Silvestri Salvatore, Field Adam, Mangalat Neal, Weatherford Tory, Hunter Christopher, McGowan Zoe, Stamile Zachary, Mattox Trevor, Barfield Tanner, Afshari Aarian, Ralls George, Papa Linda
Program Director, Orlando Health Emergency Medicine Residency, Orlando Regional Medical Center, Orlando, Florida; Associate EMS Medical Director, Orange County EMS System, Orlando, Florida.
Resident, Emergency Medicine, University of Arizona, Tucson, Arizona.
Am J Disaster Med. 2017 Winter;12(1):27-33. doi: 10.5055/ajdm.2017.0255.
We compared Sort, Assess, Lifesaving Intervention, Treatment/Transport (SALT) and Simple Triage and Rapid Treatment (START) triage methodologies to a published reference standard, and evaluated the accuracy of the START method applied by emergency medical services (EMS) personnel in a field simulation.
Simulated mass casualty incident (MCI). Paramedics trained in START triage assigned each victim to green (minimal), yellow (delayed), red (immediate), or black (dead) categories. These victim classifications were recorded by investigators and compared to reference standard definitions of each triage category. The victim scenarios were also compared to the a priori classifications as developed by the investigators.
MCI field simulation.
Comparison of the correlation of START and SALT triage methodologies to reference standard definitions. Another outcome measure was the accuracy of the application of START triage by EMS personnel in the field exercise.
The strongest correlation to the reference standard was SALT with an r = 0.860 (p < 0.001) and κ = 0.632 (p < 0.001). START and SALT triage systems agreed 100 percent on both black and green classifications. There were significant correlations between the field triage and both START and SALT methods (p < 0.001, respectfully). SALT had a significantly lower undertriage rate (9 percent [95%CI 2-15]) than both START (20 percent [95%CI 11-28]) and field triage (37 percent [95%CI 24-52]). There were no significant differences in overtriage rates.
In our study, the SALT triage system was overall more accurate triage method than START at classi-fying patients, specifically in the delayed and immediate categories. In our field exercise, paramedic use of the START methodology yielded a higher rate of undertriage compared to the SALT classification.
我们将分类、评估、救生干预、治疗/转运（SALT）和简单分诊与快速治疗（START）分诊方法与已发表的参考标准进行了比较，并在现场模拟中评估了紧急医疗服务（EMS）人员应用START方法的准确性。
模拟大规模伤亡事件（MCI）。接受START分诊培训的护理人员将每个受害者分为绿色（轻伤）、黄色（延迟治疗）、红色（立即治疗）或黑色（死亡）类别。这些受害者分类由调查人员记录，并与每个分诊类别的参考标准定义进行比较。受害者场景也与调查人员事先制定的分类进行了比较。
MCI现场模拟。
比较START和SALT分诊方法与参考标准定义的相关性。另一个观察指标是EMS人员在现场演练中应用START分诊的准确性。
与参考标准相关性最强的是SALT，r = 0.860（p < 0.001），κ = 0.632（p < 0.001）。START和SALT分诊系统在黑色和绿色分类上的一致性为100%。现场分诊与START和SALT方法之间均存在显著相关性（分别为p < 0.001）。SALT的漏诊率（9%[95%CI 2 - 15]）显著低于START（20%[95%CI 11 - 28]）和现场分诊（37%[95%CI 24 - 52]）。误诊率没有显著差异。
在我们的研究中，SALT分诊系统在对患者进行分类时总体上比START更准确，特别是在延迟治疗和立即治疗类别中。在我们的现场演练中，与SALT分类相比，护理人员使用START方法导致漏诊率更高。
