Hart Alexander, Nammour Elias, Mangolds Virginia, Broach John
1Department of Emergency Medicine,Beth Israel Deaconess Medical Center,Boston,MassachusettsUSA.
2University of Massachusetts Medical School,Medical Education,Worcester,MassachusettsUSA.
Prehosp Disaster Med. 2018 Aug;33(4):355-361. doi: 10.1017/S1049023X18000626.
IntroductionThe most commonly used methods for triage in mass-casualty incidents (MCIs) rely upon providers to take exact counts of vital signs or other patient parameters. The acuity and volume of patients which can be present during an MCI makes this a time-consuming and potentially costly process.HypothesisThis study evaluates and compares the speed of the commonly used Simple Triage and Rapid Treatment (START) triage method with that of an "intuitive triage" method which relies instead upon the abilities of an experienced first responder to determine the triage category of each victim based upon their overall first-impression assessment. The research team hypothesized that intuitive triage would be faster, without loss of accuracy in assigning triage categories.
Local adult volunteers were recruited for a staged MCI simulation (active-shooter scenario) utilizing local police, Emergency Medical Services (EMS), public services, and government leadership. Using these same volunteers, a cluster randomized simulation was completed comparing START and intuitive triage. Outcomes consisted of the time and accuracy between the two methods.
The overall mean speed of the triage process was found to be significantly faster with intuitive triage (72.18 seconds) when compared to START (106.57 seconds). This effect was especially dramatic for Red (94.40 vs 138.83 seconds) and Yellow (55.99 vs 91.43 seconds) patients. There were 17 episodes of disagreement between intuitive triage and START, with no statistical difference in the incidence of over- and under-triage between the two groups in a head-to-head comparison.
Significant time may be saved using the intuitive triage method. Comparing START and intuitive triage groups, there was a very high degree of agreement between triage categories. More prospective research is needed to validate these results. HartA, NammourE, MangoldsV, BroachJ. Intuitive versus algorithmic triage Prehosp Disaster Med. 2018;33(4):355-361.
引言
在大规模伤亡事件（MCI）中，最常用的分诊方法依赖于医护人员精确统计生命体征或其他患者参数。在大规模伤亡事件中，患者的数量和伤情严重程度使得这一过程既耗时又可能成本高昂。
假设
本研究评估并比较了常用的简单分诊与快速治疗（START）分诊方法和“直觉分诊”方法的速度，后者依赖于经验丰富的急救人员根据对每个受害者的整体第一印象评估来确定分诊类别。研究团队假设直觉分诊会更快，且在分诊类别分配上不会损失准确性。
方法
招募当地成年志愿者参与一个模拟的大规模伤亡事件（活跃枪手场景），参与者包括当地警察、紧急医疗服务（EMS）人员、公共服务人员和政府领导。使用相同的志愿者，完成了一项集群随机模拟，比较START分诊和直觉分诊。结果包括两种方法的时间和准确性。
结果
与START分诊（106.57秒）相比，直觉分诊（72.18秒）的分诊过程总体平均速度明显更快。对于红色（94.40秒对138.83秒）和黄色（55.99秒对91.43秒）类别的患者，这种效果尤为显著。直觉分诊和START分诊之间有17次不一致情况，在直接比较中，两组之间过度分诊和分诊不足的发生率没有统计学差异。
结论
使用直觉分诊方法可显著节省时间。比较START分诊组和直觉分诊组，分诊类别之间有非常高的一致性。需要更多前瞻性研究来验证这些结果。
哈特A、纳穆尔E、曼戈尔德斯V、布罗奇J。直觉分诊与算法分诊。《院前灾难医学》。2018年；33（4）：355 - 361。
