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A Comparison Between Differently Skilled Prehospital Emergency Care Providers in Major-Incident Triage in South Africa

Published online by Cambridge University Press:  29 August 2018

Annet Ngabirano Alenyo ,
Wayne P. Smith ,
Michael McCaul  and
Daniel J. Van Hoving
Annet Ngabirano Alenyo*
Affiliation:
Division of Emergency Medicine, Stellenbosch University, Stellenbosch, South Africa
Wayne P. Smith
Affiliation:
Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
Michael McCaul
Affiliation:
Biostatistics Unit, Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics,Stellenbosch University, Stellenbosch, South Africa
Daniel J. Van Hoving
Affiliation:
Division of Emergency Medicine, Stellenbosch University, Stellenbosch, South Africa
*
Correspondence: Annet Ngabirano Alenyo Division of Emergency Medicine Stellenbosch University Francie Van Zijl Dr.Tygerberg HospitalCape Town, South Africa 7505 E-mail: aalenyo@yahoo.com
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Abstract

Introduction

Major-incident triage ensures effective emergency care and utilization of resources. Prehospital emergency care providers are often the first medical professionals to arrive at any major incident and should be competent in primary triage. However, various factors (including level of training) influence their triage performance.

Hypothesis/Problem

The aim of this study was to determine the difference in major-incident triage performance between different training levels of prehospital emergency care providers in South Africa utilizing the Triage Sieve algorithm.

Methods

This was a cross-sectional study involving differently trained prehospital providers: Advanced Life Support (ALS); Intermediate Life Support (ILS); and Basic Life Support (BLS). Participants wrote a validated 20-question pre-test before completing major-incident training. Two post-tests were also completed: a 20-question written test and a three-question face-to-face evaluation. Outcomes measured were triage accuracy and duration of triage. The effect of level of training, gender, age, previous major-incident training, and duration of service were determined.

Results

A total of 129 prehospital providers participated. The mean age was 33.4 years and 65 (50.4%) were male. Most (n=87; 67.4%) were BLS providers. The overall correct triage score pre-training was 53.9% (95% CI, 51.98 to 55.83), over-triage 31.4% (95% CI, 29.66 to 33.2), and under-triage 13.8% (95% CI, 12.55 to 12.22). Post-training, the overall correct triage score increased to 63.6% (95% CI, 61.72 to 65.44), over-triage decreased to 17.9% (95% CI, 16.47 to 19.43), and under-triage increased to 17.8% (95% CI, 16.40 to 19.36). The ALS providers had both the highest likelihood of a correct triage score post-training (odds ratio 1.21; 95% CI, 0.96-1.53) and the shortest duration of triage (median three seconds, interquartile range two to seven seconds; P=.034). Participants with prior major-incident training performed better (P=.001).

Conclusion

Accuracy of major-incident triage across all levels of prehospital providers in South Africa is less than optimal with non-significant differences post-major-incident training. Prior major-incident training played a significant role in triage accuracy indicating that training should be an ongoing process. Although ALS providers were the quickest to complete triage, this difference was not clinically significant. The BLS and ILS providers with major-incident training can thus be utilized for primary major-incident triage allowing ALS providers to focus on more clinical roles.

AlenyoAN, SmithWP, McCaulM, Van HovingDJ. A Comparison Between Differently Skilled Prehospital Emergency Care Providers in Major-Incident Triage in South Africa. Prehosp Disaster Med. 2018;33(6):575–580.

Keywords

low-resource settingmajor incidentprehospitalSouth Africatriage sieve
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 33 , Issue 6 , December 2018 , pp. 575 - 580
Copyright
© World Association for Disaster and Emergency Medicine 2018 

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Footnotes

Conflicts of interest: none

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