽  
Strong Negative Correlation ◽  
Life Saving ◽  
Significant Difference ◽  
New Generation ◽  
Better Than

Abstract Introduction Tourniquet application is an urgent life-saving procedure. Previous studies demonstrated several drawbacks in tourniquet design and application methods that limit their efficacy; among them, loose application of the device before windlass twisting is a main pitfall. A new generation of modern combat tourniquets was developed to overcome these pitfalls. The objective of this study was to assess the effectiveness of three new tourniquet designs: the CAT Generation 7 (CAT7), the SAM Extremity Tourniquet (SAM-XT), and the SOF Tactical Tourniquet Wide (SOFTT-W) as well as its correlation to the degree of slack. Materials and Methods The three tourniquet models were applied in a randomized sequence on a HapMed leg tourniquet trainer, simulating an above-the-knee traumatic amputation by 60 military medicine track cadets. Applied pressure, hemorrhage control status, time until the bleeding stopped, estimated blood volume loss, and slack were measured. Results The mean (±SD) pressure applied using the SAM-XT (186 mmHg ±63) or the CAT7 (175 mmHg ±79) was significantly higher compared to the pressure applied by the SOFTT-W (104 mmHg ±101, P < 0.017), with no significant difference between the first two (P > 0.05). Hemorrhage control rate was similar (P > 0.05) with SAM-XT (73.3%) and CAT7 (67.7%), and both were significantly better than the SOFTT-W (35%, P < 0.017). Slack was similar between CAT7 and SAM-XT (5.2 mm ± 3.4 vs. 5 mm ± 3.5, P > 0.05), yet significantly lower compared to the SOFTT-W (9 mm ± 5, P < 0.017). A strong negative correlation was found between slack and hemorrhage control rate (3.2 mm ± 1.5 mm in success vs. 10.5 mm ± 3.4 mm in failure, P < 0.001) and applied pressure (Pearson’s correlation coefficient of −0.83, P < 0.001). Conclusions Both SAM-XT and CAT7 demonstrated a better pressure profile and hemorrhage control rate compared to SOFTT-W, with no significant difference between the two. The better outcome measures were strongly correlated to less slack.

User-Managed Inventory: An Approach to Forward-Deployment of Urgently Needed Medical Countermeasures for Mass-Casualty and Terrorism Incidents

2012 ◽  
Vol 6 (4) ◽  
pp. 408-414 ◽  
Author(s):  
C. Norman Coleman ◽  
Chad Hrdina ◽  
Rocco Casagrande ◽  
Kenneth D. Cliffer ◽  
Monique K. Mansoura ◽  
...  
Keyword(s):  
Cost Effective ◽  
Distribution Networks ◽  
The United States ◽  
Mass Casualty ◽  
Life Saving ◽  
Medical Facilities ◽  
Response Capacity ◽  
Regional Medical ◽  
Federal Response ◽  
Medical Countermeasures

ABSTRACTThe user-managed inventory (UMI) is an emerging idea for enhancing the current distribution and maintenance system for emergency medical countermeasures (MCMs). It increases current capabilities for the dispensing and distribution of MCMs and enhances local/regional preparedness and resilience. In the UMI, critical MCMs, especially those in routine medical use (“dual utility”) and those that must be administered soon after an incident before outside supplies can arrive, are stored at multiple medical facilities (including medical supply or distribution networks) across the United States. The medical facilities store a sufficient cache to meet part of the surge needs but not so much that the resources expire before they would be used in the normal course of business. In an emergency, these extra supplies can be used locally to treat casualties, including evacuees from incidents in other localities. This system, which is at the interface of local/regional and federal response, provides response capacity before the arrival of supplies from the Strategic National Stockpile (SNS) and thus enhances the local/regional medical responders' ability to provide life-saving MCMs that otherwise would be delayed. The UMI can be more cost-effective than stockpiling by avoiding costs due to drug expiration, disposal of expired stockpiled supplies, and repurchase for replacement.(Disaster Med Public Health Preparedness. 2012;6:408-414)

Private School Personnel Food Allergy and Anaphylaxis Knowledge Education

2017 ◽  
Vol 139 (2) ◽  
pp. AB195
Author(s):  
Maya Gharfeh ◽  
Lily Luo ◽  
Daisy Tran ◽  
Danielle Guffey ◽  
Charles Minard ◽  
...  
Keyword(s):  
Food Allergy ◽  
Private School ◽  
School Personnel

scholarly journals Systematic review on knowledge and skills level among nurses following cardiopulmonary resuscitation (cpr) training

2021 ◽  
Author(s):  
S Ahmed ◽  
I Ismail ◽  
K Lee ◽  
PY Lim
Keyword(s):  
Systematic Review ◽  
Teaching Methods ◽  
Knowledge Retention ◽  
Medical Emergency ◽  
Future Research ◽  
Eligibility Criteria ◽  
Systematic Analysis ◽  
Knowledge And Skills ◽  
Skills Retention ◽  
Cpr Training

Abstract Introduction: Although millions of healthcare providers and lay providers are trained globally in CPR each year, there are major gaps in delivering adequate medical emergency care such as poor quality CPR in the hospitals or none performance of CPR in out of hospital settings for people with cardiac arrest. Objective This systematic review aim to highlight the effect of training on knowledge and skills retention as well as the effect of different methods of training on knowledge and skills Methods The review used six online databases: Scopus, ProQuest, PubMed, ScienceDirect, CINAHL, Medline and reviewed reference citations for additional studies. Systematic analysis was use in excluding articles from the database by the latest 2015 American Heart Association (AHA) guidelines, known as Grading of Recommendations, Assessment, Development and Evaluation (GRADE) for the evaluation of knowledge and skills retention. Results A total of 71,671 possible articles were registered in six databases, with 331 articles found meeting eligibility criteria. And only 20 were finally included that met all the qualifying criteria for this systemic analysis. Most research used multi-choice questionnaires to assess retention of both knowledge and skills. From the pretest to the posttest, studies have shown that knowledge or skill rates differ and decrease from 6 weeks to 2 years after training. Between the reviewed papers, significant variations in retaining knowledge and skills were found between instructor-led training and other forms of teaching methods. Conclusion Between the pre-test and post-test outcomes, knowledge and skills have shown a substantial overall improvement in acquisition and retention. However, skills were observed to decay faster than knowledge. Skills start to decay as early as 2 weeks whereas knowledge retention start to decline on average between 1 month and 6 month after BLS/CPR training. Most of the articles showed that other forms of teaching methods are also as effective as the instructor led/traditional teaching methods in knowledge and skills levels among nurses. Therefore, future research should concentrate on the ideal timeline needed after initial training for the re-certification of the BLS/CPR.

Triage in Complex, Coordinated Terrorist Attacks

2019 ◽  
Vol 34 (04) ◽  
pp. 442-448 ◽  
Author(s):  
Matt Pepper ◽  
Frank Archer ◽  
John Moloney
Keyword(s):  
Physiological Stress ◽  
Mass Casualty ◽  
Terrorist Attacks ◽  
Mass Violence ◽  
Patient Movement ◽  
Terror Attacks ◽  
Physiological Variables ◽  
Large Numbers ◽  
Life Saving ◽  
San Bernardino

AbstractIntroduction:Terror attacks have increased in frequency, and tactics utilized have evolved. This creates significant challenges for first responders providing life-saving medical care in their immediate aftermath. The use of coordinated and multi-site attack modalities exacerbates these challenges. The use of triage is not well-validated in mass-casualty settings, and in the setting of intentional mass violence, new and innovative approaches are needed.Methods:Literature sourced from gray and peer-reviewed sources was used to perform a comparative analysis on the application of triage during the 2011 Oslo/Utoya Island (Norway), 2015 Paris (France), and 2015 San Bernardino (California USA) terrorist attacks. A thematic narrative identifies strengths and weaknesses of current triage systems in the setting of complex, coordinated terrorist attacks (CCTAs).Discussion:Triage systems were either not utilized, not available, or adapted and improvised to the tactical setting. The complexity of working with large numbers of patients, sensory deprived environments, high physiological stress, and dynamic threat profiles created significant barriers to the implementation of triage systems designed around flow charts, physiological variables, and the use of tags. Issues were identified around patient movement and “tactical triage.”Conclusion:Current triage tools are inadequate for use in insecure environments, such as the response to CCTAs. Further research and validation are required for novel approaches that simplify tactical triage and support its effective application. Simple solutions exist in tactical triage, patient movement, and tag use, and should be considered as part of an overall triage system.

Tabletop Application of SALT Triage to 10, 100, and 1000 Pediatric Victims

2020 ◽  
Vol 35 (2) ◽  
pp. 165-169
Author(s):  
Nicholas McGlynn ◽  
Ilene Claudius ◽  
Amy H. Kaji ◽  
Emilia H. Fisher ◽  
Alaa Shaban ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Pediatric Trauma ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Trauma Patients ◽  
Kappa Test ◽  
Life Saving ◽  
Number Of Patients ◽  
Level 1 ◽  
Level 1 Trauma Center

AbstractIntroduction:The Sort, Access, Life-saving interventions, Treatment and/or Triage (SALT) mass-casualty incident (MCI) algorithm is unique in that it includes two subjective questions during the triage process: “Is the victim likely to survive given the resources?” and “Is the injury minor?”Hypothesis/Problem:Given this subjectivity, it was hypothesized that as casualties increase, the inter-rater reliability (IRR) of the tool would decline, due to an increase in the number of patients triaged as Minor and Expectant.Methods:A pre-collected dataset of pediatric trauma patients age <14 years from a single Level 1 trauma center was used to generate “patients.” Three trained raters triaged each patient using SALT as if they were in each of the following scenarios: 10, 100, and 1,000 victim MCIs. Cohen’s kappa test was used to evaluate IRR between the raters in each of the scenarios.Results:A total of 247 patients were available for triage. The kappas were consistently “poor” to “fair:” 0.37 to 0.59 in the 10-victim scenario; 0.13 to 0.36 in the 100-victim scenario; and 0.05 to 0.36 in the 1,000-victim scenario. There was an increasing percentage of subjects triaged Minor as the number of estimated victims increased: 27.8% increase from 10- to 100-victim scenario and 7.0% increase from 100- to 1,000-victim scenario. Expectant triage categorization of patients remained stable as victim numbers increased.Conclusion:Overall, SALT demonstrated poor IRR in this study of increasing casualty counts while triaging pediatric patients. Increased casualty counts in the scenarios did lead to increased Minor but not Expectant categorizations.

scholarly journals Mass Casualty Triage: An Evaluation of the Data and Development of a Proposed National Guideline

2008 ◽  
Vol 2 (S1) ◽  
pp. S25-S34 ◽  
Author(s):  
E. Brooke Lerner ◽  
Richard B. Schwartz ◽  
Phillip L. Coule ◽  
Eric S. Weinstein ◽  
David C. Cone ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Scientific Evidence ◽  
The United States ◽  
Mass Casualty ◽  
National Guideline ◽  
Public Health Preparedness ◽  
Life Saving ◽  
Review Reports ◽  
Triage Decisions

ABSTRACTMass casualty triage is a critical skill. Although many systems exist to guide providers in making triage decisions, there is little scientific evidence available to demonstrate that any of the available systems have been validated. Furthermore, in the United States there is little consistency from one jurisdiction to the next in the application of mass casualty triage methodology. There are no nationally agreed upon categories or color designations. This review reports on a consensus committee process used to evaluate and compare commonly used triage systems, and to develop a proposed national mass casualty triage guideline. The proposed guideline, entitled SALT (sort, assess, life-saving interventions, treatment and/or transport) triage, was developed based on the best available science and consensus opinion. It incorporates aspects from all of the existing triage systems to create a single overarching guide for unifying the mass casualty triage process across the United States. (Disaster Med Public Health Preparedness. 2008;2(Suppl 1):S25–S34)

Combat Medicine: A Model for Civilian Mass Casualty Managment?

2002 ◽  
Vol 46 (16) ◽  
pp. 1501-1505
Author(s):  
John P. Holmquist ◽  
John S. Barnett
Keyword(s):  
World War I ◽  
Mass Casualty ◽  
Home Front ◽  
Digital Networks ◽  
World War ◽  
Technological Advances ◽  
Life Saving ◽  
Combat Medics ◽  
State And Local ◽  
Combat Medicine

Casualty management is vital in combat. Prior to World War I, the wounded soldier's outlook for survival was dismal. However, technological advances of the twentieth-century introduced combat medics, triage, and improved medicines to the front lines, as well as, paramedics, 9-1-1 response, and state and local emergency centers on the home front, reducing pain and saving lives. Emerging technology promises to bring further life-saving techniques to the future battlefield and civilian disasters. With the advent of digital networks and sophisticated information technology, the ability to assist the wounded and evacuate casualties from the combat zone and city emergency areas promises tremendous improvements in casualty management and subsequent patient survival. This paper provides a brief review of the evolution of battlefield medicine and extrapolates how combining applied human factors with emergent digital technology could enhance battlefield and disaster casualty management.

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