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Little is known about the preparedness of hospitals to care for pediatric patients during a major incident in Japan. This study assessed the disaster preparedness of a children’s hospital in Japan by using a disaster drill.
Materials and Methods
We performed a triage drill with all hospitalized patients. The triage tags and medical records were reviewed retrospectively. We determined the efficacy of triage education, the validity of the Simple Triage and Rapid Treatment (START) method for children, and the potential need for evacuation through the disaster drill.
This study highlights 3 important issues about the hospital’s preparedness. First, it is difficult to promote disaster education for staff who are not well trained on handling disasters. Second, the START method is suitable for children older than 5 years, but it has a high rate of over-triaging among younger children. Third, approximately 40% of patients who are coded as immediate may require transportation resources in a hospital evacuation.
Our findings suggest that disaster preparedness, such as educating hospital staff regarding disasters and establishing evacuation systems for a number of pediatric patients when a disaster happens, is essential for caring for hospitalized children during a mass casualty incident. (Disaster Med Public Health Preparedness. 2019;13:429-432)
To compare emergency department triage nurses’ time to triage and accuracy of a simulated mass casualty incident (MCI) population using a computerized version of CTAS or START systems.
This pilot study was a prospective trial using a convenience sample. A total of 20 ED triage nurses, 10 in each arm of the study, were recruited. The paper-based questionnaire contained nine simulated MCI vignettes. An expert panel arrived at consensuses on the wording of the vignettes and created a standard triage score from which to compare the study participants. Linear regression and chi-squared test were used to examine the time to triage and accuracy of triage, respectively.
The mean triage time for computerized CTAS (cCTAS) and START were 138 seconds/patient and 33 seconds/patient, respectively. The effect size due to triage method was 108 seconds/patient (95% CI 83-134 seconds/patient). The cumulative triage accuracy for the cCTAS and START tools were 70/90 (77.8%) and 65/90 (72.2%), respectively. The percent difference between cumulative triage was 6% (95% CI −19-8%).
Triage nurses completed START triage 105 seconds/patient faster when compared to cCTAS triage and a similar level of accuracy between the two methods was achieved. However, when the typing time is taken into consideration cCTAS took 45 seconds/patient longer. The use of either CTAS or START in the ED during a MCI may be reasonable but choosing one method over another is not justified from this investigation.
Primary triage in a mass-casualty event setting using low-visibility tags may lead to informational confusion and difficulty in judging triage attribution of patients. In this simulation study, informational confusion during primary triage was investigated using a method described in a prior study that applied Shannon’s Information Theory to triage.
Primary triage using a low-visibility tag leads to a risk of informational confusion in prioritizing care, owing to the intermingling of pre- and post-triage patients. It is possible that Shannon’s entropy evaluates the degree of informational confusion quantitatively and improves primary triage.
The Simple Triage and Rapid Treatment (START) triage method was employed. In Setting 1, entropy of a triage area with 32 patients was calculated for the following situations: Case 1 – all 32 patients in the triage area at commencement of triage; Case 2 – 16 randomly imported patients to join 16 post-triage patients; Case 3 – eight patients imported randomly and another eight grouped separately; Case 4 – 16 patients grouped separately; Case 5 – random placement of all 32 post-triage patients; Case 6 – isolation of eight patients of minor priority level; Case 7 – division of all patients into two groups of 16; and Case 8 – separation of all patients into four categories of eight each. In Setting 2, entropies in the triage area with 32 patients were calculated continuously with each increase of four post-triage patients in Systems A and B (System A – triage conducted in random manner; and System B – triage arranged into four categories).
In Setting 1, entropies in Cases 1-8 were 2.00, 3.00, 2.69, 2.00, 2.00, 1.19, 1.00, and 0.00 bits/symbol, respectively. Entropy increased with random triage. In Setting 2, entropies of System A maintained values the same as, or higher than, those before initiation of triage: 2.00 bits/symbol throughout the triage. The graphic waveform showed a concave shape and took 3.00 bits/symbol as maximal value when the probability of each category was 1/8, whereas the values in System B showed a linear decrease from 2.00 to 0.00 bits/symbol.
Informational confusion in a primary triage area measured using Shannon’s entropy revealed that random triage using a low-visibility tag might increase the degree of confusion. Methods for reducing entropy, such as enhancement of triage colors, may contribute to minimizing informational confusion.
AjimiY, SasakiM, UchidaY, KanekoI, NakaharaS, SakamotoT. Primary Triage in a Mass-casualty Event Possesses a Risk of Increasing Informational Confusion: A Simulation Study Using Shannon’s Entropy. Prehosp Disaster Med. 2016;31(5):498–504.
This chapter presents a description of the triage systems. These systems include Simple Triage and Rapid Treatment (START), Homebush Triage Standard, CareFlight Triage, Triage Sieve, the Sacco Triage Method, the CESIRA Protocol, MASS Triage, and Military/NATO Triage. The chapter provides a brief discussion of the Sort, Assess, Lifesaving measures, Treat/Transport (SALT) system. SALT begins with a global sorting of patients to prioritize them for individual assessment. The chapter discusses the secondary triage systems SAVE and Triage Sort, as well as the pediatric specific systems, JumpSTART and the Pediatric Triage Tape. There are two categories of outcomes that could be used in assessing how triage affects patient outcome: patient-based scoring systems and resource based systems. Specific attention to chemical, biological, and radiological/nuclear (CBRN) events is a critical component of state of the art triage systems and must be considered when choosing a triage methodology.
Terrorist attacks have occurred in Tel-Aviv that have caused mass-casualties.The objective of this study was to draw lessons from the medical response to an event that occurred on 19 January 2006, near the central bus station, Tel-Aviv, Israel. The lessons pertain to the management of primary triage, evacuation priorities, and rapid primary distribution between adjacent hospitals and the operational mode of the participating hospitals during the event.
Data were collected in formal debriefings both during and after the event. Data were analyzed to learn about medical response components, interactions, and main outcomes. The event is described according to Disastrous Incidents Systematic AnalysiS Through—Components, Interactions and Results (DISAST-CIR) methodology.
A total of 38 wounded were evacuated from the scene, including one severely injured, two moderately injured, and 35 mildly injured. The severe casualty was the first to be evacuated 14 minutes after the explosion. All of the casualties were evacuated from the scene within 29 minutes. Patients were distributed between three adjacent hospitals including one non-Level-1 Trauma Center that received mild casualties. Twenty were evacuated to the nearby, Level-1 Sourasky Medical Center, including the only severely injured patient. Nine mildly injured patients were evacuated to the Sheba Medical Center and nine to Wolfson Hospital, a non-Level-1 Trauma Center hospital. All the receiving hospitals were operated according to the mass-casualty incident doctrine.
When a mass-casualty incident occurs in the vicinity of more than one hospital, primary triage, evacuation priority decision-making, and rapid distribution of casualties between all of the adjacent hospitals enables efficient and effective containment of the event.
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