Triage decisions of prehospital emergency health care providers, using a multiple casualty scenario paper exercise

Abstract

Objective: To examine the accuracy of theoretical triage decision making among emergency prehospital health care professionals, using a multiple casualty paper exercise. Methods: A standardised 20 casualty paper exercise requiring each casualty to be prioritised for treatment was given to 100 doctors, 59 nurses, and 74 ambulance paramedics who could potentially be involved at the scene of a multiple casualty incident. Each paper was scored using the triage sieve algorithm. The paper contained descriptions of two casualties regarded as dead, six priority 1 casualties, six priority 2 casualties, and six priority 3 casualties. Results: There was no significant difference in the scores received by both doctors and nurses, but paramedics did significantly less well than both nurses and doctors (p<0.05) However, the actual difference in mean scores is only just over 1; both doctors and nurses had a mean score of 13.03 and paramedics a mean score of 11.83. All professional groups tended to over triage patients. While there was no significant difference between doctors and nurses there was a significant difference (p<0.001) between paramedics and both doctors and nurses. Conclusions: There is little difference in the accuracy of triage decision making between the professional groups, with doctors and nurses scoring marginally better than paramedics. The rates of over triage are high posing the risk of overwhelming available resources further. Under triage rates are also high, with potentially life threatening conditions going unrecognised. However, some margin of error may be accounted for by the untested validity of the triage sieve methodology.

Factors that influence the accuracy of triage nurses' judgement in emergency departments

“…Göransson et al 1 found that the percentage of the accuracy ratings among registered nurses was only 58%, and Considine et al 7 found that ED nurses were more likely to under-triage (18%) than to over-triage (14.1%). However, this finding contradicted the study by Kilner8 which found that all professional providers tended to over-triage patients. The differences in results may be due to variations in the healthcare delivery system and in the educational level of the triage nurses.…”

The reality of multiple casualty triage: putting triage theory into practice at the scene of multiple casualty vehicular accidents

“…The first ambulance personnel on the scene of an incident make the triage decisions 2. It has been concluded that this process involves complex cognitive and decision making processes 3.…”

“…The processes of rapid triage sieve and sort are defined in the Major Incident and Medical Management Support Course (MIMMS) developed in the UK. Regular re-triage is important because patient acuity may change unexpectedly and triage is a dynamic process2 Triage systems allocate priority based on potential casualty outcomes and survivability, as opposed to diagnosis, in an effort to ration medical care and resources 18…”

“…Previous research has focused on validating the physiological underpinning of triage scales1 or has considered the comparative performance of health professionals in using such scales 2. There is limited evidence concerning the application of current theoretical models in real world triage practice.…”

Physician versus Paramedic in the Setting of Ground Forces Operations: Are They Interchangeable?

“…To the best of our knowledge, most of the published studies in this matter describe advantages of physicians over paramedics or emergency medicine technicians, although the settings of these studies were different from the one we are dealing with in this work. These advantages include better triage decisions 2,3 and improved clinical judgment. 4 Several studies demonstrate a better patient outcome when treated by a physician compared to patients treated by paramedics.…”