Kate Field1, Ian Norton. 1. Emergency Department National Critical Care and Trauma Response Centre, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
Abstract
OBJECTIVE: The aim of this study was to determine if any disaster triage tag is superior to others, based on objective parameters (time, accuracy) and subjective parameters (user preference). A secondary aim was to determine the average time to perform triage assessment using 'sieve and sort'. METHODS: This was a prospective, randomised cross-over trial comparing triage cards currently used, or being implemented, across Australia. De-identified patient information from a trauma database was used to create 125 cases. Volunteer participants were selected from Major Incident Medical Management and Support certified doctors, nurses, paramedics and defence medics and randomised into five groups. Participants completed timed 'sieve and sort' triage exercises on 25 different cases with each of the five triage tags and were then asked to rank the tags in order of preference. Participants also performed timed practical triage assessments (sieve and sort) on two healthy volunteers. RESULTS: Based on the objective measures we did not find that one card was superior to others; however, the Northern Territory card was significantly slower and less accurate (P < 0.001). Doctors were the fastest and most accurate 'sorters' (P < 0.001); however, inaccuracy was the same for all professional groups for the 'sieve'. Participants preferred the SMART card to any other tag. Participants' time to carry out a sieve was approximately 30 s, and 60 s for a sort. CONCLUSION: The SMART card was preferred by participants based on design issues, which supports its implementation. We suggest that doctors are best used in the casualty clearing post.
RCT Entities:
OBJECTIVE: The aim of this study was to determine if any disaster triage tag is superior to others, based on objective parameters (time, accuracy) and subjective parameters (user preference). A secondary aim was to determine the average time to perform triage assessment using 'sieve and sort'. METHODS: This was a prospective, randomised cross-over trial comparing triage cards currently used, or being implemented, across Australia. De-identified patient information from a trauma database was used to create 125 cases. Volunteer participants were selected from Major Incident Medical Management and Support certified doctors, nurses, paramedics and defence medics and randomised into five groups. Participants completed timed 'sieve and sort' triage exercises on 25 different cases with each of the five triage tags and were then asked to rank the tags in order of preference. Participants also performed timed practical triage assessments (sieve and sort) on two healthy volunteers. RESULTS: Based on the objective measures we did not find that one card was superior to others; however, the Northern Territory card was significantly slower and less accurate (P < 0.001). Doctors were the fastest and most accurate 'sorters' (P < 0.001); however, inaccuracy was the same for all professional groups for the 'sieve'. Participants preferred the SMART card to any other tag. Participants' time to carry out a sieve was approximately 30 s, and 60 s for a sort. CONCLUSION: The SMART card was preferred by participants based on design issues, which supports its implementation. We suggest that doctors are best used in the casualty clearing post.