Simple triage and rapid treatment protocol for emergency department mass casualty incident victim triage

Triage plays an essential role in emergency medical care. It is crucial to adopt appropriate triage in a mass casualty incident (MCI) when resources are limited. The simple triage and rapid treatment (START) protocol is commonly used worldwide; however, the effectiveness of the START protocol for em...

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Bibliographic Details
Published in:The American journal of emergency medicine 2022-03, Vol.53, p.99-103
Main Authors: Lin, Yun-Kuan, Chen, Kun-Chuan, Wang, Jen-Hung, Lai, Pei-Fang
Format: Article
Language:English
Subjects:
Accuracy
Adult
Clinical outcomes
Clinical Protocols
Disaster Planning - methods
Earthquakes
Emergency department triage
Emergency medical care
Emergency medical services
Emergency Service, Hospital
Female
Humans
Laboratories
Mass casualty incident
Mass Casualty Incidents
Mortality
Patients
Performance evaluation
Retrospective Studies
Simple triage and rapid treatment
Surgery
Trauma
Triage
Triage - methods
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Summary:Triage plays an essential role in emergency medical care. It is crucial to adopt appropriate triage in a mass casualty incident (MCI) when resources are limited. The simple triage and rapid treatment (START) protocol is commonly used worldwide; however, the effectiveness of the START protocol for emergency department (ED) triage is unclear. This study aimed to examine the accuracy of START for the ED triage of victims following a MCI. We retrospectively reviewed the records of victims who presented to our ED during a MCI response after a train crash. The ED nurses applied the START protocol upon patient arrival, and we used a consensus-based standard to determine the outcome-based categories of these same patients. We compared the START protocol and outcome-based categories. In addition, the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of START in terms of predicting surgery and ED disposition were determined. This study enrolled 47 patients (predominantly women, 68.1%; median age: 39.0years). Most victims were triaged into the START minor category (61.7%) and discharged from the ED (68.1%). Twenty-nine patients had matched START and outcome-based categories, whereas 2 patients were over-triaged and 16 patients were under-triaged. Additionally, the START system had acceptable AUC and sensitivities for predicting surgery and ED disposition (AUC/sensitivity/specificity for surgery: 0.850/100%/69.1%; AUC/sensitivity/specificity for admission: 0.917/93.3%/87.5%; AUC/sensitivity/specificity for intensive care unit (ICU)/ED death: 0.994/100%/97.8%). This study demonstrated poor agreement between START categories, as determined in the ED, and the consensus-based standard categories. However, the START protocol was acceptable in terms of identifying emergent patients (100% sensitivity for the immediate and deceased categories) and predicting ED disposition (surgery, admission, and ICU/ED mortality). Although START is not perfect, our findings suggest that it could be used for the ED triage of trauma-related MCI victims. •Research on in-hospital mass casualty triage is insufficient and inconsistent.•The accuracy of the START protocol was examined using a consensus-based standard.•Poor agreement was found between START and the consensus-based standard categories.•The START protocol had acceptable performance in identifying emergent patients.•The START protocol could be used for emergency department mass casualty triage.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2021.12.037