Intuitive versus Algorithmic Triage.

Area of Science:

• Emergency Medicine
• Disaster Management
• Clinical Triage Research

Background:

• Current mass-casualty incident (MCI) triage methods, like Simple Triage and Rapid Treatment (START), rely on detailed vital sign counts, which can be time-consuming and costly.
• The high volume and acuity of patients during MCIs necessitate efficient and accurate triage strategies.

Purpose of the Study:

• To compare the speed and accuracy of an intuitive triage method against the established START triage method.
• To evaluate if experienced first responders can accurately and rapidly categorize patients based on overall first-impression assessment during simulated MCIs.

Main Methods:

• A cluster randomized simulation involving adult volunteers was conducted to compare intuitive triage with the START method.
• The simulation utilized a staged active-shooter scenario involving various emergency services and leadership.
• Key outcomes measured included the time taken for triage and the accuracy of patient categorization.

Main Results:

• Intuitive triage was significantly faster, with a mean process time of 72.18 seconds compared to START's 106.57 seconds.
• Time savings were particularly pronounced for critically injured (Red) and moderately injured (Yellow) patients.
• Despite speed differences, there was a high degree of agreement between intuitive triage and START, with no significant difference in over- or under-triage rates.

Conclusions:

• The intuitive triage method offers significant time savings during mass-casualty incidents.
• Intuitive triage demonstrates comparable accuracy to the START method, suggesting its potential as an effective alternative.
• Further prospective research is recommended to validate these findings in real-world MCI scenarios.