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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.
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.
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).
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.
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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