Improved and sustained triage skills in firemen after a short training intervention

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Carl-Oscar Jonson¹  Helene Nilsson¹  Maria Lampi¹  Kristian Åslund¹  Abraham Nilsson¹ 

[1] Centre for Teaching & Research in Disaster Medicine and Traumatology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, SE-581 85, Sweden

关键词: Firemen;    Direct instruction;    Trauma cards;    SALT Mass Casualty Triage Algorithm;    Triage training;    Triage;   

Others  :  1231306
DOI  :  10.1186/s13049-015-0162-7

 received in 2015-06-09, accepted in 2015-10-08,  发布年份 2015

【 摘 要 】

Background

A previous study has shown no measurable improvement in triage accuracy among physicians attending the Advanced Trauma Life Support (ATLS) course and suggests a curriculum revision regarding triage. Other studies have indicated that cooperative learning helps students acquire knowledge.

Objective

The present study was designed to evaluate the effectiveness of trauma cards in triage training for firemen.

Methods

Eighty-six firemen were randomly assigned into two groups: the trauma card group and the direct instruction group. Both groups received the same 30-min PowerPoint lecture on how to perform triage according to the Sort Assess Lifesaving interventions Treatment and transport (SALT) Mass Casualty Triage Algorithm. In the trauma card group, the participants were divided into groups of 3–5 and instructed to triage 10 trauma victims according to the descriptions on the trauma cards. In the direct instruction group, written forms about the same 10 victims were used and discussed as a continuation of the PowerPoint lecture. Total training time was 60 min for both groups. A test was distributed before and after the educational intervention to measure the individual triage skills. The same test was applied again 6 months later.

Results

There was a significant improvement in triage skills directly after the intervention and this was sustained 6 months later. No significant difference in triage skills was seen between the trauma card group and the direct instruction group. Previous experience of multi-casualty incidents, years in service, level of education or age did not have any measurable effects on triage accuracy.

Conclusions

One hour of triage training with the SALT Mass Casualty Triage Algorithm was enough to significantly improve triage accuracy in both groups of firemen with sustained skills 6 months later. Further studies on the first assessment on scene versus patient outcome are necessary to provide evidence that this training can improve casualty outcome. The efficacy and validity of trauma cards for disaster management training need to be tested in future studies.

【 授权许可】

   
2015 Nilsson et al.

【 图 表 】

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【 参考文献 】

• [1]Schenk E, Wijetunge G, Mann NC, Lerner EB, Longthorne A, Dawson D. Epidemiology of mass casualty incidents in the United States. Prehosp Emerg Care. 2014; 18:408-16.
• [2]American College of Surgeons. About advanced trauma life support. 2013. http://www.facs.org/trauma/atls/history.html. Accessed 22 Nov 2013.
• [3]Frykberg ER. Triage: principles and practice. Scand J Surg. 2005; 94:272-8.
• [4]Waeckerle JF. Disaster planning and response. N Engl J Med. 1991; 324:815-21.
• [5]Debacker M, Hubloue I, Dhondt E, Rockenschaub G, Ruter A, Codreanu T et al.. Utstein-style template for uniform data reporting of acute medical response in disasters. PLoS Curr. 2012; 4:e4f6cf3e8df15a.
• [6]Johnson DW, Johnson RT, Smith KA. Cooperative learning returns to college. Change. 1998; 30:26.
• [7]Pourshanazari A, Roohbakhsh A, Khazaei M, Tajadini H. Comparing the long-term retention of a physiology course for medical students with the traditional and problem-based learning. Adv Health Sci Educ. 2013; 18:91-7.
• [8]Lampi M, Vikstrom T, Jonson CO. Triage performance of Swedish physicians using the ATLS algorithm in a simulated mass casualty incident: a prospective cross-sectional survey. Scand J Trauma Resusc Emerg Med. 2013; 21:90. BioMed Central Full Text
• [9]PHTLS: Prehospital Trauma Life Support. 7th ed. Mosby Jems/Elsevier, St. Louis; 2011.
• [10]Jenkins JL, McCarthy ML, Sauer LM, Green GB, Stuart S, Thomas TL et al.. Mass-casualty triage: time for an evidence-based approach. Prehosp Disaster Med. 2008; 23(1):3-8.
• [11]Lerner EB, Schwartz RB, Coule PL, Weinstein ES, Cone DC, Hunt RC et al.. Mass casualty triage: an evaluation of the data and development of a proposed national guideline. Disaster Med Public Health Prep. 2008; 2 Suppl 1:S25-34.
• [12]Kahn CA, Schultz CH, Miller KT, Anderson CL. Does START triage work? An outcomes assessment after a disaster. Ann Emerg Med. 2009; 54:424-30.
• [13]Nasjonal veileder for masseskadetriage [in norwegian]. Helsedirektoratet, Norway; 2013.
• [14]Lennquist S. Katastrofmedicin. Liber, Stockholm; 2009.
• [15]Deluhery MR, Lerner EB, Pirrallo RG, Schwartz RB. Paramedic accuracy using SALT triage after a brief initial training. Prehosp Emerg Care. 2011; 15:526-32.
• [16]Lerner EB, Schwartz RB, Coule PL, Pirrallo RG. Use of SALT triage in a simulated mass-casualty incident. Prehosp Emerg Care. 2010; 14:21-5.
• [17]Sanddal TL, Loyacono T, Sanddal ND. Effect of JumpSTART training on immediate and short-term pediatric triage performance. Pediatr Emerg Care. 2004; 20:749-53.
• [18]Risavi BL, Salen PN, Heller MB, Arcona S. A two-hour intervention using START improves prehospital triage of mass casualty incidents. Prehosp Emerg Care. 2001; 5:197-9.
• [19]Risavi BL, Terrell MA, Lee W, Holsten DL. Prehospital mass-casualty triage training-written versus moulage scenarios: how much do EMS providers retain? Prehosp Disaster Med. 2013; 28:251-6.
• [20]Wakasugi M, Nilsson H, Ruter A. Figurant cards as a tool to link live field and virtual simulation exercises in disaster medical training. J Clin Simul Res. 2013; 2(1):29-34.
• [21]Cone DC, Serra J, Kurland L. Comparison of the SALT and smart triage systems using a virtual reality simulator with paramedic students. Eur J Emerg Med. 2011; 18:314-21.
• [22]Debacker M, Ullrich C, Van Utterbeeck F, Dejardin E, Dhondt E, Hubloue I. Triage decreases the mortality in a simulated road traffic MCI scenario. Amsterdam: 8th European Congress on Emergency Medicin. 2014. Accessed date 28/9-1/10. http://archive2014. eusemcongress.org/upload/finalok.pdf webcite
• [23]Considine J, Botti M, Thomas S. Do knowledge and experience have specific roles in triage decision-making? Acad Emerg Med. 2007; 14:722-6.