BACKGROUND: The aim of this study was to quantitatively analyze the impact of hospital triage on the workload of trauma teams in the Emergency Department during a mass casualty incident, using a computer model. METHODS: The inflow and triage of casualties into an Emergency Department with 5 trauma teams was modeled using the Monte Carlo method. Triage was represented as a binary classification task performed in one or two sequential steps. The input variables were triage accuracy (specificity and sensitivity) and casualty load, and the key output variable was the time to saturation (TTS) of the trauma teams, which was computed from the available and needed team minutes. RESULTS: The relationship between an increasing casualty load and the TTS describes a sigmoid-shaped curve. Improving triage accuracy extends the TTS and shifts the curve to the right. Switching to sequential competent triage (80% accuracy) results in TTS that is similar to perfect single-step triage (100% accuracy) but at the cost of investing less team time in urgent casualties. The optimal ratio of trauma teams to urgent casualties in sequential mode is 1:8, indicating that the treatment of urgent casualties must be delegated to reinforcement staff. CONCLUSIONS: This study introduces innovative tools for quantitative analysis of hospital triage in mass casualty incidents and shows how triage accuracy and mode affect the ability of trauma teams to cope with heavy casualty loads. These tools can be used to optimize the hospital response to future threats.
BACKGROUND: The aim of this study was to quantitatively analyze the impact of hospital triage on the workload of trauma teams in the Emergency Department during a mass casualty incident, using a computer model. METHODS: The inflow and triage of casualties into an Emergency Department with 5 trauma teams was modeled using the Monte Carlo method. Triage was represented as a binary classification task performed in one or two sequential steps. The input variables were triage accuracy (specificity and sensitivity) and casualty load, and the key output variable was the time to saturation (TTS) of the trauma teams, which was computed from the available and needed team minutes. RESULTS: The relationship between an increasing casualty load and the TTS describes a sigmoid-shaped curve. Improving triage accuracy extends the TTS and shifts the curve to the right. Switching to sequential competent triage (80% accuracy) results in TTS that is similar to perfect single-step triage (100% accuracy) but at the cost of investing less team time in urgent casualties. The optimal ratio of trauma teams to urgent casualties in sequential mode is 1:8, indicating that the treatment of urgent casualties must be delegated to reinforcement staff. CONCLUSIONS: This study introduces innovative tools for quantitative analysis of hospital triage in mass casualty incidents and shows how triage accuracy and mode affect the ability of trauma teams to cope with heavy casualty loads. These tools can be used to optimize the hospital response to future threats.
Authors: Jeffrey R Dichter; Robert K Kanter; David Dries; Valerie Luyckx; Matthew L Lim; John Wilgis; Michael R Anderson; Babak Sarani; Nathaniel Hupert; Ryan Mutter; Asha V Devereaux; Michael D Christian; Niranjan Kissoon Journal: Chest Date: 2014-10 Impact factor: 9.410
Authors: Justin W Timbie; Jeanne S Ringel; D Steven Fox; Francesca Pillemer; Daniel A Waxman; Melinda Moore; Cynthia K Hansen; Ann R Knebel; Richard Ricciardi; Arthur L Kellermann Journal: Ann Emerg Med Date: 2013-03-20 Impact factor: 5.721
Authors: Erik R Barthel; James R Pierce; Catherine J Goodhue; Henri R Ford; Tracy C Grikscheit; Jeffrey S Upperman Journal: Theor Biol Med Model Date: 2011-10-12 Impact factor: 2.432
Authors: Michel Debacker; Ives Hubloue; Erwin Dhondt; Gerald Rockenschaub; Anders Rüter; Tudor Codreanu; Kristi L Koenig; Carl Schultz; Kobi Peleg; Pinchas Halpern; Samuel Stratton; Francesco Della Corte; Herman Delooz; Pier Luigi Ingrassia; Davide Colombo; Maaret Castrèn Journal: PLoS Curr Date: 2012-03-23
Authors: James Williams; Michael Gustafson; Yu Bai; Samuel Prater; Charles E Wade; Oscar D Guillamondegui; Mansoor Khan; Megan Brenner; Paula Ferrada; Derek Roberts; Tal Horer; David Kauvar; Andrew Kirkpatrick; Carlos Ordonez; Bruno Perreira; Artai Priouzram; Juan Duchesne; Bryan A Cotton Journal: Shock Date: 2021-12-01 Impact factor: 3.454