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Triage Decisions of United Kingdom Police Firearms Officers Using a Multiple-Casualty Scenario Paper Exercise

Published online by Cambridge University Press:  28 June 2012

Tim Kilner  and
F. John Hall
Tim Kilner*
Affiliation:
Head of Education and Development, Gloucestershire Ambulance Service NHS Trust, Gloucester, UK
F. John Hall
Affiliation:
Honorary Lecturer in Emergency Care, Department of Anaesthetics, The University of Birmingham, The Medical School, Edgbaston, Birmingham, UK
*
Head of Education and Development, Gloucestershire Ambulance Service, NHS Trust, Triservice Emergency Centre, Waterwells Drive, Waterwells Business Park, Quedgeley, Gloucester, GL2 2BA, UK E-mail: t.kilner@virgin.net
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Abstract

Introduction:

British police officers authorized to carry firearms may need to make judgments about the severity of injury of individuals or the relative priority of clinical need of a group of injured patients in tactical and non-tactical situations. Most of these officers receive little or no medical training beyond basic first aid to enable them to make these clinical decisions. Therefore, the aim of this study is to determine the accuracy of triage decision-making of firearms-trained police officers with and without printed decision-support materials.

Methods:

Eighty-two police firearms officers attending a tactical medicine course (FASTAid) were recruited to the study. Data were collected using a paper-based triage exercise that contained brief, clinical details of 20 adults and 10 children. Subjects were asked to assign a clinical priority of immediate or priority 1 (P1); urgent or priority 2 (P2); delayed or priority 3 (P3); or dead, to each casualty. Then, they were provided with decision-making materials, but were not given any instruction as to how these materials should be used. Subjects then completed a second triage exercise, identical to the first, except this time using the decision-support materials.

Data were analyzed using mixed between-within subjects analysis of variance. This allowed comparisons to be made between the scores for Exercise 1 (no decision-support material) and Exercise 2 (with decision-support material). It also allowed any differences between those students with previous triage training and those without previous training to be explored.

Results:

The use of triage decision-making materials resulted in a significant increase in correct responses (p <0.001). Improvement in accuracy appears to result mainly from a reduction in the extent of under-triage. There were significant differences (p <0.05) between those who had received previous triage training and those who had not, with those having received triage training doing slightly better.

Conclusion:

It appears that significant improvements in the accuracy of triage decision-making by police firearms officers can be achieved with the use of appropriate triage decision-support materials. Training may offer additional improvements in accuracy, but this improvement is likely to be small when decision-support materials are provided. With basic clinical skills and appropriate decision-support materials, it is likely that the police officer can make accurate triage decisions in a multiple-casualty scenario or make judgments of the severity of injury of a given individual in both tactical and non-tactical situations.

Keywords

multiple-casualty incidentpediatric triage tapeTactical Emergency Medical Support (TEMS)triage sievetriage systems
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 20 , Issue 1 , February 2005 , pp. 40 - 46
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2005

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References

1. Santaniello, J, Esposito, T, Luchette, F et al. : Mechanism of injury does not predict acuity or level of service needed: Field triage criteria revisited. Surgery 2003;134:698–703.Google Scholar
2. Quarantelli, EL: Delivery of Emergency Medical Services in Disasters: Assumptions and Realities. New York:Irvington Publishers, 1983.Google Scholar
3. Frykberg, ER, Tepas, JJ: Terrorist bombings. Lessons learned from Belfast to Beirut. Ann Surg 1988;208:569–576.CrossRefGoogle ScholarPubMed
4. Harris, M, Patterson, J, Morse, J: Doctors, nurses, and parents are equally poor at estimating pediatric weights. Pediatr Emerg Care 1999;15:17–18.Google Scholar
5. Kilner, T: Triage decisions of prehospital emergency health care providers, using a multiple-casualty scenario paper exercise. Emerg Med J 2002;19: 348–353.CrossRefGoogle ScholarPubMed
6. Uesugi, T, Okada, N, Sakai, K et al. : Accuracy of visual estimation of body height and weight in supine pediatric patients. Pediatr Anaesth 2002; 12:489–494.Google Scholar
7. Hodgetts, T, Hall, J, Maconochie, I, Smart, C: Pediatric Triage Tape. Prehosp Immediate Care 1998;2:155–159.Google Scholar
8. Champion, H, Sacco, W, Carnazzo, A et al. : Trauma score. Crit Care Med 1981;9:672–676.Google Scholar
9. Champion, H, Sacco, W, Copes, W: A revision of the Trauma Score. Journal of Trauma Injury Infection and Critical Care 1989;29:623–629.CrossRefGoogle ScholarPubMed
10. Sampalis, J, Hala, T, Nikolis, A et al. : Predictive validity and internal consistency of the Pre-hospital Index measured on-site by physicians. Accid Anal Prev 1996;28:675–684.Google Scholar
11. Tepas, J, Mollitt, D, Talbert, J, Bryant, M: The pediatric Trauma Score as a predictor of injury severity in the injured child. J Pediatr Surg 1987;22:14–18.Google Scholar
12. Ramenofsky, M, Jurkovich, G et al. : The predictive validity of the Pediatric Trauma Score. Journal of Trauma Injury Infection and Critical Care 1988;28:1038–1042.Google Scholar
13. Cohen, J, Cohen, P: Applied Multiple Regression Correlation Analysis for the Behavioral Sciences. New York:Lawrence Erlbaum Associates, 1975.Google Scholar