James Vassallo1, Jason E Smith2, Stevan R Bruijns3, Lee A Wallis3. 1. Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa; Institute of Naval Medicine, Alverstoke, Gosport, UK. Electronic address: vassallo@doctors.org.uk. 2. Emergency Department, Derriford Hospital, Plymouth, UK; Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Medical Directorate, Joint Medical Command, Birmingham, UK. 3. Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa.
Abstract
INTRODUCTION: Triage is a key principle in the effective management of major incidents. The process currently relies on algorithms assigning patients to specific triage categories; there is, however, little guidance as to what these categories represent. Previously, these algorithms were validated against injury severity scores, but it is accepted now that the need for life-saving intervention is a more important outcome. However, the definition of a life-saving intervention is unclear. The aim of this study was to define what constitutes a life-saving intervention, in order to facilitate the definition of an adult priority one patient during the definitive care phase of a major incident. METHODS: We conducted a modified Delphi study, using a panel of subject matter experts drawn from the United Kingdom and Republic of South Africa with a background in Emergency Care or Major Incident Management. The study was conducted using an online survey tool, over three rounds between July and December 2013. A four point Likert scale was used to seek consensus for 50 possible interventions, with a consensus level set at 70%. RESULTS: 24 participants completed all three rounds of the Delphi, with 32 life-saving interventions reaching consensus. CONCLUSIONS: This study provides a consensus definition of what constitutes a life-saving intervention in the context of an adult, priority one patient during the definitive care phase of a major incident. The definition will contribute to further research into major incident triage, specifically in terms of validation of an adult major incident triage tool.
INTRODUCTION: Triage is a key principle in the effective management of major incidents. The process currently relies on algorithms assigning patients to specific triage categories; there is, however, little guidance as to what these categories represent. Previously, these algorithms were validated against injury severity scores, but it is accepted now that the need for life-saving intervention is a more important outcome. However, the definition of a life-saving intervention is unclear. The aim of this study was to define what constitutes a life-saving intervention, in order to facilitate the definition of an adult priority one patient during the definitive care phase of a major incident. METHODS: We conducted a modified Delphi study, using a panel of subject matter experts drawn from the United Kingdom and Republic of South Africa with a background in Emergency Care or Major Incident Management. The study was conducted using an online survey tool, over three rounds between July and December 2013. A four point Likert scale was used to seek consensus for 50 possible interventions, with a consensus level set at 70%. RESULTS: 24 participants completed all three rounds of the Delphi, with 32 life-saving interventions reaching consensus. CONCLUSIONS: This study provides a consensus definition of what constitutes a life-saving intervention in the context of an adult, priority one patient during the definitive care phase of a major incident. The definition will contribute to further research into major incident triage, specifically in terms of validation of an adult major incident triage tool.
Authors: James Vassallo; Saisakul Chernbumroong; Nabeela Malik; Yuanwei Xu; Damian Keene; George Gkoutos; Mark D Lyttle; Jason Smith Journal: Emerg Med J Date: 2021-10-27 Impact factor: 3.814