Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-10T13:09:49.425Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access Rights & Permissions [Opens in a new window]

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. National Counterterrorism Center: Report on incidents of terrorism 2005. Available at http://www.fas.org/irp/threat/nctc2005.pdf. Accessed 10 January 2007.Google Scholar
2. Greenberg, MI, Hendrickson, RG, CIMERC, Drexel University Emergency Department Terrorism Preparedness Consensus: Report of the CIMERC/Drexel University Emergency Department Terrorism Preparedness Consensus Panel. Acad Emerg Med 2003;10:783–738.Google ScholarPubMed
3. US Centers for Disease Control and Prevention: Oubreak of Ebola Viral Hemorrhagic Fever—Zaire, 1995. MMWR 1995;44:381–382.Google Scholar
4. Nozaki, H, Hori, S, Shinozawa, Y., Fujishima, S, Takuma, K, Sagoh, M, Kimura, H, Ohki, T, Suzuki, M, Aikawa, N: Secondary exposure of medical staff to sarin vapor in the emergency room. Intensive Care Med 1995;21:1032–1035.CrossRefGoogle ScholarPubMed
5. Varia, M, Wilson, S, Sarwal, S, McGeer, A, Gournis, E, Galanis, E, Henry, B, Hospital Outbreak Investigation, T: Investigation of a nosocomial outbreak of severe acute respiratory syndrome (SARS) in Toronto, Canada. CMAJ 2003;169:285–292.Google Scholar
6. Miller, GT, Scott, JA, Gordon, DL, Issenberg, SB, Brotons, AA: Training for acts of terrorism. The University of Miami introduces a new curriculum for EMS personnel emphasizing practical skills and simulation training. JEMS 2003;28:48–55.Google Scholar
7. Parrish, AR, Oliver, S, Jenkins, D, Ruscio, B, Green, JB, Colenda, C: A short medical school course on responding to bioterrorism and other disasters. Acad Med 2005;80:820–823.CrossRefGoogle Scholar
8. Pryor, E, Heck, E, Norman, L, Weiner, B, Mathews, R, Black, J, Terndrup, T: Integrated decision-making in response to weapons of mass destruction incidents: Development and initial evaluation of a course for healthcare professionals. Prehospital Disast Med 2006;21:24–30.CrossRefGoogle ScholarPubMed
9. Westphal, RG, Jewell, S, Skawinski, E: Development of an on-line bioterrorism preparedness course. J Public Health Manag Pract 2005;Suppl:s132–s134.Google Scholar
10. Kyle, RR, Via, DK, Lowy, RJ, Madsen, JM, Marty, AM, Mongan, PD: A multi-disciplinary approach to teach responses to weapons of mass destruction and terrorism using combined simulation modalities. J Clin Anes 2004;16:152–158.CrossRefGoogle Scholar
11. Subbarao, I, Bond, W, Johnson, C, Hsu, E, Wasser, T: Using innovative simulation modalities for civilian-based, chemical, biological, radiological, nuclear, and explosive training in the acute management of terrorist victims: A pilot study. Prehospital Disast Med 2006;21:272–275.CrossRefGoogle ScholarPubMed
12. Berkenstadt, H, Ziv, A, Barsuk, D, Levine, I, Cohen, A, Vardi, A: The use of advanced simulation in the training of anesthesiologists to treat chemical warfare casualties. Anesthes Analg 2003;96:1739–1742.CrossRefGoogle ScholarPubMed
13. Lester, J, Christos, S, Kordick, M, Chan, S: Terrorism: Would emergency physicians be able to recognize terrorism syndromes? Ann Emerg Med 2006;48:51. (Abstract).Google Scholar
14. Leiba, A, Goldberg, A, Hourvitz, A, Amsalem, Y, Aran, A, Weiss, G, Leiba, R, Yehezkelli, Y, Goldberg, A, Levi, Y, Bar-Dayan, Y: Lessons learned from clinical anthrax drills: Evaluation of knowledge and preparedness for a bioterrorist threat in Israeli emergency departments. Ann Emerg Med 2006;48:194–199.CrossRefGoogle ScholarPubMed
15. Jasper, E, Lewis, J, Berg, D, Gates, E: Evaluation of full scale exercise participation as a tool to improve hospital preparedness for a radiological terrorism event. Ann Emerg Med 2006;48:52 (Abstract).CrossRefGoogle Scholar
16. Terrorism Response Task Force of the American College of Emergency Physicians: Positioning America's emergency health care system to respond to acts of terrorism, 2002.Google Scholar
17. Henretig, FM, Cieslak, TJ, Kortepeter, MG, Fleisher, GR: Medical management of the suspected victim of bioterrorism: An algorithmic approach to the undifferentiated patient. Emerg Med Clinics North America 2002;20:351–364 CrossRefGoogle Scholar
18. Cieslak, TJ, Rowe, JR, Kortepeter, MG, Madsen, JM, Newmark, J, Christopher, GW, Culpepper, RC, Eitzen, EM Jr: A field-expedient algorithmic approach to the clinical management of chemical and biological casualties. Mil Med 2000;165:659–662.CrossRefGoogle Scholar
19. Bond, W, Subbarao, I, Schwid, H, Bair, A, Johnson, C: Using screen-based computer simulation to design and test a civilian, symptom-based terrorism triage algorithm. International Trauma Care 2006;16:19–25.Google Scholar
20. Subbarao, I, Johnson, C, Bond, W, Schwid, H, Wasser, T, Deye, G, Burkhart, K: Symptom-based, algorithmic approach for handling the initial encounter with victims of a potential terrorist attack. Prehospital Disast Med 2005;20:301–308.CrossRefGoogle ScholarPubMed
21. Departments of the Army, the Navy, and the Air Force, and Commandant, Marine Corps: Field Manual: Treatment of Chemical Agent Casualties an Conventional Military Chemicial Injuries. Departments of the Army, the Navy, and the Air Force, and Commandant, Marine Corps, 2000.Google Scholar
22. Cureton, E: The upper and lower twenty-seven per cent rule. Psychometrika 1957:22:293–296.CrossRefGoogle Scholar
23. Allen, M, Yen, W: Introduction to Measurement Theory. Belmont, CA: Wadsworth 1979.Google Scholar
24. Casebeer, L, Andolsek, K, Abdolrasulnia, M, Green, J, Weissman, N, Pryor, E, Zheng, S, Terndrup, T: Evaluation of an online bioterrorism continuing medical education course. J Contin Educ Health Prof 2006;26:137–144.CrossRefGoogle ScholarPubMed
25. Johns Hopkins University Evidence-Based Practice Center: Training of Clinicians for Public Health Events Relevant to Bioterrorism Preparedness. Agency for Healthcare Research and Quality, 2001.Google Scholar
26. Terndrup, T, Nafziger, S, Weissman, N, Casebeer, L, Pryor, E: Online bioterrorism continuing medical education: Development and preliminary testing. Acad Emerg Med 2005;12:45–50.CrossRefGoogle ScholarPubMed
27. Health Resources and Services Administration: National Bioterrorism Hospital Preparedness Program Fiscal Year 2007 justification for Appropriations Committees. Available at http://www.hrsa.gov/about/budgetjustification07/NationalBioterrorismHospitalPreparednessProgram.htm. Accessed 02 April 2007.Google Scholar