Cicero Mark Xavier, Whitfill Travis, Overly Frank, Baird Janette, Walsh Barbara, Yarzebski Jorge, Riera Antonio, Adelgais Kathleen, Meckler Garth D, Baum Carl, Cone David Christopher, Auerbach Marc
Prehosp Emerg Care. 2017 Mar-Apr;21(2):201-208. doi: 10.1080/10903127.2016.1235239. Epub 2016 Oct 17.
Paramedics and emergency medical technicians (EMTs) triage pediatric disaster victims infrequently. The objective of this study was to measure the effect of a multiple-patient, multiple-simulation curriculum on accuracy of pediatric disaster triage (PDT).
Paramedics, paramedic students, and EMTs from three sites were enrolled. Triage accuracy was measured three times (Time 0, Time 1 [two weeks later], and Time 2 [6 months later]) during a disaster simulation, in which high and low fidelity manikins and actors portrayed 10 victims. Accuracy was determined by participant triage decision concordance with predetermined expected triage level (RED [Immediate], YELLOW [Delayed], GREEN [Ambulatory], BLACK [Deceased]) for each victim. Between Time 0 and Time 1, participants completed an interactive online module, and after each simulation there was an individual debriefing. Associations between participant level of training, years of experience, and enrollment site were determined, as were instances of the most dangerous mistriage, when RED and YELLOW victims were triaged BLACK.
The study enrolled 331 participants, and the analysis included 261 (78.9%) participants who completed the study, 123 from the Connecticut site, 83 from Rhode Island, and 55 from Massachusetts. Triage accuracy improved significantly from Time 0 to Time 1, after the educational interventions (first simulation with debriefing, and an interactive online module), with a median 10% overall improvement (p < 0.001). Subgroup analyses showed between Time 0 and Time 1, paramedics and paramedic students improved more than EMTs (p = 0.002). Analysis of triage accuracy showed greatest improvement in overall accuracy for YELLOW triage patients (Time 0 50% accurate, Time1 100%), followed by RED patients (Time 0 80%, Time 1 100%). There was no significant difference in accuracy between Time 1 and Time 2 (p = 0.073).
This study shows that the multiple-victim, multiple-simulation curriculum yields a durable 10% improvement in simulated triage accuracy. Future iterations of the curriculum can target greater improvements in EMT triage accuracy.
护理人员和急救医疗技术员（EMT）很少对儿科灾难受害者进行分诊。本研究的目的是评估多患者、多模拟课程对儿科灾难分诊（PDT）准确性的影响。
招募了来自三个地点的护理人员、护理专业学生和EMT。在一次灾难模拟中，对分诊准确性进行了三次测量（时间0、时间1[两周后]和时间2[6个月后]），其中高仿真和低仿真人体模型以及演员扮演10名受害者。准确性通过参与者的分诊决定与每个受害者预先确定的预期分诊级别（红色[立即处理]、黄色[延迟处理]、绿色[可走动]、黑色[死亡]）的一致性来确定。在时间0和时间1之间，参与者完成了一个交互式在线模块，并且每次模拟后都有一次单独的汇报。确定了参与者的培训水平、工作年限和招募地点之间的关联，以及最危险的误分诊情况（即红色和黄色受害者被分诊为黑色）的实例。
该研究招募了331名参与者，分析包括261名（78.9%）完成研究的参与者，其中123名来自康涅狄格州地点，83名来自罗德岛，55名来自马萨诸塞州。在教育干预（第一次模拟及汇报和一个交互式在线模块）后，从时间0到时间1，分诊准确性显著提高，总体中位数提高了10%（p<0.001）。亚组分析显示，在时间0和时间1之间，护理人员和护理专业学生的提高幅度大于EMT（p = 0.002）。分诊准确性分析显示，黄色分诊患者的总体准确性提高最大（时间0为50%准确，时间1为100%），其次是红色患者（时间0为80%，时间1为100%）。时间1和时间2之间的准确性没有显著差异（p = 0.073）。
本研究表明，多受害者、多模拟课程在模拟分诊准确性方面产生了持久的10%的提高。该课程的未来迭代可以针对进一步提高EMT分诊准确性。
