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.

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 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 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.

How a major incident plan can be used in an acute healthcare setting

2018 ◽  
Vol 166 (1) ◽  
pp. 17-20 ◽  
Author(s):  
Seth Makin ◽  
L Smith ◽  
K McDevitt
Keyword(s):  
Emergency Preparedness ◽  
Healthcare Setting ◽  
Healthcare Services ◽  
The Body ◽  
Major Incident ◽  
Diverse Range ◽  
Major Incidents ◽  
Infrastructure Failure ◽  
Key Aspects ◽  
Acute Healthcare

All NHS Trusts face a diverse range of potential threats and disruptions that can overwhelm the delivery of their routine healthcare services. Major incidents range from significant infrastructure failure to responding to significant casualty numbers from natural disasters and malicious incidents. Major incident plans are one of the body of documents that support trusts and in this instance acute NHS trusts in emergency preparedness. Major incident plans can be used as a reference point for staff of all disciplines, that is, clinical and non-clinical. Major incident plans incorporate the requirements of the Civil Contingencies Act 2004 for NHS-funded providers to ensure trusts conduct risk assessments, emergency planning, cooperating with other organisations, and internal and external communication. This paper summarises some of the key aspects in the construction and the use of major incident plans in acute care trusts.

scholarly journals A Surprise Mass Casualty Incident Simulation: Does It Improve Knowledge or Is It Just a Bit of Fun?

2019 ◽  
Vol 34 (s1) ◽  
pp. s18-s19
Author(s):  
Brad Mitchell ◽  
Karen Hammad ◽  
Dana Aldwin
Keyword(s):  
Emergency Department ◽  
Low Cost ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Major Incident ◽  
Likert Scales ◽  
The Past ◽  
Emergency Department Nurses ◽  
Major Incidents ◽  
Simulation Scenario

Introduction:We opened a national conference in Australia with a surprise mass casualty simulation scenario of a van versus multiple persons outside the conference venue. The purpose of this exercise was to increase awareness of, and preparation for, mass casualty incident (MCI) events for the conference delegates who were paramedics, emergency department nurses, and doctors.Aim:The aim of the research is to understand whether a surprise MCI simulation is a useful way to increase knowledge and motivate preparedness.Methods:A survey hosted on Qualtrics was circulated to delegates via email. The survey was designed by the research team and had 38 questions about demographics and respondents’ experience with MCIs, as well as their perceptions of the simulation exercise. The questions were a mixture of 5-point Likert scales, multiple choice, and short answers.Results:The majority of respondents were clinicians (n = 66, 76%) and those who worked in emergency departments or the prehospital setting (n = 75, 86%). While the majority had not responded to an MCI in the past 5 years (n = 67, 77%), more than half (n = 50, 57%) had undertaken MCI training during this time. Overall, a vast majority of respondents found the simulation to be a worthwhile exercise that increased knowledge and preparedness. An overwhelming majority also reported that the simulation was relevant to practice, of high quality, and a useful way to teach about major incidents.Discussion:Our surprise major incident simulation was a fun and effective way to raise awareness and increase knowledge in prehospital and emergency department clinicians about MCI response. This approach to simulation can be easily replicated at relatively low cost and is, therefore, a useful solution to training a group of multidisciplinary health professionals outside of the workplace.

Course in Prehospital Major Incidents Management for Health Care Providers in Saudi Arabia

2018 ◽  
Vol 33 (6) ◽  
pp. 587-595 ◽  
Author(s):  
Nidaa A. Bajow ◽  
Wajdan I. AlAssaf ◽  
Ameera A. Cluntun
Keyword(s):  
Health Care ◽  
Saudi Arabia ◽  
Health Care Providers ◽  
Core Competencies ◽  
Wilcoxon Test ◽  
Major Incident ◽  
Incident Management ◽  
Care Providers ◽  
Post Test ◽  
Major Incidents

AbstractIntroductionUnacceptable practices of health care providers during disasters have been observed because they work outside the scope of their daily practices and have inadequate training. A greater need for the involvement of health professionals in disaster management has been noted in Saudi Arabia. This study evaluates the efficacy of a training course in prehospital major incident management for health care providers in Saudi Arabia.MethodsAn interactive course for general principles in prehospital major incident management was developed with domains and core competencies. The course was designed according to the local context and was based on international standards. It was piloted over four days at the Officers Club of the Ministry of Interior (Riyadh, Saudi Arabia) and was sponsored by Mohammed Bin Naif Medical Center, King Fahd Security College in Riyadh, Saudi Arabia. The participants (n=29) were from different disciplines from main government health facilities in Riyadh. They completed a pre-test and a post-test.ResultsThe overall score was 55.1% on the pre-test and 68.4% on the post-test (Wilcoxon test for paired samples, P <.05). Three out of the four domains had significant difference between pre- and post-test results, as well as the overall total knowledge.Conclusion:Conducting inter-disciplinary and competency-based disaster medicine courses for health care providers can augment appropriate disaster preparedness for major incidents in Saudi Arabia.BajowNA,AlAssafWI,CluntunAA.Course in prehospital major incidents management for health care providers in Saudi Arabia.Prehosp Disaster Med.2018;33(6):587–595.

An Introduction to Major Incident Management

2017 ◽  
Author(s):  
Ian Greaves ◽  
Paul Hunt
Keyword(s):  
Emergency Services ◽  
Major Incident ◽  
Incident Management ◽  
Roles And Responsibilities ◽  
Communication Assessment ◽  
Major Incidents ◽  
And Control ◽  
Structured Approach ◽  
Mass Fatalities

Chapter 1 covers information on what a major incident is, definitions and classifications including chemical, biological, radiological and nuclear (CBRN), special arrangements, historical and recent major incidents, mass fatalities, the Civil Contingencies Act 2004, nomenclature, and the Joint Emergency Services Inter-operability Programme (JESIP). The phases and objectives of a response to a major incident are described. This chapter also outlines the generic structured approach including command and control, safety (including zones and cordons), communication, assessment, triage and categorization systems, casualty treatment, roles and responsibilities, and casualty transportation.

scholarly journals Alternative Leadership in Flexible Surge Capacity—The Perceived Impact of Tabletop Simulation Exercises on Thai Emergency Physicians Capability to Manage a Major Incident

2020 ◽  
Vol 12 (15) ◽  
pp. 6216 ◽  
Author(s):  
Phatthranit Phattharapornjaroen ◽  
Viktor Glantz ◽  
Eric Carlström ◽  
Lina Dahlén Holmqvist ◽  
Amir Khorram-Manesh
Keyword(s):  
Emergency Management ◽  
Major Incident ◽  
Emergency Physicians ◽  
Surge Capacity ◽  
Incident Command ◽  
Perceived Ability ◽  
Major Incidents ◽  
Knowledge And Attitude ◽  
And Control ◽  
Simulation Exercises

Flexible surge capacity aims to activate and utilize other resources than normally are surged in a community during the primary and secondary surge capacity. The presence of alternative leadership, skilled and knowledgeable in hospital and prehospital emergency management, is invaluable. Thai emergency physicians work at both levels, emphasizing their important role in emergency management of any source in a disaster-prone country. We aimed to investigate Thai emergency physicians’ ability in terms of knowledge and preparedness to manage potential emergencies using tabletop simulation exercises. Using an established method for training collaboration, two training courses were arranged for over 50 Thai emergency physicians, who were divided into three teams of prehospital, hospital, and incident command groups. Three scenarios of a terror attack along with a bomb explosion, riot, and shooting, and high building fire were presented, and the participants’ performance was evaluated regarding their preparedness, response and gained knowledge. Two senior observers followed the leadership characteristic in particular. Thai physicians’ perceived ability in command and control, communication, collaboration, coordination, and situation assessment improved in all groups systematically. New perspectives and innovative measures were presented by participants, which improved the overall management on the final day. Tabletop simulation exercise increased the perceived ability, knowledge, and attitude of Thai emergency physicians in managing major incidents and disasters. It also enabled them to lead emergency management in a situation when alternative leadership is a necessity as part of the concept of a flexible surge capacity response system.

Major Incident Experience and Preparedness in a Developing Country

2013 ◽  
Vol 7 (3) ◽  
pp. 313-318 ◽  
Author(s):  
Hesam Seyedin ◽  
Rouhollah Zaboli ◽  
Hamid Ravaghi
Keyword(s):  
Public Health ◽  
Positive Impact ◽  
Lessons Learned ◽  
Major Incident ◽  
Incident Management ◽  
Semistructured Interview ◽  
Framework Analysis ◽  
Health Organizations ◽  
Research Software ◽  
Major Incidents

AbstractBackgroundResearch shows that having previous experience of major incidents has a positive impact on awareness and preparedness of organizations. We investigated the effects of major incident experience on preparedness of health organizations on future disasters in Iran.MethodsA qualitative study using a semistructured interview technique was conducted with 65 public health and therapeutic affairs managers. Analysis of the data was performed used the framework analysis technique, which was supported by qualitative research software.ResultsThe study found that prior experience of major incidents results in better performance, coordination, and cooperation in response to future events. There was a positive effect on policy making and resource distribution and an increase in (1) preparedness activities, (2) raising population awareness, and (3) improving knowledge. However, the preparedness actions were predominantly individual-dependent.ConclusionsOur findings showed that to increase system efficiency and effectiveness within health organizations, an appropriate major incident management system is needed. The new system can use lessons learned from previous major incidents to better equip health organizations to cope with similar events in the future. (Disaster Med Public Health Preparedness. 2013;7:313-318)

Templates for handling multi-agency collaboration activities and priorities in mining injury incidents: a Delphi study

2020 ◽  
Vol 9 (3) ◽  
pp. 257-271
Author(s):  
Lina Gyllencreutz ◽  
Monica Rådestad ◽  
Britt-Inger Saveman
Keyword(s):  
Delphi Study ◽  
Research Field ◽  
Content Type ◽  
Control Center ◽  
Rescue Service ◽  
Life Saving ◽  
Major Incidents ◽  
And Control ◽  
Agency Management ◽  
Group Opinion

PurposeThe purpose of this study was from a Swedish perspective to map experts' opinions on theoretical statements of essential collaboration activities for management of mining injury incidents.Design/methodology/approachA Delphi technique was performed, asking opinions from experts in iterative rounds to generate understanding and form consensus on group opinion around multi-agency management. The experts were personnel from emergency medical service, rescue service and mine industry, all with operative command positions.FindingsThree iterative rounds were performed. The first round was conducted as a workshop to collect opinions about the most important multi-agency collaboration activities to optimize victim's outcome from an injury incident in an underground mine. This resulted in 63 statements and additional three were added during the second round. The statements were divided into one trajectory and seventh time phases and comprised, e.g. early alarm routines, support of early life-saving interventions, relevant resources and equipment for the assignment and command and control center and functions with predefined action plans for response. It also comprised shared and communicated decisions about each agency's responsibility and safety. All statements reached consensus among the experts in Round 3.Research limitations/implicationsThe experts included in this study seem to be adequate but there could be other experts and different statements that other researchers might consider.Practical implicationsThese statements could be used to evaluate collaboration in major incidents exercises. The statements can also be quality indicators for reporting results from multi-agency management.Originality/valueThis paper contributes to the research field of collaboration and joint practices between and among personnel involved in rescue operations.

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