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A Modified Simple Triage and Rapid Treatment Algorithm from the New York City (USA) Fire Department

Published online by Cambridge University Press:  17 February 2015

Faizan H. Arshad ,
Alan Williams ,
Glenn Asaeda ,
Douglas Isaacs ,
Bradley Kaufman ,
David Ben-Eli ,
Dario Gonzalez ,
John P. Freese ,
Joan Hillgardner  and
Jessica Weakley
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Faizan H. Arshad
Affiliation:
Fire Department of the City of New York, Office of Medical Affairs, Brooklyn, New York USA
Alan Williams
Affiliation:
Fire Department of the City of New York, Office of Medical Affairs, Brooklyn, New York USA
Glenn Asaeda
Affiliation:
Fire Department of the City of New York, Office of Medical Affairs, Brooklyn, New York USA
Douglas Isaacs
Affiliation:
Fire Department of the City of New York, Office of Medical Affairs, Brooklyn, New York USA
Bradley Kaufman
Affiliation:
Fire Department of the City of New York, Office of Medical Affairs, Brooklyn, New York USA
David Ben-Eli
Affiliation:
Fire Department of the City of New York, Office of Medical Affairs, Brooklyn, New York USA
Dario Gonzalez
Affiliation:
Fire Department of the City of New York, Office of Medical Affairs, Brooklyn, New York USA
John P. Freese
Affiliation:
Fire Department of the City of New York, Office of Medical Affairs, Brooklyn, New York USA
Joan Hillgardner
Affiliation:
Fire Department of the City of New York, Office of Medical Affairs, Brooklyn, New York USA
Jessica Weakley
Affiliation:
Fire Department of the City of New York, Office of Medical Affairs, Brooklyn, New York USA Montefiore Medical Center, Department of Medicine, Bronx, New York USA
Charles B. Hall
Affiliation:
Fire Department of the City of New York, Office of Medical Affairs, Brooklyn, New York USA Montefiore Medical Center, Department of Medicine, Bronx, New York USA Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, New YorkUSA
Mayris P. Webber
Affiliation:
Fire Department of the City of New York, Office of Medical Affairs, Brooklyn, New York USA Montefiore Medical Center, Department of Medicine, Bronx, New York USA Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, New YorkUSA
David J. Prezant*
Affiliation:
Fire Department of the City of New York, Office of Medical Affairs, Brooklyn, New York USA Montefiore Medical Center, Department of Medicine, Bronx, New York USA Albert Einstein College of Medicine, Department of Medicine, Pulmonary Division, Bronx, New YorkUSA
*
Correspondence: David J. Prezant, MD Chief Medical Officer Fire Department of the City of New York 9 Metrotech Center (room 8N-7) Brooklyn, New York 11201 USA E-mail David.Prezant@fdny.nyc.gov
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Abstract

Introduction

The objective of this study was to determine if modification of the Simple Triage and Rapid Treatment (START) system by the addition of an Orange category, intermediate between the most critically injured (Red) and the non-critical, non-ambulatory injured (Yellow), would reduce over- and under-triage rates in a simulated mass-casualty incident (MCI) exercise.

Methods

A computer-simulation exercise of identical presentations of an MCI scenario involving a 2-train collision, with 28 case scenarios, was provided for triaging to two groups: the Fire Department of the City of New York (FDNY; n = 1,347) using modified START, and the Emergency Medical Services (EMS) providers from the Eagles 2012 EMS conference (Lafayette, Louisiana USA; n = 110) using unmodified START. Percent correct by triage category was calculated for each group. Performance was then compared between the two EMS groups on the five cases where Orange was the correct answer under the modified START system.

Results

Overall, FDNY-EMS providers correctly triaged 91.2% of cases using FDNY-START whereas non-FDNY-Eagles providers correctly triaged 87.1% of cases using unmodified START. In analysis of the five Orange cases (chest pain or dyspnea without obvious trauma), FDNY-EMS performed significantly better using FDNY-START, correctly triaging 86.3% of cases (over-triage 1.5%; under-triage 12.2%), whereas the non-FDNY-Eagles group using unmodified START correctly triaged 81.5% of cases (over-triage 17.3%; under-triage 1.3%), a difference of 4.9% (95% CI, 1.5-8.2).

Conclusions

The FDNY-START system may allow providers to prioritize casualties using an intermediate category (Orange) more properly aligned to meet patient needs, and as such, may reduce the rates of over-triage compared with START. The FDNY-START system decreases the variability in patient sorting while maintaining high field utility without needing computer assistance or extensive retraining. Comparison of triage algorithms at actual MCIs is needed; however, initial feedback is promising, suggesting that FDNY-START can improve triage with minimal additional training and cost.

ArshadFH, WilliamsA, AsaedaG, IsaacsD, KaufmanB, Ben-EliD, GonzalezD, FreeseJP, HillgardnerJ, WeakleyJ, HallCB, WebberMP, PrezantDJ. A Modified Simple Triage and Rapid Treatment Algorithm from the New York City (USA) Fire Department. Prehosp Disaster Med. 2015;30(2):1-6.

Keywords

assessmentdisasterEmergency Medical Servicesmass-casualty incidentsimulationtriage
Type
Brief Report
Information
Prehospital and Disaster Medicine , Volume 30 , Issue 2 , April 2015 , pp. 199 - 204
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2015 

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