Lee Christopher W C, McLeod Shelley L, Van Aarsen Kristine, Klingel Michelle, Franc Jeffrey M, Peddle Michael B
1Division of Emergency Medicine,Department of Medicine,Schulich School of Medicine and Dentistry,Western University,London,Ontario,Canada.
2Department of Emergency Medicine, Faculty of Medicine and Dentistry,University of Alberta,Edmonton,Alberta,Canada.
Prehosp Disaster Med. 2016 Apr;31(2):150-4. doi: 10.1017/S1049023X16000091. Epub 2016 Feb 9.
During mass-casualty incidents (MCIs), patient volume often overwhelms available Emergency Medical Services (EMS) personnel. First responders are expected to triage, treat, and transport patients in a timely fashion. If other responders could triage accurately, prehospital EMS resources could be focused more directly on patients that require immediate medical attention and transport.
Triage accuracy, error patterns, and time to triage completion are similar between second-year primary care paramedic (PCP) and fire science (FS) students participating in a simulated MCI using the Sort, Assess, Life-saving interventions, Treatment/Transport (SALT) triage algorithm.
All students in the second-year PCP program and FS program at two separate community colleges were invited to participate in this study. Immediately following a 30-minute didactic session on SALT, participants were given a standardized briefing and asked to triage an eight-victim, mock MCI using SALT. The scenario consisted of a four-car motor vehicle collision with each victim portrayed by volunteer actors given appropriate moulage and symptom coaching for their pattern of injury. The total number and acuity of victims were unknown to participants prior to arrival to the mock scenario.
Thirty-eight PCP and 29 FS students completed the simulation. Overall triage accuracy was 79.9% for PCP and 72.0% for FS (∆ 7.9%; 95% CI, 1.2-14.7) students. No significant difference was found between the groups regarding types of triage errors. Over-triage, under-triage, and critical errors occurred in 10.2%, 7.6%, and 2.3% of PCP triage assignments, respectively. Fire science students had a similar pattern with 15.2% over-triaged, 8.7% under-triaged, and 4.3% critical errors. The median [IQR] time to triage completion for PCPs and FSs were 142.1 [52.6] seconds and 159.0 [40.5] seconds, respectively (P=.19; Mann-Whitney Test).
Primary care paramedics performed MCI triage more accurately than FS students after brief SALT training, but no difference was found regarding types of error or time to triage completion. The clinical importance of this difference in triage accuracy likely is minimal, suggesting that fire services personnel could be considered for MCI triage depending on the availability of prehospital medical resources and appropriate training.
在大规模伤亡事件（MCI）中，患者数量常常会超出可用的紧急医疗服务（EMS）人员的应对能力。急救人员需要及时对患者进行分诊、治疗和转运。如果其他响应人员能够准确分诊，那么院前EMS资源就能更直接地集中于需要立即医疗护理和转运的患者身上。
在使用分类、评估、救生干预、治疗/转运（SALT）分诊算法参与模拟MCI的二年级初级护理护理人员（PCP）和消防科学（FS）专业学生之间，分诊准确性、错误模式和分诊完成时间相似。
邀请了两所不同社区学院的二年级PCP课程和FS课程的所有学生参与本研究。在进行了30分钟关于SALT的理论课程后，立即对参与者进行标准化简报，并要求他们使用SALT对一场有八名受害者的模拟MCI进行分诊。场景设定为一起四车机动车碰撞事故，每名受害者由志愿演员扮演，并针对其受伤模式给予适当的外伤模拟和症状指导。在参与者到达模拟场景之前，他们不知道受害者的总数和严重程度。
38名PCP学生和29名FS学生完成了模拟。PCP学生的总体分诊准确率为79.9%，FS学生为72.0%（差值7.9%；95%置信区间，1.2 - 14.7）。两组在分诊错误类型方面未发现显著差异。PCP分诊任务中过度分诊、分诊不足和严重错误分别发生在10.2%、7.6%和2.3%的案例中。消防科学专业学生有类似模式，过度分诊为15.2%，分诊不足为8.7%，严重错误为4.3%。PCP学生和FS学生分诊完成的中位时间[四分位间距]分别为142.1[52.6]秒和159.0[40.5]秒（P = 0.19；曼 - 惠特尼检验）。
经过简短的SALT培训后，初级护理护理人员在MCI分诊方面比FS专业学生表现得更准确，但在错误类型或分诊完成时间方面未发现差异。这种分诊准确性差异的临床重要性可能很小，这表明根据院前医疗资源的可用性和适当培训情况，消防人员也可考虑参与MCI分诊。
