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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
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- Journal:
- Prehospital and Disaster Medicine / Volume 30 / Issue 2 / April 2015
- Published online by Cambridge University Press:
- 17 February 2015, pp. 199-204
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- April 2015
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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
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- By Naila A. Ahmad, Dua M. Anderson, Jennifer Aunspaugh, Sabrina T. Bent, Adam Broussard, Staci Cameron, Rahul Dasgupta, Ravinder Devgun, Ofer N. Eytan, Sean H. Flack, Terry G. Fletcher, Charles James Fox, Mary Elise Fox, Scott Friedman, Louise K. Furukawa, Sonja Gennuso, Stanley M. Hall, Hani Hanna, Jacob Hummel, James E. Hunt, Ranu Jain, Joe R. Jansen, Deepa Kattail, Alan David Kaye, David J. Krodel, Gregory J. Latham, Sungeun Lee, Michael G. Levitzky, Alexander Y. Lin, Carl Lo, Hoa N. Luu, Camila Lyon, Kelly A. Machovec, Lizabeth D. Martin, Maria Matuszczak, Patrick S. McCarty, Brenda C. McClain, J. Grant McFadyen, Helen Nazareth, Dolores B. Njoku, Christina M. Pabelick, Shannon M. Peters, Amit Prabhakar, Michael Richards, Kasia Rubin, Joel A. Saltzman, Lisgelia Santana, Gabriel Sarah, Katherine Stammen, John Stork, Kim M. Strupp, Lalitha V. Sundararaman, Rosalie F. Tassone, Douglas R. Thompson, Nicole C. P. Thompson, Paul A. Tripi, Jacqueline L. Tutiven, Navyugjit Virk, Stacey Watt, B. Craig Weldon, Maria Zestus
- Edited by Alan David Kaye, Louisiana State University, Charles James Fox, Tulane University School of Medicine, Louisiana, James H. Diaz, Louisiana State University
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- Essentials of Pediatric Anesthesiology
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- 05 November 2014
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- 16 October 2014, pp ix-xii
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- By Sofya Abazyan, Saskia S. Arndt, Jonathon C. Arnold, Sandra Beeské, Odd-Geir Berge, Valerie J. Bolivar, David Borchelt, Marie-Françoise Chesselet, Yoon H. Cho, Angelo Contarino, John C. Crabbe, Wim E. Crusio, Bianca De Filippis, Mara Dierssen, Stephanie C. Dulawa, Emily C. Eastwood, Haim Einat, Raul R. Gainetdinov, David Gordon, Guy Griebel, F. Scott Hall, John H. Harkness, Christopher Janus, Zhengping Jia, Nirit Kara, Tim Karl, Martien J. H. Kas, Federica Klaus, Robert Lalonde, Glenda Lassi, Giovanni Laviola, Iddo Magen, Stephen C. Maxson, Douglas Ashley Monks, Rebecca E. Nordquist, Lucy R. Osborne, Tamara J. Phillips, Alisdair R. Philp, Marina R. Picciotto, Susanna Pietropaolo, Mikhail V. Pletnikov, Christopher R. Pryce, James L. Resnick, Laura Ricceri, Frans Sluyter, Emily Y. Smith, Ichiro Sora, Tatyana D. Sotnikova, Rebecca C. Steiner, Ortrud K. Steinlein, Catherine Strazielle, Enejda Subashi, Ashlyn Swift-Gallant, Aki Takahashi, Kevin Talbot, Stewart Thompson, Valter Tucci, F. Josef van der Staay, Gertjan van Dijk, Nancy S. Woehrle
- Edited by Susanna Pietropaolo, Centre National de la Recherche Scientifique (CNRS), Paris, Frans Sluyter, University of Portsmouth, Wim E. Crusio, Centre National de la Recherche Scientifique (CNRS), Paris
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- Behavioral Genetics of the Mouse
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- 05 October 2014
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- 25 September 2014, pp ix-xii
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Chapter 5 - Hydropower
- Edited by Ottmar Edenhofer, Ramón Pichs-Madruga, Youba Sokona, Kristin Seyboth, Susanne Kadner, Timm Zwickel, Patrick Eickemeier, Gerrit Hansen, Steffen Schlömer, Christoph von Stechow, Patrick Matschoss
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- Renewable Energy Sources and Climate Change Mitigation
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- 05 December 2011
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- 21 November 2011, pp 437-496
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Summary
Executive Summary
Hydropower offers significant potential for carbon emissions reductions. The installed capacity of hydropower by the end of 2008 contributed 16% of worldwide electricity supply, and hydropower remains the largest source of renewable energy in the electricity sector. On a global basis, the technical potential for hydropower is unlikely to constrain further deployment in the near to medium term. Hydropower is technically mature, is often economically competitive with current market energy prices and is already being deployed at a rapid pace. Situated at the crossroads of two major issues for development, water and energy, hydro reservoirs can often deliver services beyond electricity supply. The significant increase in hydropower capacity over the last 10 years is anticipated in many scenarios to continue in the near term (2020) and medium term (2030), with various environmental and social concerns representing perhaps the largest challenges to continued deployment if not carefully managed.
Hydropower is a renewable energy source where power is derived from the energy of water moving from higher to lower elevations. It is a proven, mature, predictable and typically price-competitive technology. Hydropower has among the best conversion efficiencies of all known energy sources (about 90% efficiency, water to wire). It requires relatively high initial investment, but has a long lifespan with very low operation and maintenance costs. The levelized cost of electricity for hydropower projects spans a wide range but, under good conditions, can be as low as 3 to 5 US cents2005 per kWh.
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. 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- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- The Cambridge Dictionary of Christianity
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- 05 August 2012
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- 20 September 2010, pp xi-xliv
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- By John D. Alderete, Arto Anttila, Diana Archangeli, Eric Baković, Ricardo Bermúdez-Otero, Barbara Bernhardt, Paula Fikkert, Stefan A. Frisch, Matthew Gordon, Carlos Gussenhoven, T. A. Hall, John Harris, René Kager, John Kingston, Paul de Lacy, John J. McCarthy, Alan Prince, Douglas Pulleyblank, Keren Rice, Joseph Paul Stemberger, Donca Steriade, Bruce Tesar, Hubert Truckenbrodt, Suzanne Urbanczyk, Adam Ussishkin, Moira Yip, Draga Zec
- Edited by Paul de Lacy, Rutgers University, New Jersey
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- The Cambridge Handbook of Phonology
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- 05 June 2016
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- 01 February 2007, pp vii-viii
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