George Washington University, Washington, DC, USA.
Prehosp Disaster Med. 2010 May-Jun;25(3):227-36. doi: 10.1017/s1049023x00008086.
Simple Triage and Rapid Treatment (START) and more recently developed prehospital casualty triage algorithms are widely used, in part because they are easy to teach and learn, and can be performed rapidly. Every rapid triage protocol has inherent, significant limitations: (1) no mechanism of injury (MOI) considerations; (2) limited assessment points; and (3) no refinement in truly mass-casualty situations where transport of "minor" or "moderate" patients may be delayed.
When rapid initial triage protocols are utilized, a significant triage deficiency ("under-triage") may occur when "minor" or "moderate" casualties actually are more severely injured than initially triaged. Some MOI produce casualties with subtle or latent (i.e., hidden or delayed) signs and symptoms not considered in the commonly used prehospital triage algorithms. This research did not focus on START or other initial triage screening methods. Instead, it focuses on developing follow-on triage guidance to more specifically prioritize "delayed transport" casualties based upon signs and symptoms related to their MOI.
Using expert opinion and accepted clinical criteria, triage algorithms were developed to re-evaluate patients triaged to "minor" and "moderate" cohorts. A detailed literature search produced a draft list of relevant signs and symptoms for each selected MOI. The lists then were evaluated by a multi-disciplinary panel of experts via an anonymous, mail-based Delphi method. The input shaped triage algorithms for each selected MOI, which then were subjected to a second stage Delphi process.
Consensus was achieved using the Delphi method. The algorithms extend patient assessment beyond the rapid initial triage protocols and incorporate triage criteria specific to each selected injury mechanism or condition: (1) penetrating injuries; (2) unconventional MOI (burns, blast, chemical, radiation); (3) smoke and other inhalation exposure; and (4) injuries with concomitant pregnancy. The full list of triage protocols is designated by the acronym "-PLUS".
"-PLUS" Prehospital Casualty Triage may supplement the strengths of already existing, widely accepted mass-casualty triage strategies. It does not displace START or other rapid initial triage protocols, but in mass-casualty situations with extensive delays in transport, it provides a method to identify under-triage of seriously injured casualties. "-PLUS" also presents a framework for capturing the triage considerations used by experienced medical providers, and so may provide a valuable teaching tool for training future triage professionals. Further research and field assessment is required.
简单分类和快速治疗（START）以及最近开发的院前伤亡分类算法被广泛应用，部分原因是它们易于教授和学习，并且可以快速执行。每个快速分类协议都存在固有且显著的局限性：（1）没有考虑到损伤机制（MOI）；（2）评估点有限；（3）在真正的大规模伤亡情况下无法细化，在这种情况下，对“轻度”或“中度”患者的转运可能会延迟。
当使用快速初步分类方案时，如果“轻度”或“中度”伤员实际上比最初分类的伤势更严重，可能会出现严重的分类不足（“分诊不足”）。某些 MOI 会导致伤员出现细微或潜伏（即隐藏或延迟）的体征和症状，这些症状和体征在常用的院前分类算法中没有考虑到。本研究并未关注 START 或其他初步分诊筛查方法。相反，它专注于开发后续分诊指导，以便根据与 MOI 相关的体征和症状，更具体地对“延迟转运”伤员进行优先级排序。
使用专家意见和公认的临床标准，开发了分类算法以重新评估分类为“轻度”和“中度”的患者。通过详细的文献搜索，为每个选定的 MOI 生成了一份相关体征和症状的草案清单。然后，由多学科专家小组通过匿名邮件德尔菲法进行评估。输入塑造了针对每个选定的损伤机制或状况的分类算法，然后对这些算法进行第二阶段德尔菲法评估。
通过德尔菲法达成了共识。这些算法将患者评估扩展到快速初步分诊方案之外，并纳入了针对每个选定的损伤机制的特定分诊标准：（1）穿透性损伤；（2）非常规 MOI（烧伤、爆炸、化学、辐射）；（3）烟雾和其他吸入暴露；（4）伴有妊娠的损伤。完整的分诊方案列表由缩写“-PLUS”表示。
“-PLUS”院前伤员分类可能会补充现有的、广泛接受的大规模伤亡分类策略的优势。它不会取代 START 或其他快速初步分诊方案，但在转运严重延误的大规模伤亡情况下，它提供了一种识别严重受伤伤员分诊不足的方法。“-PLUS”还为捕捉经验丰富的医疗提供者使用的分诊考虑因素提供了一个框架，因此可能成为培训未来分诊专业人员的有价值的教学工具。需要进一步的研究和现场评估。
