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Testing the Use of Symptom-Based Terrorism Triage Algorithms with Hospital-Based Providers

Part of: Prehospital and Disaster Medicine Counterterrorism Collection

Published online by Cambridge University Press:  17 February 2017

William F. Bond ,
Italo Subbarao ,
Sharon R. Kimmel ,
Jeffrey Kuklinski ,
Christopher Johnson ,
Mary Eberhardt  and
John Vozenilek
William F. Bond*
Affiliation:
Department of Emergency Medicine, Lehigh Valley Hospital and Health Network, Allentown, Pennsylvania, USA
Italo Subbarao
Affiliation:
Office of Public Health Preparedness, The American Medical Association, Chicago, Illinois, USA
Sharon R. Kimmel
Affiliation:
Division of Health Studies, Lehigh Valley Hospital and Health Network, Allentown, Pennsylvania, USA
Jeffrey Kuklinski
Affiliation:
Department of Emergency Medicine, Lehigh Valley Hospital and Health Network, Allentown, Pennsylvania, USA
Christopher Johnson
Affiliation:
Department of Emergency Medicine, Munroe Regional Medical Center, Ocala, Florida, USA
Mary Eberhardt
Affiliation:
Department of Emergency Medicine, St. Luke's Hospital, Bethlehem, Pennsylvania, USA
John Vozenilek
Affiliation:
Department of Emergency Medicine, Evanston Northwestern Healthcare, Evanston, Illinois, USA
*
William Bond, MD Lehigh Valley Hospital and Health Network Suite 202 1247 Cedar Crest Blvd. Allentown, PA 18105 USA, E-mail: william.bond@lvh.com
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Abstract

Introduction: A set of symptom-based, all-hazards, decision-making algorithms was designed to aid the first-contact provider during early patient presentations after a terrorist incident.

Objective: The primary objective was to assess the usability of these algorithms. A secondary objective was to assess the psychometric properties of the testing scenarios.

Methods: This was a written, usability assessment of the algorithms employing a convenience sample of hospital-based, healthcare providers who had not taken any specific training in the use of the algorithms. A series of 26 paragraph-length, moderately difficult scenarios was created to reflect possible agents, means of attack, and types of patients. Each of the 26 scenarios requires that one make a triage choice on the “attack” algorithm (the trunk algorithm), then proceed to one of four other branch algorithms (dirty resuscitation, chemical agents, biological agents, bomb/blast/radiation dispersal device) to make a final triage choice. Conditional scores based on getting both the attack and final card correct were calculated for each algorithm.

Results: Nineteen attending physicians, 50 emergency medicine residents, and 41 nurses took the assessment. The total score was 45% correct for all participants. The score on the attack algorithm was 66% correct. Dirty resuscitation, biological, chemical, and bomb/blast scores were 46%, 54%, 46%, and 51% respectively. The probability of guessing the correct answer on the attack algorithm was 1/7 or 14%. The conditional probability of guessing both the attack algorithm and the final card correct ranged from 4.7% for the biological, chemical, and bomb/blast algorithms to 2.4% for the dirty resuscitation algorithm. Item discrimination, item difficulty, and Cronbach's alpha were acceptable for the overall test. Certain individual items had item difficulty levels suggesting they were too difficult and should be replaced in future versions of the test.

Conclusions: Performance on the test suggests that participants did substantially better than would have been expected by chance alone. Future efforts will revise the algorithms with the goal of simplification. Revision of the testing instrument and testing algorithm use after instruction also are needed.

Keywords

algorithmbioterrorismchemicalbiologicalradiologicalnuclearor explosiveterrorismtriage
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 23 , Issue 3 , June 2008 , pp. 234 - 241
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2008

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