Triage Decisions of United Kingdom Police Firearms Officers Using a Multiple-Casualty Scenario Paper Exercise

Abstract

Introduction:British police officers authorized to carry firearms may need to make judgments about the severity of injury of individuals or the relative priority of clinical need of a group of injured patients in tactical and non-tactical situations. Most of these officers receive little or no medical training beyond basic first aid to enable them to make these clinical decisions. Therefore, the aim of this study is to determine the accuracy of triage decision-making of firearms-trained police officers with and without printed decision-support materials.Methods:Eighty-two police firearms officers attending a tactical medicine course (FASTAid) were recruited to the study. Data were collected using a paper-based triage exercise that contained brief, clinical details of 20 adults and 10 children. Subjects were asked to assign a clinical priority of immediate or priority 1 (P1); urgent or priority 2 (P2); delayed or priority 3 (P3); or dead, to each casualty. Then, they were provided with decision-making materials, but were not given any instruction as to how these materials should be used. Subjects then completed a second triage exercise, identical to the first, except this time using the decision-support materials.Data were analyzed using mixed between-within subjects analysis of variance. This allowed comparisons to be made between the scores for Exercise 1 (no decision-support material) and Exercise 2 (with decision-support material). It also allowed any differences between those students with previous triage training and those without previous training to be explored.Results:The use of triage decision-making materials resulted in a significant increase in correct responses (p <0.001). Improvement in accuracy appears to result mainly from a reduction in the extent of under-triage. There were significant differences (p <0.05) between those who had received previous triage training and those who had not, with those having received triage training doing slightly better.Conclusion:It appears that significant improvements in the accuracy of triage decision-making by police firearms officers can be achieved with the use of appropriate triage decision-support materials. Training may offer additional improvements in accuracy, but this improvement is likely to be small when decision-support materials are provided. With basic clinical skills and appropriate decision-support materials, it is likely that the police officer can make accurate triage decisions in a multiple-casualty scenario or make judgments of the severity of injury of a given individual in both tactical and non-tactical situations.

Paramedic Accuracy Using SALT Triage After a Brief Initial Training

“…other mass-casualty triage systems, which have shown improvement in triage rates after a one-hour didactic session, 7 after a two-hour educational session, 8 after an approximately 30-minute Internet training session, 9 and after being given decision-making materials. 10 Of note, a previous study showed that providers' comfort with mass-casualty triage increases when they participate in a drill after a didactic training session. 4 While drills likely improve performance, they are expensive and difficult to coordinate for large groups.…”

First Responder Accuracy Using SALT after Brief Initial Training

“…17 Kilner et al revealed that UK police officers were able to understand and apply Triage Sieve to triage a paper-based MCI scenario. The officers were able to apply the triage tool accurately in 81.4% of cases.…”

Evaluation of a CT triage protocol for mass casualty incidents: results from two large-scale exercises

“…As reported in other studies, initial field triage helps to distribute patients to hospitals with different levels of specialization and facilities according to the injury patterns [2,[9][10][11][12]. However, errors in this distribution are likely to some extent, so secondary triage after admission is important to correct categorization and to avoid overuse and blocking of resources [13].…”