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BackgroundThe Amberg-Schwandorf Algorithm for Primary Triage (ASAV) is a novel primary triage concept specifically for physician manned emergency medical services (EMS) systems. In this study, we determined the diagnostic reliability and the time requirements of ASAV triage.MethodsSeven hundred eighty triage runs performed by 76 trained EMS providers of varying professional qualification were included into the study. Patients were simulated using human dummies with written vital signs sheets. Triage results were compared to a standard solution, which was developed in a modified Delphi procedure. Test performance parameters (e.g. sensitivity, specificity, likelihood ratios (LR), under-triage, and over-triage) were calculated. Time measurements comprised the complete triage and tagging process and included the time span for walking to the subsequent patient. Results were compared to those published for mSTaRT. Additionally, a subgroup analysis was performed for employment status (career/volunteer), team qualification, and previous triage training.ResultsFor red patients, ASAV sensitivity was 87%, specificity 91%, positive LR 9.7, negative LR 0.139, over-triage 6%, and under-triage 10%. There were no significant differences related to mSTaRT. Per patient, ASAV triage required a mean of 35.4 sec (75th percentile 46 sec, 90th percentile 58 sec). Volunteers needed slightly more time to perform triage than EMS professionals. Previous mSTaRT training of the provider reduced under-triage significantly. There were significant differences in time requirements for triage depending on the expected triage category.ConclusionsThe ASAV is a specific concept for primary triage in physician governed EMS systems. It may detect red patients reliably. The test performance criteria are comparable to that of mSTaRT, whereas ASAV triage might be accomplished slightly faster. From the data, there was no evidence for a clinically significant reliability difference between typical staffing of mobile intensive care units, patient transport ambulances, or disaster response volunteers. Up to now, there is no clinical validation of either triage concept. Therefore, reality based evaluation studies are needed.

BackgroundTriage is a mainstay of early mass casualty incident (MCI) management. Standardized triage protocols aim at providing valid and reproducible results and, thus, improve triage quality. To date, there is little data supporting the extent and content of training and re-training on using such triage protocols within the Emergency Medical Services (EMS). The study objective was to assess the decline in triage skills indicating a minimum time interval for re-training. In addition, the effect of a one-hour repeating lesson on triage quality was analyzed.MethodsA dummy based trial on primary MCI triage with yearly follow-up after initial training using the ASAV algorithm (Amberg-Schwandorf Algorithm for Primary Triage) was undertaken. Triage was assessed concerning accuracy, sensitivity, specificity, over-triage, under-triage, time requirement, and a comprehensive performance measure. A subgroup analysis of professional paramedics was made.ResultsNine hundred ninety triage procedures performed by 51 providers were analyzed. At 1 year after initial training, triage accuracy and overall performance dropped significantly. Professional paramedic’s rate of correctly assigned triage categories deteriorated from 84 to 71%, and the overall performance score decreased from 95 to 90 points (maximum = 100). The observed decline in triage performance at 1 year after education made it necessary to conduct re-training. A brief didactic lecture of 45 min duration increased accuracy to 88% and the overall performance measure to 97.ConclusionsTo improve disaster preparedness, triage skills should be refreshed yearly by a brief re-education of all EMS providers.

Zusammenfassung Die Sichtung ist eine grundlegende ?rztliche Ma?nahme der Lageerkundung beim Massenanfall von Verletzten (MANV). In der fr?hen Einsatzphase kann eine Vorsichtung durch geeignetes, nicht?rztliches Rettungsdienstpersonal sinnvoll sein, um einen raschen Lage?berblick zu erhalten, weil der ersteintreffende Notarzt oder Leitende Notarzt im Rahmen seiner Leitungsfunktion zun?chst eine Grundordnung an der Einsatzstelle herstellen muss. Es wird ?ber ein Projekt zur Erarbeitung eines Vorsichtungskonzepts im Rettungsdienstbereich Amberg (Bayern) berichtet. In einem informellen Gruppenprozess wurden Zieldefinitionen f?r das Konzept erarbeitet, ein Vorsichtungsalgorithmus samt Sichtungskennzeichnung entwickelt, und dieser in ein Gesamtkonzept f?r die erste Einsatzphase eingebettet. Zuletzt wurden Festlegungen zur Ausbildung, Zertifizierung und Implementierung getroffen. Der Amberg-Schwandorf-Algorithmus f?r die Vorsichtung (ASAV) ist im Vergleich zu dem ?berregional bekannten mSTaRT-Algorithmus verk?rzt. Die beiden mSTaRT-Elemente zur Atmung wurden zu einem Punkt ?Atemst?rung?? zusammengefasst. Eine weitere Modifikation betrifft die Blutstillung. Die Sichtungskennzeichnung erfolgt mit farbigen Plastikb?ndern. Ein Algorithmus f?r die Fr?hphase eines MANV-Einsatzes beschreibt das Vorgehen durch die ersteintreffende rettungsdienstliche Fahrzeugbesatzung. Zur Durchf?hrung der Vorsichtung ist eine strukturierte Ausbildung sowie das Absolvieren einer praktischen Pr?fung erforderlich. Das Amberg-Schwandorf-Konzept schlie?t die L?cke der fr?hen Einsatzphase bei bisherigen MANV-Konzepten. Der zugrunde liegende Algorithmus geht im Gegensatz zu mSTaRT mit den Anforderungen der nationalen Sichtungs-Konsensus-Konferenzen konform. Als Limitation ist zu formulieren, dass die G?te der Vorsichtung in weiteren Untersuchungen verifiziert werden muss.

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