Norwegian Air Ambulance Foundation, Drøbak, Norway.
BMC Emerg Med. 2010 Aug 11;10:17. doi: 10.1186/1471-227X-10-17.
Efficient management of major incidents involves triage, treatment and transport. In the absence of a standardised interdisciplinary major incident management approach, the Norwegian Air Ambulance Foundation developed Interdisciplinary Emergency Service Cooperation Course (TAS). The TAS-program was established in 1998 and by 2009, approximately 15 500 emergency service professionals have participated in one of more than 500 no-cost courses. The TAS-triage concept is based on the established triage Sieve and Paediatric Triage Tape models but modified with slap-wrap reflective triage tags and paediatric triage stretchers. We evaluated the feasibility and accuracy of the TAS-triage concept in full-scale simulated major incidents.
The learners participated in two standardised bus crash simulations: without and with competence of TAS-triage and access to TAS-triage equipment. The instructors calculated triage accuracy and measured time consumption while the learners participated in a self-reported before-after study. Each question was scored on a 7-point Likert scale with points labelled "Did not work" (1) through "Worked excellent" (7).
Among the 93 (85%) participating emergency service professionals, 48% confirmed the existence of a major incident triage system in their service, whereas 27% had access to triage tags. The simulations without TAS-triage resulted in a mean over- and undertriage of 12%. When TAS-Triage was used, no mistriage was found. The average time from "scene secured to all patients triaged" was 22 minutes (range 15-32) without TAS-triage vs. 10 minutes (range 5-21) with TAS-triage. The participants replied to "How did interdisciplinary cooperation of triage work?" with mean 4,9 (95% CI 4,7-5,2) before the course vs. mean 5,8 (95% CI 5,6-6,0) after the course, p < 0,001.
Our modified triage Sieve tool is feasible, time-efficient and accurate in allocating priority during simulated bus accidents and may serve as a candidate for a future national standard for major incident triage.
有效的重大事故管理包括分诊、治疗和转运。由于缺乏标准化的跨学科重大事故管理方法，挪威空中急救基金会开发了跨学科紧急服务合作课程（TAS）。该 TAS 计划于 1998 年成立，截至 2009 年，已有约 15500 名紧急服务专业人员参加了 500 多场免费课程。TAS 分诊概念基于已建立的分诊筛检和儿科分诊带模型，但经过修改，采用了拍打式反射分诊标签和儿科分诊担架。我们评估了 TAS 分诊概念在全面模拟重大事故中的可行性和准确性。
学习者参加了两次标准化的公共汽车碰撞模拟：无 TAS 分诊和有 TAS 分诊及 TAS 分诊设备。在学习者进行自我报告的前后研究的同时，指导员计算分诊准确性并测量时间消耗。每个问题都在 7 点李克特量表上进行评分，分数标记为“不起作用”（1）到“效果极好”（7）。
在 93 名（85%）参与的紧急服务专业人员中，48%的人确认他们的服务中存在重大事件分诊系统，而 27%的人可以使用分诊标签。没有 TAS 分诊的模拟导致平均分诊过度和不足为 12%。当使用 TAS-Triage 时，未发现分诊错误。从“现场安全到所有患者分诊”的平均时间为 22 分钟（范围 15-32），没有 TAS-Triage 与 10 分钟（范围 5-21），有 TAS-Triage。参与者在课程前回答“分诊的跨学科合作如何运作？”平均得分为 4.9（95%CI 4.7-5.2），而在课程后平均得分为 5.8（95%CI 5.6-6.0），p<0.001。
我们修改的分诊筛检工具在模拟公共汽车事故中分配优先级是可行的、高效的和准确的，可能成为未来重大事故分诊的国家标准候选。
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