Addressing the Triage Training Gap: Effects of Brief SALT Training on Triage Accuracy Among Nonmedical Military...

Early triage decisions during large-scale combat operations (LSCO) are often made by nonmedical personnel before medical assets arrive and directly influence casualty survival and the care casualties ultimately receive. Although established triage frameworks provide clear decision pathways, the ability to translate these frameworks into accurate, real-time decision-making by nonmedical military personnel remains a critical determinant of operational readiness. The Sort, Assess, Lifesaving interventions, Treatment/Transport (SALT) triage framework is embedded within current U.S. Army medical doctrine. It was selected as a practical, doctrine-aligned platform to evaluate whether brief, standardized video-based training can improve triage decision-making among nonmedical military personnel in a pre-deployment setting.

This prospective pre-post quality improvement project was conducted at a large U.S. Army installation. One hundred twenty-eight active-duty personnel scheduled for Tactical Combat Casualty Care (TCCC) training completed a scenario-based triage assessment, viewed a 22-minute SALT triage training video, and then completed the same assessment before beginning the TCCC course. The primary evaluation metric was the change in overall triage accuracy. Supporting evaluation metrics included rates of over-triage, under-triage, and critical errors, as well as self-reported confidence, satisfaction, perceived relevance to LSCO, and likelihood of recommending the integration of the training. Pre-post comparisons used paired t-tests (α = 0.05), with Wilcoxon signed-rank sensitivity analyses for Likert outcomes. This project was determined to be not human subjects research and was approved by the Wake Forest University School of Medicine Institutional Review Board (IRB #00122433).

Following the video intervention, overall triage accuracy improved from 48.3% to 82.1%, an absolute improvement of 33.8 percentage points (95% CI 30.4-37.2; P < .001; Cohen's d = 1.72, a large effect size) and a 70.0% relative increase, with 93.0% of participants demonstrating improvement. Critical triage errors decreased from 12.9% to 1.9% (P < .001), an 85.5% relative reduction. Over-triage decreased from 28.0% to 9.9% (P < .001) and under-triage from 10.8% to 6.1% (P < .001). Participants also reported higher confidence and satisfaction after training and rated it highly relevant to LSCO, with a strong likelihood of recommending integrating the SALT triage method into future training.

A brief, 22-minute SALT triage training video was associated with substantial immediate improvements in scenario-based triage performance among nonmedical military service members, with marked reductions in critical errors. These findings suggest that brief, standardized video-based instruction can serve as a practical, cost-effective complement to existing pre-deployment and unit-level training programs. SALT was used as a representative, doctrine-aligned framework to evaluate training delivery rather than to compare specific triage systems. Further evaluation is warranted to assess the durability of the effect and overall operational impact.