Improving Triage Accuracy in First Responders: Measurement of Short Structured Protocols to Improve Identification of Salient Triage Features

• Author: Sarah Loth,Nina Shaafi Kabiri,Kevin Thomas,Jaspreet S. Bhangu,Mark Moss,Alanna C. Cote,Ann Zumwalt
• Date: 01 June 2019
• Published date: 01 June 2019
• DOI: http://doi.org/10.1002/wmh3.306

163

doi: 10.1002/wmh3.306

© 2019 Policy Studies Organization

Improving Triage Accuracy in First Responders:

Measurement of Short Structured Protocols to Improve

Identification of Salient Triage Features

Sarah Loth, Alanna C. Cote, Nina Shaafi Kabiri , Jaspreet S. Bhangu ,

Ann Zumwalt, Mark Moss, and Kevin Thomas

Gaze tracking is used in biomedical teaching for situations requiring the assessment of complex visual

data. We employed gaze tracking techniques to examine an adapted training protocol using simple

triage and rapid treatment (START)triage principles. This study utilized a case‐control design. Both

groups were presented with a series of computer images, each corresponding to four levels of injury

severity. Subsequently, the experimental group underwent training using the START triage program

while the control group underwent training regarding patient transportation. Participants who

underwent training with the START protocol fixated upon salient features significantly earlier post‐

training as evidenced by decreased post‐training entry time (ms). 1376.35 (1665.69)(p=.02, 95%

confidence interval [CI] [318.02–2434.68]); circulation: 1986.57 (2268.38)(p=.01, 95% CI

[545.31–3427.84]). Those who underwent training only on patient transport and not on the adapted

START triage protocol demonstrated no statistically significant between‐session gaze measure-

ment. Subjects who underwent START triage training significantly improved in their first fixation

entry time, indicating a faster recognition of salient triage features. We have shown the effectiveness of

a short, directed triage training tool in improving the recognition of triage features.

KEY WORDS: triage, training, education, mass casuality incident

Background

A mass casualty incident (MCI)was defined in 2007 by the World Health

Organization (2007)as “an event that generates more patients at one time than

locally available resources can manage using routine procedures.”Triage involves

evaluating, sorting, and prioritizing victims based on the extent of injury and

survival probability (Andreatta et al., 2010; Frykberg & Schecter, 2013). To ensure

efficient and successful treatment of victims during an MCI, triage training for first

responders is essential (Lerner et al., 2008). As the nature of an actual mass casualty

event differs with each situation, a simple and easy‐to‐follow triage training tool is

needed to ensure adequate and efficient training.

The simple triage and rapid treatment (START)triage program has been used

by first responders since 1983 (Jenkins et al., 2008). It is one of over 20 triage