3 results
A Modified Simple Triage and Rapid Treatment Algorithm from the New York City (USA) Fire Department
- Faizan H. Arshad, Alan Williams, Glenn Asaeda, Douglas Isaacs, Bradley Kaufman, David Ben-Eli, Dario Gonzalez, John P. Freese, Joan Hillgardner, Jessica Weakley, Charles B. Hall, Mayris P. Webber, David J. Prezant
-
- Journal:
- Prehospital and Disaster Medicine / Volume 30 / Issue 2 / April 2015
- Published online by Cambridge University Press:
- 17 February 2015, pp. 199-204
- Print publication:
- April 2015
-
- Article
- Export citation
-
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.
MethodsA 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.
ResultsOverall, 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).
ConclusionsThe 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.
. ,Arshad FH ,Williams A ,Asaeda G ,Isaacs D ,Kaufman B ,Ben-Eli D ,Gonzalez D ,Freese JP ,Hillgardner J ,Weakley J ,Hall CB ,Webber MP .Prezant DJ A Modified Simple Triage and Rapid Treatment Algorithm from the New York City (USA) Fire Department . Prehosp Disaster Med.2015 ;30 (2 ):1 -6
Contributors
-
- By Jon G. Allen, Robert F Anda, Susan L. Andersen, Carl M. Anderson, Wendy d’ Andrea, Tal Astrachan, Anthony W. Bateman, Carla Bernardes, Renato Borgatti, Bekh Bradley, J. Douglas Bremner, John Briere, Amy F. Buckley, Jean-Francois Bureau, Kathleen M. Chard, Dennis Charney, Anthony Charuvastra, Jeewook Choi, Marylene Cloitre, Melody D. Combs, Constance J. Dalenberg, Martin J. Dorahy, Michael D. De Bellis, Anne P. DePrince, Erin C. Dunn, Vincent J. Felitti, Philip A. Fisher, Peter Fonagy, Julian D. Ford, Amit Goldenberg, Megan R. Gunnar, Udi Harari, Felicia Heidenreich, Christine Heim, Judith Herman MD, Monica Hodges, Shlomit Jacobson-Pick, Joan Kaufman, Karestan C. Koenen, Ruth A. Lanius, Jamie L. LaPrairie, Alicia F. Lieberman, Richard J. Loewenstein, Sonia J. Lupien MD, Karlen Lyons-Ruth, Jodi Martin, Bruce McEwen, Alexander C. McFarlane, Rosario Montirosso, Charles B. Nemeroff, Pat Ogden, Fatih Ozbay, Clare Pain, Kelsey Paulson, Oxana G. Palesh, Ms. Keren Rabi, Gal Richter-Levin, Andrea L. Roberts, Cécile Rousseau, Cécile Rousseau, Monica Ruiz-Casares, Christian Schmahl, Allan N. Schore, Sally B. Seraphin, Vansh Sharma, Yi-Shin Sheu, Kelly Skelton, Steven Southwick, David Spiegel, Deborah M. Stone, Nathan Szajnberg, Martin H. Teicher, Akemi Tomoda, Ed Tronick, Onno van der Hart, Bessel van der Kolk, Eric Vermetten, Tamara Weiss, Victor Welzant
- Edited by Ruth A. Lanius, University of Western Ontario, Eric Vermetten, Universiteit Utrecht, The Netherlands, Clare Pain, University of Toronto
-
- Book:
- The Impact of Early Life Trauma on Health and Disease
- Published online:
- 03 May 2011
- Print publication:
- 05 August 2010, pp vii-xii
-
- Chapter
- Export citation
Impact of Citywide Blackout on an Urban Emergency Medical Services System
- John Freese, Neal J. Richmand, Robert A. Silverman, James Braun, Bradley J. Kaufman, John Clair
-
- Journal:
- Prehospital and Disaster Medicine / Volume 21 / Issue 6 / December 2006
- Published online by Cambridge University Press:
- 28 June 2012, pp. 372-378
- Print publication:
- December 2006
-
- Article
- Export citation
-
Introduction:
On 14 August 2003, New York City and a large portion of the northeastern United States experienced the largest blackout in the history of the country. An analysis of such a widespread disaster on emergency medical service (EMS) operations may assist in planning for and managing such disasters in the future.
Methods:A retrospective review of all EMS activity within New York City's 9-1-1 emergency telephone system during the 29 hours during which all or parts of the city were without power (16:11 hours (h) on 14 August 2003 until 21:03 h on 15 August 2003) was performed. Control periods were established utilizing identical time periods during the five weeks preceding the blackout.
Results:Significant increases were identified in the overall EMS demand (7,844 incidents vs. 3,860 incidents; p<0.001) as well as in 20 of the 62 calltypes of the system, including ca rd i ac arrests (119 vs.76, p= 0.043).Significant decreases were found only among calls related to psychological emergencies (114 vs. 221; p= 0.006) and drugor alcohol-related emergencies (78 vs. 146; p = 0.009). Though median response times increased by only 60 seconds, median call-processing times within the 9-1-1 emergency telephone system EMS dispatch center of the city increased from 1.1 to 5.5 minutes.
Conclusions:The citywide blackout resulted in dramatic changes in the demands upon the EMS system of New York City, the types of patients for whom EMS providers were assigned to provide care, and the dispositions for those assignments. During this time of increased, system-wide demand, the use of cross-trained firefighter and first-responder engine companies resulted in improved response times to cardiac arrest patients. Finally, the ability of the EMS dispatch center to process the increased requests for EMS assistance proved to be the rate-limiting step in responding to these emergencies.These findings will prove useful in planning for future blackouts or any disaster that may broadly impact the infrastructure of a city.