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Testing the START Triage Protocol: Can It Improve the Ability of Nonmedical Personnel to Better Triage Patients During Disasters and Mass Casualties Incidents ?

Published online by Cambridge University Press:  09 January 2017

Stefano Badiali ,
Aimone Giugni  and
Lucia Marcis
Stefano Badiali*
Affiliation:
Bologna NHS Emergency Department, Bologna, Italy
Aimone Giugni
Affiliation:
Bologna NHS Emergency Department, Bologna, Italy
Lucia Marcis
Affiliation:
Italian Red Cross Bologna Committee - Rizzoli Orthopedic Institute of Bologna, Bologna, Italy
*
Correspondence and reprint requests to Stefano Badiali MD, via Aldo Cividali 12, 40133 Bologna BO, Italy (e-mail stebad@me.com).
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Abstract

Objective

START (Simple Triage and Rapid Treatment) triage is a tool that is available even to nonmedical rescue personnel in case of a disaster or mass casualty incident (MCI). In Italy, no data are available on whether application of the START protocol could improve patient outcomes during a disaster or MCI. We aimed to address whether “last-minute” START training of nonmedical personnel during a disaster or MCI would result in more effective triage of patients.

Methods

In this case-control study, 400 nonmedical ambulance crew members were randomly assigned to a non-START or a START group (200 per group). The START group received last-minute START training. Each group examined 6000 patients, obtained from the Emergo Train System (ETS Italy, Bologna, Italy) victims database, and assigned patients a triage code (black-red-yellow-green) along with a reason for the assignment. Each rescuer triaged 30 patients within a 30-minute time frame. Results were analyzed according to Fisher’s exact test for a P value<0.01. Under- and over-triage ratios were analyzed as well.

Results

The START group completed the evaluations in 15 minutes, whereas the non-START group took 30 minutes. The START group correctly triaged 94.2% of their patients, as opposed to 59.83% of the non-START group (P<0.01). Under- and over-triage were, respectively, 2.73% and 3.08% for the START group versus 13.67% and 26.5% for the non-START group. The non-START group had 458 “preventable deaths” on 6000 cases because of incorrect triage, whereas the START group had 91.

Conclusions

Even a “last-minute” training on the START triage protocol allows nonmedical personnel to better identify and triage the victims of a disaster or MCI, resulting in more effective and efficient medical intervention. (Disaster Med Public Health Preparedness. 2017;11:305–309)

Keywords

START triagetriage effectivenessnonmedical first responderstriage accuracy
Type
Brief Reports
Information
Disaster Medicine and Public Health Preparedness , Volume 11 , Issue 3 , June 2017 , pp. 305 - 309
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2017 

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References

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