Emergency medical triage decisions are swayed by computer-manipulated cues of physical dominance in caller’s voice

AbstractIntroduction: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.

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Patient-tailored triage decisions by anaesthesiologist-staffed prehospital critical care teams: a retrospective descriptive study

BMJ Open ◽

10.1136/bmjopen-2017-019813 ◽

2018 ◽

Vol 8 (7) ◽

pp. e019813 ◽

Cited By ~ 1

Author(s):

Morten Langfeldt Friberg ◽

Leif Rognås

Keyword(s):

Critical Care ◽

Fast Track ◽

Road Traffic ◽

Descriptive Study ◽

University Hospital ◽

Emergency Medical Technician ◽

Hospital Department ◽

Emergency Medical ◽

Triage Decisions ◽

Direct Referral

ObjectivesThe primary objective was to estimate the incidence of patients in the Central Denmark Region triaged to bypass the local emergency department without being part of a predefined fast-track protocol. The secondary objective was to describe these triage decisions in more detail with regard to the most common diagnoses, incidence of direct referral sorted by the prehospital critical care team (PHCCT) and the destination hospital.DesignRetrospective descriptive study.Setting and participantsThe emergency medical service in the Central Denmark Region primarily consists of emergency medical technician (EMT)-staffed ambulances and anaesthesiologist-EMT-staffed PHCCTs. Patients treated by the nine ground-based PHCCTs in the region constituted the study population. The inclusion criteria were all patients treated by the PHCCTs during 2013 and 2014. The exclusion criteria were interhospital transfers, and patients with ST-segment elevation myocardial infarction, stroke or were in active labour.EndpointsIncidence of prehospital critical care anaesthesiologist-initiated direct referral, prehospital tentative diagnoses and transport destination.ResultsDuring the study period, the PHCCTs treated 39 396 patients and diverted 989 (2.5%) patients not covered by a predefined fast-track protocol to a specialised hospital department. ‘Resuscitated from cardiac arrest’(n=143),‘treatment and observations following road traffic accident’(n=105) and‘observation and treatment for an unspecified disease/condition’(n=78) were the most common prehospital tentative diagnoses, accounting for 33.0% of all diverted patients. In total, 943 (95.3%) of the PHCCT-diverted patients were diverted to a department at Aarhus University Hospital.ConclusionOur results demonstrate that in 1 out of 40 patient contacts, the anaesthesiologist-staffed PHCCTs in the Central Denmark Region divert critically ill and injured patients directly to a specialised hospital department, bypassing local emergency departments and potentially reducing time to definitive care for these patients. There may be a potential for increased referral of patients with no predefined fast-track directly to specialised departments in the Central Denmark Region.

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The effect of the introduction of a regional major trauma network on triage decisions made by a physician-staffed helicopter emergency medical service

European Journal of Emergency Medicine ◽

10.1097/mej.0000000000000272 ◽

2015 ◽

Vol 22 (6) ◽

pp. 395-400 ◽

Cited By ~ 1

Author(s):

Adam Chesters ◽

Ronan Fenton

Keyword(s):

Emergency Medical Service ◽

Major Trauma ◽

Medical Service ◽

Helicopter Emergency Medical Service ◽

Trauma Network ◽

Emergency Medical ◽

Triage Decisions

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Emergency Medical Workers' Responses to Death

OMEGA - Journal of Death and Dying ◽

10.2190/6qw5-5v92-v7g8-134e ◽

1998 ◽

Vol 37 (4) ◽

pp. 273-288 ◽

Cited By ~ 1

Author(s):

Sharon Rae Jenkins

Keyword(s):

Severity Index ◽

Mass Casualty ◽

Positive Outcomes ◽

Obsessive Compulsive ◽

Global Severity Index ◽

Psychosomatic Symptoms ◽

Emergency Medical ◽

Before And After ◽

Initial Shock ◽

Triage Decisions

Four aspects of emergency medical workers' exposure to death in a mass casualty shooting incident were related to their reactions to the incident and their reported psychological and psychosomatic symptoms. This study assessed thirty-six emergency medical workers' psychological and psychosomatic symptoms self-rated for the weeks before and after the shooting; thirty-one responded again one month post-event. Obsessive-Compulsive, Hostility, Depression, Anxiety, and Global Severity Index SCL90R Scales showed acute elevations that resolved within a month except for the first two. Objective and subjective exposure to the twenty-one on-scene deaths was related to acute increases in Obsessive-Compulsive and Depression self-ratings; stress from triage decisions was also related to the former, and was best relieved by help from coworkers. A task-focused first reaction was associated with more positive outcomes than was an initial shock reaction.

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