Claudius Ilene, Kaji Amy H, Santillanes Genevieve, Cicero Mark X, Donofrio J Joelle, Gausche-Hill Marianne, Srinivasan Saranya, Chang Todd P
1Department of Emergency Medicine,Keck School of Medicine,University of Southern California,Los Angeles,CaliforniaUSA.
2Department of Emergency Medicine,Harbor-University of California Los Angeles Medical Center,Los Angeles,CaliforniaUSA.
Prehosp Disaster Med. 2015 Oct;30(5):457-60. doi: 10.1017/S1049023X15005002. Epub 2015 Sep 1.
Using the pediatric version of the Simple Triage and Rapid Treatment (JumpSTART) algorithm for the triage of pediatric patients in a mass-casualty incident (MCI) requires assessing the results of each step and determining whether to move to the next appropriate action. Inappropriate application can lead to performance of unnecessary actions or failure to perform necessary actions. Hypothesis/Problem To report overall accuracy and time required for triage, and to assess if the performance of unnecessary steps, or failure to perform required steps, in the triage algorithm was associated with inaccuracy of triage designation or increased time to reach a triage decision.
Medical students participated in an MCI drill in which they triaged both live actors portraying patients and computer-based simulated patients to the four triage levels: minor, delayed, immediate, and expectant. Their performance was timed and compared to intended triage designations and a priori determined critical actions.
Thirty-three students completed 363 scenarios. The overall accuracy was 85.7% and overall mean time to assign a triage designation was 70.4 seconds, with decreasing times as triage acuity level decreased. In over one-half of cases, the student omitted at least one action and/or performed at least one action that was not required. Each unnecessary action increased time to triage by a mean of 8.4 seconds and each omitted action increased time to triage by a mean of 5.5 seconds. Discussion Increasing triage level, performance of inappropriate actions, and omission of recommended actions were all associated with increasing time to perform triage.
在大规模伤亡事件（MCI）中使用儿童简易分诊与快速治疗（JumpSTART）算法对儿科患者进行分诊时，需要评估每个步骤的结果，并确定是否采取下一步适当行动。应用不当可能导致执行不必要的操作或未能执行必要的操作。假设/问题 报告分诊的总体准确性和所需时间，并评估分诊算法中不必要步骤的执行情况或所需步骤的遗漏是否与分诊指定的不准确或做出分诊决定的时间增加有关。
医学生参加了一次MCI演练，他们将扮演患者的现场演员和基于计算机模拟的患者分诊到四个分诊级别：轻伤、延迟治疗、立即治疗和期待治疗。对他们的表现进行计时，并与预期的分诊指定和预先确定的关键行动进行比较。
33名学生完成了363个场景演练。总体准确率为85.7%，做出分诊指定的总体平均时间为70.4秒，随着分诊 acuity 水平的降低，时间逐渐减少。在超过一半的案例中，学生至少遗漏了一项行动和/或执行了至少一项不需要的行动。每项不必要行动使分诊时间平均增加8.4秒，每项遗漏行动使分诊时间平均增加5.5秒。讨论 分诊级别提高、不当行动的执行以及推荐行动的遗漏均与分诊执行时间增加有关
