Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-26T20:59:10.689Z Has data issue: false hasContentIssue false
  • English
  • Français

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

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 

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.)

Footnotes

Conflicts of interest: none

References

1. Lax, P, Prior, K. Major incident pre-hospital care. Surgery (Oxford). 2015;33(9):419–423.Google Scholar
2. Baker, MS. Creating order from chaos: Part I: triage, initial care, and tactical considerations in mass casualty and disaster response. Mil Med. 2007;172(3):232–236.Google Scholar
3. Vassallo, SLJ, Horne, LCS, Ball, S, Whitley, LJ. UK triage the validation of a new tool to counter an evolving threat. Injury. 2014;45(12):2071–2075.Google Scholar
4. Bostick, NA, Subbarao, I, Burkle, FMJ, Hsu, EB, Armstrong, JH, James, JJ. Disaster triage systems for large-scale catastrophic events. Disaster Med Public Health Prep. 2008;2 Suppl 1:S35–S39.Google Scholar
5. Jenkins, JL, McCarthy, ML, Sauer, LM, et al. Mass-casualty triage: time for an evidence-based approach. Prehosp Disaster Med. 2008;23(1):3–8.Google Scholar
6. Helenis, M. Major incident medical management and support: the practical approach at the scene. Emerg Nurse. 2012;20(3):9.Google Scholar
7. Benson, M, Koenig, KL, Schultz, CH. Disaster triage: START, then SAVE--a new method of dynamic triage for victims of a catastrophic earthquake. Prehosp Disaster Med. 1996;11(2):117–124.Google Scholar
8. Martí, R, Robles, S, Martín-Campillo, A, Cucurull, J. Providing early resource allocation during emergencies: the mobile triage tag. J Netw Comput Appl. 2009;32(6):1167–1182.Google Scholar
9. Frykberg, ER. Triage: principles and practice. Scand J Surg. 2005;94(4):272–278.Google Scholar
10. Frykberg, ER. Medical management of disasters and mass casualties from terrorist bombings: how can we cope? J Trauma. 2002;53(2):201–212.Google Scholar
11. Van Laarhoven, JJEM, Lansink, KWW, Van Heijl, M, Lichtveld, RA, Leenen, LPH. Accuracy of the field triage protocol in selecting severely injured patients after high energy trauma. Injury. 2014;45(5):869–873.Google Scholar
12. Postma, ILE, Weel, H, Heetveld, MJ, et al. Patient distribution in a mass casualty event of an airplane crash. Injury. 2013;44(11):1574–1578.Google Scholar
13. Postma, ILE, Weel, H, Heetveld, MJ, et al. Mass casualty triage after an airplane crash near Amsterdam. Injury. 2013;44(8):1061–1067.Google Scholar
14. Fitzharris, M, Stevenson, M, Middleton, P, Sinclair, G. Adherence with the pre-hospital triage protocol in the transport of injured patients in an urban setting. Injury. 2012;43(9):1368–1376.Google Scholar
15. Wong, C, Lui, C, So, F, Tsui, K TS. Prevalence and predictors of under-diversion in the primary trauma diversion system in Hong Kong. Hong Kong J Emerg Med. 2013;20(5):276–286.Google Scholar
16. Robertson‐Steel, I. Evolution of triage systems. EMJ. 2006;23(2):154–155.Google Scholar
17. Van Hoving, D, Lategan, H, Wallis, L, Smith, W. The epidemiology of major incidents in the Western Cape Province. South African Medical Journal. 2015;105(10):831.Google Scholar
18. Annual Report: 1 April 2016 to 31 March 2017; Provincial Disaster Management Centre. Cape Town, South Africa; 2017. https://www.westerncape.gov.za/sites/www.westerncape.gov.za/files/wcdmc_-_annual_report_16-17-_signed_copy.pdf. Accessed November 4, 2017.Google Scholar
19. Mackway-Jones, K. Major Incident Medical Management and Support: The Practical Approach at the Scene. Hoboken, New Jersey: Wiley-Blackwell; 2011:89–102.Google Scholar
20. Smith, W. Triage in mass casualty situations. CME. 2012;30(11):413–415.Google Scholar
21. Statistics South Africa: Mid-year population estimates. Pretoria. July 2017; http://www.statssa.gov.za/publications/P0302/P03022017.pdf. Accessed November 4, 2017.Google Scholar
22. Statistics South Africa. Census 2011 Municipal Report – Western Cape. Pretoria: SSA, 2012. https://www.statssa.gov.za/Census2011/Products/WC_Municipal_Report.pdf. Accessed September 4, 2014.Google Scholar
23. Deluhery, MR, Lerner, EB, Pirrallo, RG, Schwartz, RB. Paramedic accuracy using SALT triage after a brief initial training. Prehospital Emerg Care. 2011;15(4):526–532.Google Scholar
24. Lee, CWC, McLeod, SL, Van Aarsen, K, Klingel, M, Franc, JM, Peddle, MB. First responder accuracy using SALT during mass-casualty incident simulation. Prehosp Disaster Med. 2016;31(2):150–154.Google Scholar
25. Sapp, RF, Brice, JH, Myers, JB, et al. Triage performance of first-year medical students using a multiple-casualty scenario, paper exercise. Prehosp Disaster Med. 2010;25(3):239–245.Google Scholar
26. Challen, K WD. Major incident triage: comparative validation using data from 7th July bombings. Injury. 2013;44(5):629–633.Google Scholar
27. Carron, PN, Taffe, P, Ribordy, V, et al. Accuracy of prehospital triage of trauma patients by emergency physicians: a retrospective study in western Switzerland. Eur J Emerg Med. 2011;18(2):86–93.Google Scholar
28. Kilner, T HF. Triage decisions of United Kingdom police firearms officers using a multiple-casualty scenario paper exercise. Prehosp Disaster Med. 2005;20(1):40–46.Google Scholar
29. Nilsson, A, et al. Improved and sustained triage skills in firemen after a short training intervention. Scandinavian J Trauma, Resuscitation, and Emerg Med. 2015;23:81.Google Scholar
Supplementary material: File

Alenyo et al. supplementary material

Appendices

Download Alenyo et al. supplementary material(File)
File 19 KB