Evaluation of a novel algorithm for primary mass casualty triage by paramedics in a physician manned EMS system: a dummy based trial

Abstract

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.

Triage decisions for ICU admission: Report from the Task Force of the World Federation of Societies of Intensive and Critical Care Medicine

“…Distributive justice refers to fairness in the distribution of limited resources and benefits. Although triage tools may support A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT 14 and improve the quality of critical care admission decisions, they probably cannot and should not supplant intensivists' experience and clinical judgment in decision making.…”

Difference in First Aid Activity During Mass Casualty Training Based on Having Taken an Educational Course

“…Most reports investigating the effectiveness of education concerning mass casualty incidents have conducted pre-and post-test evaluations, just after the course ended. [5][6][7][8] This study was not a pre-and post-test study but a comparative study of observations from independent groups. However, in the present study, we found that education concerning mass casualty incidents was effective in improving performance even though the evaluation was not performed immediately after the education.…”

Primary mass casualty incident triage: evidence for the benefit of yearly brief re-training from a simulation study

“…Written informed consent was obtained from all study participants. Triage training and data acquisition was performed as reported previously in detail [ 3 , 4 ].…”

“…The Amberg-Schwandorf Algorithm for Primary Triage (ASAV, Amberg-Schwandorf-Algorithmus für die Vorsichtung ) (Fig. 1 ) served as triage algorithm for this purpose [ 3 , 4 , 6 ].

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Fig. 1 The Amberg-Schwandorf Algorithm for Primary Triage (ASAV) [ 4 ]. I = red category, II = yellow category, III = green category

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