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Medical Management of Chemical Warfare Agents
Published in Brian J. Lukey, James A. Romano, Salem Harry, Chemical Warfare Agents, 2019
Triage may also employ the “START triage” system, which assesses respiratory, circulatory, and neurological status to determine the need for immediate treatment. This technique is simple, requires a minimum of time, and yet is a highly effective and reproducible triage evaluation method (Benson et al., 1996; Super, 1994). Please refer to Figure 30.1.
Virtual Reality Triage Training Can Provide Comparable Simulation Efficacy for Paramedicine Students Compared to Live Simulation-Based Scenarios
Published in Prehospital Emergency Care, 2020
Brennen Mills, Peggy Dykstra, Sara Hansen, Alecka Miles, Tim Rankin, Luke Hopper, Luke Brook, Danielle Bartlett
Learning objectives focused on the user’s ability to make decisions for fast and effective triage of patients. The scenario itself opened at the aftermath of an incident resulting from a car chase between a perpetrator and police. The car chase ended with the vehicle crashing into pedestrians and the perpetrator shooting one police officer, two pedestrians and then himself, resulting in multiple casualties with varying injuries. Participants were tasked with triaging all ten patients. The triage method utilized was based on the Simple Triage and Rapid Treatment (START) adult triage algorithm (20). Since the development of the START triage method in the 1980’s, it has been adopted by pre-hospital trauma life support education providers, health care systems and ambulance service providers all over the world (21). Patient profiles with corresponding vitals provided to participants can be seen in Table 1.
Comparing the Accuracy of Mass Casualty Triage Systems When Used in an Adult Population
Published in Prehospital Emergency Care, 2020
Courtney H. McKee, Robert W. Heffernan, Brian D. Willenbring, Richard B. Schwartz, J. Marc Liu, M. Riccardo Colella, E. Brooke Lerner
To truly compare the accuracy of mass casualty triage systems, patient outcomes should be considered using a metric that is accepted and standardized across investigators. Recently, a nationally representative, multi-disciplinary panel of experts developed a consensus definition for each triage category using a modified Delphi method as a way to determine the accuracy of mass casualty triage systems (19). This criterion standard defines the “correct” triage category for a patient when the patient’s complete outcome is known. This criterion standard definition has previously been piloted in a pediatric emergency department-based population (20). The objective of this study was to use this previously published criterion standard to compare the accuracy of 4 different mass casualty triage systems (Sort, Assess, Lifesaving Interventions, Treatment/Transport [SALT], Simple Triage and Rapid Treatment [START], Triage Sieve, and CareFlight) when used in an emergency department-based adult population.
Challenges of Burn Mass Casualty Incidents in the Prehospital Setting: Lessons From the Formosa Fun Coast Park Color Party
Published in Prehospital Emergency Care, 2019
Chien-Hao Lin, Chih-Hao Lin, Chih-Yi Tai, Yu-You Lin, Frank Fuh-Yuan Shih
First, current triage protocols could be insufficient in BMCIs. In the initial response phase, the EMTs adopted the Simple triage and rapid treatment (START) triage protocol (8), which is developed for primary triage in MCIs. However, the triage results were found to be misleading. In this incident, some of the patients with inhalation injuries deteriorated rapidly and subsequently required endotracheal intubation. These patients might not have initially presented with tachypnea, and thus, were prone to be under-triaged using the START protocol. These patients quickly developed airway obstruction and hypoxia while waiting for transportation. EMTs in Taiwan are only allowed to intubate patients who have experienced out-of-hospital cardiac arrests and are undergoing resuscitation efforts. Thus, frequent reassessment for the presence of airway injuries and signs of difficult respiration were crucial for prioritizing hospital transfer. Estimating the sizes of burns by measuring the total body surface area (TBSA) and determining the severity in the field were difficult in a dark environment, especially in the absence of adequate pain control for patients. In order to evaluate the burn size at the scene, it was necessary to remove clothing around the burn-affected areas. However, this proved to be time-consuming and was refused by many patients due to gender and cultural concerns. We suggest that evaluation of inhalation injury should be incorporated into current triage procedures of burn victims in future BMCIs.