A modified simple triage and rapid treatment algorithm from the New York City (USA) fire department

Faizan H. Arshad, Alan Williams, Glenn Asaeda, Douglas Isaacs, Bradley Kaufman, David Ben-Eli, Dario Gonzalez, John P. Freese, Joan Hillgardner, Jessica Weakley, Charles B. Hall, Mayris P. Webber, David J. Prezant

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Introduction The objective of this study was to determine if modification of the Simple Triage and Rapid Treatment (START) system by the addition of an Orange category, intermediate between the most critically injured (Red) and the non-critical, non-ambulatory injured (Yellow), would reduce over- and under-triage rates in a simulated mass-casualty incident (MCI) exercise. Methods A computer-simulation exercise of identical presentations of an MCI scenario involving a 2-train collision, with 28 case scenarios, was provided for triaging to two groups: the Fire Department of the City of New York (FDNY; n = 1,347) using modified START, and the Emergency Medical Services (EMS) providers from the Eagles 2012 EMS conference (Lafayette, Louisiana USA; n = 110) using unmodified START. Percent correct by triage category was calculated for each group. Performance was then compared between the two EMS groups on the five cases where Orange was the correct answer under the modified START system. Results Overall, FDNY-EMS providers correctly triaged 91.2% of cases using FDNY-START whereas non-FDNY-Eagles providers correctly triaged 87.1% of cases using unmodified START. In analysis of the five Orange cases (chest pain or dyspnea without obvious trauma), FDNY-EMS performed significantly better using FDNY-START, correctly triaging 86.3% of cases (over-triage 1.5%; under-triage 12.2%), whereas the non-FDNY-Eagles group using unmodified START correctly triaged 81.5% of cases (over-triage 17.3%; under-triage 1.3%), a difference of 4.9% (95% CI, 1.5-8.2). Conclusions The FDNY-START system may allow providers to prioritize casualties using an intermediate category (Orange) more properly aligned to meet patient needs, and as such, may reduce the rates of over-triage compared with START. The FDNY-START system decreases the variability in patient sorting while maintaining high field utility without needing computer assistance or extensive retraining. Comparison of triage algorithms at actual MCIs is needed; however, initial feedback is promising, suggesting that FDNY-START can improve triage with minimal additional training and cost. Arshad FH, Williams A, Asaeda G, Isaacs D, Kaufman B, Ben-Eli D, Gonzalez D, Freese JP, Hillgardner J, Weakley J, Hall CB, Webber MP, Prezant DJ.

Original languageEnglish (US)
Pages (from-to)199-204
Number of pages6
JournalPrehospital and Disaster Medicine
Volume30
Issue number2
DOIs
StatePublished - Feb 17 2015

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Triage
Therapeutics
Emergency Medical Services
Eagles
Mass Casualty Incidents
Exercise

Keywords

  • assessment
  • disaster
  • Emergency Medical Services
  • mass-casualty incident
  • simulation
  • triage

ASJC Scopus subject areas

  • Emergency
  • Emergency Medicine
  • Medicine(all)

Cite this

A modified simple triage and rapid treatment algorithm from the New York City (USA) fire department. / Arshad, Faizan H.; Williams, Alan; Asaeda, Glenn; Isaacs, Douglas; Kaufman, Bradley; Ben-Eli, David; Gonzalez, Dario; Freese, John P.; Hillgardner, Joan; Weakley, Jessica; Hall, Charles B.; Webber, Mayris P.; Prezant, David J.

In: Prehospital and Disaster Medicine, Vol. 30, No. 2, 17.02.2015, p. 199-204.

Research output: Contribution to journalArticle

Arshad, FH, Williams, A, Asaeda, G, Isaacs, D, Kaufman, B, Ben-Eli, D, Gonzalez, D, Freese, JP, Hillgardner, J, Weakley, J, Hall, CB, Webber, MP & Prezant, DJ 2015, 'A modified simple triage and rapid treatment algorithm from the New York City (USA) fire department', Prehospital and Disaster Medicine, vol. 30, no. 2, pp. 199-204. https://doi.org/10.1017/S1049023X14001447
Arshad, Faizan H. ; Williams, Alan ; Asaeda, Glenn ; Isaacs, Douglas ; Kaufman, Bradley ; Ben-Eli, David ; Gonzalez, Dario ; Freese, John P. ; Hillgardner, Joan ; Weakley, Jessica ; Hall, Charles B. ; Webber, Mayris P. ; Prezant, David J. / A modified simple triage and rapid treatment algorithm from the New York City (USA) fire department. In: Prehospital and Disaster Medicine. 2015 ; Vol. 30, No. 2. pp. 199-204.
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T1 - A modified simple triage and rapid treatment algorithm from the New York City (USA) fire department

AU - Arshad, Faizan H.

AU - Williams, Alan

AU - Asaeda, Glenn

AU - Isaacs, Douglas

AU - Kaufman, Bradley

AU - Ben-Eli, David

AU - Gonzalez, Dario

AU - Freese, John P.

AU - Hillgardner, Joan

AU - Weakley, Jessica

AU - Hall, Charles B.

AU - Webber, Mayris P.

AU - Prezant, David J.

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N2 - Introduction The objective of this study was to determine if modification of the Simple Triage and Rapid Treatment (START) system by the addition of an Orange category, intermediate between the most critically injured (Red) and the non-critical, non-ambulatory injured (Yellow), would reduce over- and under-triage rates in a simulated mass-casualty incident (MCI) exercise. Methods A computer-simulation exercise of identical presentations of an MCI scenario involving a 2-train collision, with 28 case scenarios, was provided for triaging to two groups: the Fire Department of the City of New York (FDNY; n = 1,347) using modified START, and the Emergency Medical Services (EMS) providers from the Eagles 2012 EMS conference (Lafayette, Louisiana USA; n = 110) using unmodified START. Percent correct by triage category was calculated for each group. Performance was then compared between the two EMS groups on the five cases where Orange was the correct answer under the modified START system. Results Overall, FDNY-EMS providers correctly triaged 91.2% of cases using FDNY-START whereas non-FDNY-Eagles providers correctly triaged 87.1% of cases using unmodified START. In analysis of the five Orange cases (chest pain or dyspnea without obvious trauma), FDNY-EMS performed significantly better using FDNY-START, correctly triaging 86.3% of cases (over-triage 1.5%; under-triage 12.2%), whereas the non-FDNY-Eagles group using unmodified START correctly triaged 81.5% of cases (over-triage 17.3%; under-triage 1.3%), a difference of 4.9% (95% CI, 1.5-8.2). Conclusions The FDNY-START system may allow providers to prioritize casualties using an intermediate category (Orange) more properly aligned to meet patient needs, and as such, may reduce the rates of over-triage compared with START. The FDNY-START system decreases the variability in patient sorting while maintaining high field utility without needing computer assistance or extensive retraining. Comparison of triage algorithms at actual MCIs is needed; however, initial feedback is promising, suggesting that FDNY-START can improve triage with minimal additional training and cost. Arshad FH, Williams A, Asaeda G, Isaacs D, Kaufman B, Ben-Eli D, Gonzalez D, Freese JP, Hillgardner J, Weakley J, Hall CB, Webber MP, Prezant DJ.

AB - Introduction The objective of this study was to determine if modification of the Simple Triage and Rapid Treatment (START) system by the addition of an Orange category, intermediate between the most critically injured (Red) and the non-critical, non-ambulatory injured (Yellow), would reduce over- and under-triage rates in a simulated mass-casualty incident (MCI) exercise. Methods A computer-simulation exercise of identical presentations of an MCI scenario involving a 2-train collision, with 28 case scenarios, was provided for triaging to two groups: the Fire Department of the City of New York (FDNY; n = 1,347) using modified START, and the Emergency Medical Services (EMS) providers from the Eagles 2012 EMS conference (Lafayette, Louisiana USA; n = 110) using unmodified START. Percent correct by triage category was calculated for each group. Performance was then compared between the two EMS groups on the five cases where Orange was the correct answer under the modified START system. Results Overall, FDNY-EMS providers correctly triaged 91.2% of cases using FDNY-START whereas non-FDNY-Eagles providers correctly triaged 87.1% of cases using unmodified START. In analysis of the five Orange cases (chest pain or dyspnea without obvious trauma), FDNY-EMS performed significantly better using FDNY-START, correctly triaging 86.3% of cases (over-triage 1.5%; under-triage 12.2%), whereas the non-FDNY-Eagles group using unmodified START correctly triaged 81.5% of cases (over-triage 17.3%; under-triage 1.3%), a difference of 4.9% (95% CI, 1.5-8.2). Conclusions The FDNY-START system may allow providers to prioritize casualties using an intermediate category (Orange) more properly aligned to meet patient needs, and as such, may reduce the rates of over-triage compared with START. The FDNY-START system decreases the variability in patient sorting while maintaining high field utility without needing computer assistance or extensive retraining. Comparison of triage algorithms at actual MCIs is needed; however, initial feedback is promising, suggesting that FDNY-START can improve triage with minimal additional training and cost. Arshad FH, Williams A, Asaeda G, Isaacs D, Kaufman B, Ben-Eli D, Gonzalez D, Freese JP, Hillgardner J, Weakley J, Hall CB, Webber MP, Prezant DJ.

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KW - disaster

KW - Emergency Medical Services

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