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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 ?

  • Stefano Badiali (a1), Aimone Giugni (a1) and Lucia Marcis (a2)

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)

Copyright

Corresponding author

Correspondence and reprint requests to Stefano Badiali MD, via Aldo Cividali 12, 40133 Bologna BO, Italy (e-mail stebad@me.com).

References

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1. START Adult Triage Algorithm. US Department of Health and Human Services, Radiation Emergency Medical Management website. https://www.remm.nlm.gov/startadult.htm. Last updated November 13, 2016. Accessed December 5, 2016.
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7. Badiali, S. Pre-hospital care. In: De Boer J, Dubouloz M, eds. Handbook of Disaster Medicine. Utrecht: Van der Wees; 2000:289-309.
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Disaster Medicine and Public Health Preparedness
  • ISSN: 1935-7893
  • EISSN: 1938-744X
  • URL: /core/journals/disaster-medicine-and-public-health-preparedness
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