Ryan Kevin, George Douglas, Liu James, Mitchell Patricia, Nelson Kerrie, Kue Ricky
Prehosp Emerg Care. 2018 Jul-Aug;22(4):520-526. doi: 10.1080/10903127.2017.1419323. Epub 2018 Feb 9.
Mass casualty incident (MCI) triage and the use of triage tags to assign treatment priorities are not fully implemented despite emergency medical services (EMS) personnel training during drills and exercises.
To compare current field triage practices during both training and actual MCIs and identify any potential barriers to use.
During training sessions from November 2015 through March 2016, an anonymous survey was distributed to personnel in 3 distinct types of paid full-time EMS systems: Boston EMS (2-tiered, municipal third-service); Portland Fire Department (fire department-based ALS); and Stokes County EMS (county-based ALS) combined with Forsyth County EMS (county-based ALS). Data included personnel demographics and previous participation experiences in both drill and actual MCIs. Personnel with any prior MCI experience were queried regarding triage tag use and type of algorithm used. Data on barriers to use of triage tags and methods of communication of patient information were also collected. Descriptive statistics were used to analyze responses.
Overall survey participation rate was 77.9% (464/596). Among all respondents, 38.7% (179/464) reported participating in both a drill and actual MCI's. In these cases, respondents reported less likely use of triage tags during actual MCI's compared to drills, (34.1 vs. 91.8%, p < 0.01), less likely to complete full triage (16.3 vs. 68.7%, p < 0.01) and less likely to employ geographical triage (56.8 vs. 90.4% p < 0.01). Verbal report was the most common communication method to hospitals (93.1%) when triage tags were not used. Responders reported proximity to the hospital as the most common reason for not using triage tags during an actual MCI (29.5%).
Despite being a fundamental skill in MCI response, triage and other standard practices have not always been utilized in actual events despite training. EMS educators and disaster planners should consider strategies to better incorporate MCI practices during real world events.
尽管急救医疗服务（EMS）人员在演练和演习中接受了培训，但大规模伤亡事件（MCI）的分诊以及使用分诊标签来确定治疗优先级并未得到充分实施。
比较培训期间和实际MCI期间当前的现场分诊做法，并确定使用过程中的任何潜在障碍。
在2015年11月至2016年3月的培训课程中，向3种不同类型的全职付费EMS系统的人员发放了一份匿名调查问卷：波士顿急救医疗服务（两级，市政第三服务）；波特兰消防局（基于消防局的高级生命支持）；以及斯托克斯县急救医疗服务（基于县的高级生命支持）与福赛思县急救医疗服务（基于县的高级生命支持）。数据包括人员人口统计学信息以及在演练和实际MCI中的参与经历。询问了有任何MCI经验的人员关于分诊标签的使用情况和所使用的算法类型。还收集了关于使用分诊标签的障碍以及患者信息沟通方法的数据。使用描述性统计分析回复。
总体调查参与率为77.9%（464/596）。在所有受访者中，38.7%（179/464）报告既参加过演练也参加过实际的MCI。在这些情况下，受访者报告在实际MCI中使用分诊标签的可能性低于演练（34.1%对91.8%，p<0.01），完成全面分诊的可能性更低（16.3%对68.7%，p<0.01），采用地理分诊的可能性也更低（56.8%对90.4%，p<0.01）。当不使用分诊标签时，口头报告是向医院传达信息最常用的方式（93.1%）。受访者表示在实际MCI中不使用分诊标签的最常见原因是距离医院较近（29.5%）。
尽管分诊是应对MCI的一项基本技能，但尽管进行了培训，在实际事件中分诊和其他标准做法并非总是得到应用。EMS教育工作者和灾难规划者应考虑采取策略，以便在实际事件中更好地纳入MCI做法。
