Rådestad Monica, Lennquist Montán Kristina, Rüter Anders, Castrén Maaret, Svensson Leif, Gryth Dan, Fossum Bjöörn
1Karolinska Institutet,Department of Clinical Science and Education,Södersjukhuset,Stockholm,Sweden.
2University of Gothenburg,Institute of Clinical Science,Department of Surgery,Gothenburg,Sweden.
Prehosp Disaster Med. 2016 Aug;31(4):376-85. doi: 10.1017/S1049023X16000480. Epub 2016 May 23.
Introduction Disaster triage is the allocation of limited medical resources in order to optimize patient outcome. There are several studies showing the poor use of triage tagging, but there are few studies that have investigated the reasons behind this. The aim of this study was to explore ambulance personnel attitude towards, and experiences of, practicing triage tagging during day-to-day management of trauma patients, as well as in major incidents (MIs).
A mixed method design was used. The first part of the study was in the form of a web-survey of attitudes answered by ambulance personnel. The question explored was: Is it likely that systems that are not used in everyday practice will be used during MIs? Two identical web-based surveys were conducted, before and after implementing a new strategy for triage tagging. This strategy consisted of a time-limited triage routine where ambulance services assigned triage category and applied triage tags in day-to-day trauma incidents in order to improve field triage. The second part comprised three focus group interviews (FGIs) in order to provide a deeper insight into the attitudes towards, and experience of, the use of triage tags. Data were analyzed using qualitative content analysis.
The overall finding was the need for daily routine when failure in practice. Analysis of the web-survey revealed three changes: ambulance personnel were more prone to use tags in minor accidents, the sort scoring system was considered to be more valuable, but it also was more time consuming after the intervention. In the analysis of FGIs, four categories emerged that describe the construction of the overall category: perceived usability, daily routine, documentation, and need for organizational strategies.
Triage is part of the foundation of ambulance skills, but even so, ambulance personnel seldom use this in routine practice. They fully understand the benefit of accurate triage decisions, and also that the use of a triage algorithm and color coded tags is intended to make it easier and more secure to perform triage. However, despite the knowledge and understanding of these benefits, sparse incidents and infrequent exercises lead to ambulance personnel's uncertainty concerning the use of triage tagging during a MI and will therefore, most likely, avoid using them. Rådestad M , Lennquist Montán K , Rüter A , Castrén M , Svensson L , Gryth D , Fossum B . Attitudes towards and experience of the use of triage tags in major incidents: a mixed method study. Prehosp Disaster Med. 2016;31(4):376-385.
引言 灾难分诊是对有限医疗资源进行分配，以优化患者治疗结果。有多项研究表明分诊标签使用情况不佳，但很少有研究探究其背后的原因。本研究旨在探讨救护人员在创伤患者日常管理以及重大事件中对实施分诊标签的态度和经验。
采用混合方法设计。研究的第一部分是对救护人员回答的关于态度的网络调查。探讨的问题是：在日常实践中未使用的系统在重大事件中有可能被使用吗？在实施新的分诊标签策略之前和之后进行了两次相同的基于网络的调查。该策略包括一个限时分诊程序，救护服务部门在日常创伤事件中指定分诊类别并应用分诊标签，以改善现场分诊。第二部分包括三次焦点小组访谈，以便更深入地了解对使用分诊标签的态度和经验。使用定性内容分析法对数据进行分析。
总体发现是在实践失败时需要日常惯例。对网络调查的分析揭示了三个变化：救护人员在轻微事故中更倾向于使用标签，分类评分系统被认为更有价值，但干预后也更耗时。在焦点小组访谈分析中，出现了四个类别来描述总体类别的构建：感知可用性、日常惯例、记录以及对组织策略的需求。
分诊是救护技能基础的一部分，但即便如此，救护人员在日常实践中很少使用。他们充分理解准确分诊决策的益处，也明白使用分诊算法和颜色编码标签旨在使分诊更轻松、更安全。然而，尽管了解这些益处，但事件稀少和演习不频繁导致救护人员在重大事件中对使用分诊标签存在不确定性，因此很可能会避免使用。拉德斯塔德M、伦奎斯特·蒙坦K、吕特A、卡斯特伦M、斯文森L、格里思D、福苏姆B。重大事件中使用分诊标签的态度和经验：一项混合方法研究。《院前灾难医学》。2016年；31(4):376 - 385。
