Major incident triage and the evaluation of the Triage Sort as a secondary triage method

2019 ◽  
Vol 36 (5) ◽  
pp. 281-286
Author(s):  
James Vassallo ◽  
Jason Smith
Keyword(s):  
Trauma Registry ◽  
Research Network ◽  
Major Incident ◽  
Effective Management ◽  
Civilian Trauma ◽  
Life Saving ◽  
Major Incidents ◽  
Detailed Assessment ◽  
The Uk ◽  
Primary Triage

IntroductionA key principle in the effective management of major incidents is triage, the process of prioritising patients on the basis of their clinical acuity. In many countries including the UK, a two-stage approach to triage is practised, with primary triage at the scene followed by a more detailed assessment using a secondary triage process, the Triage Sort. To date, no studies have analysed the performance of the Triage Sort in the civilian setting. The primary aim of this study was to determine the performance of the Triage Sort at predicting the need for life-saving intervention (LSI).MethodsUsing the Trauma Audit Research Network (TARN) database for all adult patients (>18 years) between 2006 and 2014, we determined which patients received one or more LSIs using a previously defined list. The first recorded hospital physiology was used to categorise patient priority using the Triage Sort, National Ambulance Resilience Unit (NARU) Sieve and the Modified Physiological Triage Tool-24 (MPTT-24). Performance characteristics were evaluated using sensitivity and specificity with statistical analysis using a McNemar’s test.Results127 233patients (58.1%) had complete data and were included: 55.6% men, aged 61.4 (IQR 43.1–80.0 years), ISS 9 (IQR 9–16), with 24 791 (19.5%) receiving at least one LSI (priority 1). The Triage Sort demonstrated the lowest accuracy of all triage tools at identifying the need for LSI (sensitivity 15.7% (95% CI 15.2 to 16.2) correlating with the highest rate of under-triage (84.3% (95% CI 83.8 to 84.8), but it had the greatest specificity (98.7% (95% CI 98.6 to 98.8).ConclusionWithin a civilian trauma registry population, the Triage Sort demonstrated the poorest performance at identifying patients in need of LSI. Its use as a secondary triage tool should be reviewed, with an urgent need for further research to determine the optimum method of secondary triage.

scholarly journals Major incident triage and the implementation of a new triage tool, the MPTT-24

2017 ◽  
Vol 164 (2) ◽  
pp. 103-106 ◽  
Author(s):  
James Vassallo ◽  
J E Smith ◽  
L A Wallis
Keyword(s):  
Trauma Registry ◽  
Research Network ◽  
Major Incident ◽  
Absolute Reduction ◽  
Life Saving ◽  
Significant Difference ◽  
Upper Respiratory ◽  
The Uk ◽  
The Military ◽  
Primary Triage

IntroductionThe Modified Physiological Triage Tool (MPTT) is a recently developed primary triage tool and in comparison with existing tools demonstrates the greatest sensitivity at predicting need for life-saving intervention (LSI) within both military and civilian populations. To improve its applicability, we proposed to increase the upper respiratory rate (RR) threshold to 24 breaths per minute (bpm) to produce the MPTT-24. Our aim was to conduct a feasibility analysis of the proposed MPTT-24, comparing its performance with the existing UK Military Sieve.MethodA retrospective review of the Joint Theatre Trauma Registry (JTTR) and Trauma Audit Research Network (TARN) databases was performed for all adult (>18 years) patients presenting between 2006–2013 (JTTR) and 2014 (TARN). Patients were defined as priority one (P1) if they received one or more LSIs. Using first recorded hospital RR in isolation, sensitivity and specificity of the ≥24 bpm threshold was compared with the existing threshold (≥22 bpm) at predicting P1 status. Patients were then categorised as P1 or not-P1 by the MPTT, MPTT-24 and the UK Military Sieve.ResultsThe MPTT and MPTT-24 outperformed existing UK methods of triage with a statistically significant (p<0.001) increase in sensitivity of between 25.5% and 29.5%. In both populations, the MPTT-24 demonstrated an absolute reduction in sensitivity with an increase in specificity when compared with the MPTT. A statistically significant difference was observed between the MPTT and MPTT-24 in the way they categorised TARN and JTTR cases as P1 (p<0.001).ConclusionsWhen compared with the existing MPTT, the MPTT-24 allows for a more rapid triage assessment. Both continue to outperform existing methods of primary major incident triage and within the military setting, the slight increase in undertriage is offset by a reduction in overtriage. We recommend that the MPTT-24 be considered as a replacement to the existing UK Military Sieve.

Triage and the Modified Physiological Triage Tool-24 (MPTT-24)

2018 ◽  
Vol 166 (1) ◽  
pp. 33-36 ◽  
Author(s):  
James Vassallo ◽  
S Horne ◽  
J E Smith
Keyword(s):  
Major Incident ◽  
Effective Management ◽  
Primary Methods ◽  
Life Saving ◽  
Major Incidents ◽  
Physiological Method

Major incidents occur on a regular basis. So far in 2017, England has witnessed five terrorism-related major incidents, resulting in approximately 40 fatalities and 400 injured. Triage is a key principle in the effective management of a major incident and involves prioritising patients on the basis of their clinical acuity. This paper describes the limitations associated with existing methods of primary major incident triage and the process of developing a new and improved triage tool—the Modified Physiological Triage Tool-24 (MPTT-24). Whilst the MPTT-24 is likely to be the optimum physiological method for primary major incident triage, it needs to be accompanied by an appropriate secondary triage process. The existing UK military and civilian secondary triage tool, the Triage Sort, is described, which offers little advantage over primary methods for identifying patients who require life-saving intervention. Further research is required to identify the optimum method of secondary triage.

scholarly journals Comparative analysis of major incident triage tools in children: a UK population-based analysis

2021 ◽  
pp. emermed-2021-211706
Author(s):  
James Vassallo ◽  
Saisakul Chernbumroong ◽  
Nabeela Malik ◽  
Yuanwei Xu ◽  
Damian Keene ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Injury Severity ◽  
Population Based ◽  
Research Network ◽  
Major Incident ◽  
Physiological Data ◽  
Primary Analysis ◽  
Life Saving ◽  
Major Incidents ◽  
Sensitivity Specificity

IntroductionTriage is a key principle in the effective management of major incidents. There is currently a paucity of evidence to guide the triage of children. The aim of this study was to perform a comparative analysis of nine adult and paediatric triage tools, including the novel ‘Sheffield Paediatric Triage Tool’ (SPTT), assessing their ability in identifying patients needing life-saving interventions (LSIs).MethodsA 10-year (2008–2017) retrospective database review of the Trauma Audit Research Network (TARN) Database for paediatric patients (<16 years) was performed. Primary outcome was identification of patients receiving one or more LSIs from a previously defined list. Secondary outcomes included mortality and prediction of Injury Severity Score (ISS) >15. Primary analysis was conducted on patients with complete prehospital physiological data with planned secondary analyses using first recorded data. Performance characteristics were evaluated using sensitivity, specificity, undertriage and overtriage.Results15 133 patients met TARN inclusion criteria. 4962 (32.8%) had complete prehospital physiological data and 8255 (54.5%) had complete first recorded physiological data. The majority of patients were male (69.5%), with a median age of 11.9 years. The overwhelming majority of patients (95.4%) sustained blunt trauma, yielding a median ISS of 9 and overall, 875 patients (17.6%) received at least one LSI. The SPTT demonstrated the greatest sensitivity of all triage tools at identifying need for LSI (92.2%) but was associated with the highest rate of overtriage (75.0%). Both the Paediatric Triage Tape (sensitivity 34.1%) and JumpSTART (sensitivity 45.0%) performed less well at identifying LSI. By contrast, the adult Modified Physiological Triage Tool-24 (MPTT-24) triage tool had the second highest sensitivity (80.8%) with tolerable rates of overtriage (70.2%).ConclusionThe SPTT and MPTT-24 outperform existing paediatric triage tools at identifying those patients requiring LSIs. This may necessitate a change in recommended practice. Further work is needed to determine the optimum method of paediatric major incident triage, but consideration should be given to simplifying major incident triage by the use of one generic tool (the MPTT-24) for adults and children.

scholarly journals Comparative Analysis of Major Incident Triage Tools in Children. A UK population based analysis.

2021 ◽  
Author(s):  
James Vassallo ◽  
Saisakul Chernbumroong ◽  
Nabeela Malik ◽  
Yuanwei Xu ◽  
Damian Keene ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Population Based ◽  
Major Incident ◽  
Physiological Data ◽  
Primary Analysis ◽  
Life Saving ◽  
Major Incidents ◽  
Secondary Analyses ◽  
Adults And Children ◽  
Sensitivity Specificity

Introduction. Triage is a key principle in the effective management of major incidents. There is currently a paucity of evidence to guide the triage of children. The aim of this study was to perform a comparative analysis of nine adult and paediatric triage tools, including the novel Sheffield Paediatric Triage Tool (SPTT), assessing their ability in identifying patients needing life-saving interventions (LSI). Methods A ten-year retrospective database review of TARN data for paediatric patients (<16years) was performed. Primary outcome was identification of patients receiving one or more LSIs from a previously defined list. Secondary outcomes included mortality and prediction of ISS>15. Primary analysis was conducted on patients with complete pre-hospital physiological data with planned secondary analyses using first recorded physiological data. Performance characteristics were evaluated using sensitivity, specificity, under and over-triage. Results 15133 patients met TARN inclusion criteria. 4962 (32.8%) had complete pre-hospital physiological data and 8255 (54.5%) had complete first recorded data. Male patients predominated (69.5%), sustaining blunt trauma (95.4%) with a median ISS of 9. 875 patients (17.6%) received at least one LSI. The SPTT demonstrated the greatest sensitivity of all triage tools at identifying need for LSI (92.2%) but was associated with the highest rate of over-triage (75.0%). Both the PTT (sensitivity 34.1%) and JumpSTART (sensitivity 45.0%) performed less well at identifying LSI. By contrast, the adult MPTT-24 triage tool had the second highest sensitivity (80.8%) with tolerable rates of over-triage (70.2%). Conclusion The SPTT and MPTT-24 outperform existing paediatric triage tools at identifying those patients requiring LSIs. This may necessitate a change in recommended practice. Further work is needed to determine the optimum method of paediatric major incident triage, but consideration should be given to simplifying major incident triage by the use of one generic tool (the MPTT-24) for adults and children.

scholarly journals Paediatric major incident triage and the use of machine learning techniques to develop an alternative triage tool with improved performance characteristics.

2021 ◽  
Author(s):  
Saisakul Chernbumroong ◽  
James Vassallo ◽  
Nabeela Malik ◽  
Yuanwei Xu ◽  
Damian Keene ◽  
...  
Keyword(s):  
Machine Learning ◽  
Machine Learning Techniques ◽  
Research Network ◽  
Major Incident ◽  
Physiological Data ◽  
Feasibility Assessment ◽  
Paediatric Patients ◽  
Life Saving ◽  
Improved Performance ◽  
Sensitivity Specificity

Background Triage is a key principle in the effective management of major incidents. However, there is an increasing body of evidence demonstrating that existing paediatric methods are associated with high rates of under-triage and are not fit for purpose. The aim of this study was to derive a novel paediatric triage tool using machine learning (ML) techniques. Methods The United Kingdom Trauma Audit Research Network (TARN) database was interrogated for all paediatric patients aged under 16 years for the ten-year period 2008-2017. Patients were categorised as Priority One if they received one or more life-saving interventions from a previously defined list. Six ML algorithms were investigated for identifying patients as Priority One. Subsequently, the best performing model was chosen for further development using a risk score approach and clinically relevant modifications in order to derive a novel triage tool (LASSO M2). Using patients with complete pre-hospital physiological data, a comparative analysis was then performed comparing this to existing pre-hospital paediatric major incident triage tools. Performance was evaluated using sensitivity, specificity, under-triage (1-sensitivity) and over-triage (1-positive predictive value). Results Complete physiological data were available for 4962 patients. The LASSO M2 model demonstrated the best performance at identifying paediatric patients in need of life-saving intervention, sensitivity 88.8% (95% CI 85.5, 91.5) and was associated with the lowest rate of under-triage, 11.2% (8.5, 14.5). In contrast, the Paediatric Triage Tape and JumpSTART both had poor sensitivity when identifying those requiring life-saving intervention (36.1% (31.8, 40.7) and 44.7% (40.2, 49.4)) respectively. Conclusion The ML derived triage tool (LASSO M2) outperforms existing methods of paediatric major incident triage at identifying patients in need of life-saving intervention. Prior to its recommendation for clinical use, further work is required to externally validate its performance and undertake a feasibility assessment in a clinical context.

Relationship between the Injury Severity Score and the need for life-saving interventions in trauma patients in the UK

2020 ◽  
pp. emermed-2019-209092
Author(s):  
James Vassallo ◽  
Gordon Fuller ◽  
Jason E Smith
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Major Trauma ◽  
Injury Severity ◽  
Research Network ◽  
Trauma Patients ◽  
Traditional Definition ◽  
Life Saving ◽  
Clinically Significant ◽  
The Uk

IntroductionMajor trauma is the third leading cause of avoidable mortality in the UK. Defining which patients require care in a major trauma centre is a critical component of developing, evaluating and enhancing regional major trauma systems. Traditionally, trauma patients have been classified using the Injury Severity Score (ISS), but resource-based criteria have been proposed as an alternative. The aim of this study was to investigate the relationship between ISS and the use of life-saving interventions (LSI).MethodsRetrospective cohort study using the Trauma Audit Research Network database for all adult patients (aged ≥18 years) between 2006 and 2014. Patients were categorised as needing an LSI if they received one or more interventions from a previously defined list determined by expert consensus.Results193 290 patients met study inclusion criteria: 56.9% male, median age 60.0 years (IQR 41.2–78.8) and median ISS 9 (IQR 9–16). The most common mechanism of injury was falls <2 m (52.1%), followed by road traffic collisions (22.2%). 15.1% received one or more LSIs. The probability of a receiving an LSI increased with increasing ISS, but only a low to moderate correlation was evident (0.334, p<0.001). A clinically significant number of cases (5.3% and 7.6%) received an LSI despite having an ISS ≤8 or <15, respectively.ConclusionsA clinically significant number of adult trauma patients requiring LSIs have an ISS below the traditional definition of major trauma. The traditional definition should be reconsidered and either lowered, or an alternative metric should be used.

scholarly journals Counselling and support services for civil emergencies and major incidents

1997 ◽  
Vol 21 (8) ◽  
pp. 486-488
Author(s):  
Anne Nightingale ◽  
George Smith ◽  
David Scott
Keyword(s):  
Mental Health ◽  
Social Work ◽  
Health Services ◽  
Support Services ◽  
Emergency Planning ◽  
Psychological Help ◽  
Major Incident ◽  
Major Incidents ◽  
The Uk ◽  
Bus Accident

Across the UK counselling and support services are being developed as an extension of emergency planning for major incidents, with the aim of offering psychological help in the immediate aftermath of a disaster. In Strathclyde, Social Work and Mental Health Services Jointly established Liaison Teams with the task of planning and preparing for a major incident. We describe the response of a Liaison Team to a serious bus accident and present reflections from a psychodynamic perspective on some of the factors which may bear on planning and delivery of services.

scholarly journals Health Data Linkage for Public Interest Research in the UK: Key Obstacles and Solutions

2019 ◽  
Vol 4 (1) ◽  
Author(s):  
Miranda Jane Mourby ◽  
James Doidge ◽  
Kerina H Jones ◽  
Ruth Gilbert ◽  
Stergios Aidinlis ◽  
...  
Keyword(s):  
Data Linkage ◽  
Health Data ◽  
Research Network ◽  
High Profile ◽  
Life Saving ◽  
Single Solution ◽  
Share Data ◽  
Key Issues ◽  
Set Up ◽  
The Uk

IntroductionAnalysis of linked health data can generate important, even life-saving, insights into population health. Yet obstacles both legal and organisational in nature can impede this work. ApproachWe focus on three UK infrastructures set up to link and share data for research: the Administrative Data Research Network, NHS Digital, and the Secure Anonymised Information Linkage Databank. Bringing an interdisciplinary perspective, we identify key issues underpinning their challenges and successes in linking health data for research. ResultsWe identify examples of uncertainty surrounding legal powers to share and link data, and around data protection obligations, as well as systemic delays and historic public backlash. These issues require updated official guidance on the relevant law, approaches to linkage which are planned for impact and ongoing utility, greater transparency between data providers and researchers, and engagement with the patient population which is both high-profile and carefully considered. ConclusionsHealth data linkage for research presents varied challenges, to which there can be no single solution. Our recommendations would require action from a number of data providers and regulators to be meaningfully advanced. This illustrates the scale and complexity of the challenge of health data linkage, in the UK and beyond: a challenge which our case studies suggest no single organisation can combat alone. Planned programmes of linkage are critical because they allow time for organisations to address these challenges without adversely affecting the feasibility of individual research projects.

Improving Agent-Based Simulation of Major Incident Response in the United Kingdom through Conceptual and Operational Validation

2015 ◽  
Vol 7 (4) ◽  
pp. 1-25
Author(s):  
Glenn I. Hawe ◽  
Graham Coates ◽  
Duncan T. Wilson ◽  
Roger S. Crouch
Keyword(s):  
United Kingdom ◽  
Emergency Preparedness ◽  
Emergency Services ◽  
Major Incident ◽  
Agent Based ◽  
The United Kingdom ◽  
Major Incidents ◽  
Operational Validation ◽  
The Uk

The aim of this paper is to report on how the credibility of an agent-based model (ABM) of the United Kingdom emergency services' response to major incidents has been improved through a process of conceptual validation, and how the ABM's software implementation has been improved through a process of operational validation. Validating the authors' ABM and its implementation contributes towards the long term goal of agent-based modelling and simulation being accepted by emergency planning officers as a means of performing emergency exercises thus playing a useful role in emergency preparedness. Both conceptual and operational validation led to the identification of potential improvements, which when implemented resulted in the authors' ABM software simulating the response to major incidents in the UK more realistically than was possible previously.

Changes in NHS Major Incident management and their relevance to the Defence Medical Services

2018 ◽  
Vol 166 (2) ◽  
pp. 84-88 ◽  
Author(s):  
Ian Gurney ◽  
S Horne ◽  
C Wright
Keyword(s):  
Emergency Services ◽  
Medical Personnel ◽  
Medical Services ◽  
Major Incident ◽  
Incident Management ◽  
Incident Response ◽  
Resource Limited ◽  
Major Incidents ◽  
The Face ◽  
The Uk

High-profile Major Incidents in the UK civilian setting in the last few years have appropriately raised awareness of the principles and frameworks involved in the design of reliable response systems. The introduction of the Joint Emergency Services Interoperability Principles in tandem with increased investment in Major Incident Planning has supported practitioners to successfully respond to high numbers of incidents.Defence Medical Services personnel are increasingly being asked to deploy to resource-limited 'contingency' settings where much of the established guidance relating to Major Incident response requires reconsideration and modification in the face of severely constrained space, manpower and equipment.This editorial seeks to review contemporary theories and principles of Major Incident response and discuss how military medical personnel may need to adapt these to address the various Major Incident challenges that they may face on operations.

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