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Triage performance of Swedish physicians using the ATLS algorithm in a simulated mass casualty incident: a prospective cross-sectional survey
Östergötlands Läns Landsting, Center for Disaster Medicine and Traumatology. Linköping University, Department of Clinical and Experimental Medicine, Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences.
Östergötlands Läns Landsting, Center for Disaster Medicine and Traumatology. Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences.
Region Östergötland, Center for Disaster Medicine and Traumatology. Linköping University, Department of Clinical and Experimental Medicine, Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences.
2013 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, Vol. 21, no 90Article in journal (Refereed) Published
Abstract [en]

Background: In a mass casualty situation, medical personnel must rapidly assess and prioritize patients for treatment and transport. Triage is an important tool for medical management in disaster situations. Lack of common international and Swedish triage guidelines could lead to confusion. Attending the Advanced Trauma Life Support (ATLS) provider course is becoming compulsory in the northern part of Europe. The aim of the ATLS guidelines is provision of effective management of single critically injured patients, not mass casualties incidents. However, the use of the ABCDE algorithms from ATLS, has been proposed to be valuable, even in a disaster environment. The objective for this study was to determine whether the mnemonic ABCDE as instructed in the ATLS provider course, affects the ability of Swedish physician's to correctly triage patients in a simulated mass casualty incident.Methods: The study group included 169 ATLS provider students from 10 courses and course sites in Sweden; 153 students filled in an anonymous test just before the course and just after the course. The tests contained 3 questions based on overall priority. The assignment was to triage 15 hypothetical patients who had been involved in a bus crash. Triage was performed according to the ABCDE algorithm. In the triage, the ATLS students used a colour-coded algorithm with red for priority 1, yellow for priority 2, green for priority 3 and black for dead. The students were instructed to identify and prioritize 3 of the most critically injured patients, who should be the first to leave the scene. The same test was used before and after the course.Results: The triage section of the test was completed by 142 of the 169 participants both before and after the course. The results indicate that there was no significant difference in triage knowledge among Swedish physicians who attended the ATLS provider course. The results also showed that Swedish physicians have little experience of real mass casualty incidents and exercises.Conclusion: The mnemonic ABCDE doesn't significantly affect the ability of triage among Swedish physicians. Actions to increase Swedish physicians' knowledge of triage, within the ATLS context or separately, are warranted.

Place, publisher, year, edition, pages
BioMed Central, 2013. Vol. 21, no 90
Keyword [en]
ATLS; Triage; Disaster; Education; Physicians; Mass casualty incident; Exercises
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-103718DOI: 10.1186/1757-7241-21-90ISI: 000329181100001OAI: oai:DiVA.org:liu-103718DiVA: diva2:690705
Available from: 2014-01-24 Created: 2014-01-24 Last updated: 2017-02-20Bibliographically approved
In thesis
1. TRIAGE: Management of the trauma patient
Open this publication in new window or tab >>TRIAGE: Management of the trauma patient
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Triage, derived from the French word for sorting, aims to assess and prioritize injured patients, regardless of whether the injuries are sustained from everyday road traffic accident with few injured or a mass casualty incident. Triage seeks to provide the greatest benefit to the largest number of casualties in order to minimize morbidity and mortality. Triage in a pre-hospital setting entails management and sorting of patients according to an assessment of medical need, prioritization, and evacuation. In-hospital triage aims to rapidly identify the most injured and ensure timely and appropriate treatment according to the patient’s clinical urgency. A number of different systems for performing triage have been established and implemented globally. The methodology is recognized and utilized but there is still a need for an evidence-based strategy to optimize training and the efficacy of the different systems.

The main aim of this thesis was to determine triage performance among prehospital personnel and investigate the potential advantage of a triage system for trauma patients. The papers included in this thesis evaluated the triage skills of physicians, pre-hospital personnel, and rescue services personnel by testing their performance before and after an educational intervention. The last paper evaluated potential benefits of using a triage system for trauma patients admitted to the emergency department at MOI Teaching and Referral Hospital in Eldoret, Kenya.

The results presented in this thesis illustrate that triage skills are lacking among physicians. Experienced pre-hospital personnel are more skilled in performing triage than physicians. The triage skills of the rescue services personnel improved significantly after the educational intervention. Moreover, the potential benefit to trauma patients of implementing an in-hospital triage system in a resource-poor environment was shown. In conclusion, health care personnel, especially physicians without experience but highly involved in trauma patient management, seem to be in need of triage training. How to train, how to implement, and how to evaluate triage skills must be considered in order to develop effective training.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2017. 48 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1563
National Category
Anesthesiology and Intensive Care Health Care Service and Management, Health Policy and Services and Health Economy Nursing
Identifiers
urn:nbn:se:liu:diva-134595 (URN)10.3384/diss-diva-134595 (DOI)9789176855744 (ISBN)
Public defence
2017-03-17, Berzeliussalen, Campus US, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2017-02-20 Created: 2017-02-20 Last updated: 2017-02-21Bibliographically approved

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Vikström, ToreJonson, Carl-Oscar

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