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Accuracy, Efficiency, and Inappropriate Actions Using JumpSTART Triage in MCI Simulations

Published online by Cambridge University Press:  01 September 2015

Ilene Claudius ,
Amy H. Kaji ,
Genevieve Santillanes ,
Mark X. Cicero ,
J. Joelle Donofrio ,
Marianne Gausche-Hill ,
Saranya Srinivasan  and
Todd P. Chang
Ilene Claudius*
Affiliation:
Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California USA
Amy H. Kaji
Affiliation:
Department of Emergency Medicine, Harbor-University of California Los Angeles Medical Center, Los Angeles, California USA
Genevieve Santillanes
Affiliation:
Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California USA
Mark X. Cicero
Affiliation:
Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut USA
J. Joelle Donofrio
Affiliation:
Department of Emergency Medicine, Harbor-University of California Los Angeles Medical Center, Los Angeles, California USA
Marianne Gausche-Hill
Affiliation:
Department of Emergency Medicine, Harbor-University of California Los Angeles Medical Center, Los Angeles, California USA
Saranya Srinivasan
Affiliation:
Department of Emergency Medicine, Children’s Hospital Los Angeles, Los Angeles, California USA
Todd P. Chang
Affiliation:
Department of Emergency Medicine, Children’s Hospital Los Angeles, Los Angeles, California USA
*
Correspondence: Ilene Claudius, MD University of Southern California Keck School of Medicine Department of Emergency Medicine 1200 North State Street, 1011 Los Angeles, California 90033 USA E-mail: iaclaudius@gmail.com
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Abstract

Introduction

Using the pediatric version of the Simple Triage and Rapid Treatment (JumpSTART) algorithm for the triage of pediatric patients in a mass-casualty incident (MCI) requires assessing the results of each step and determining whether to move to the next appropriate action. Inappropriate application can lead to performance of unnecessary actions or failure to perform necessary actions.

Hypothesis/Problem

To report overall accuracy and time required for triage, and to assess if the performance of unnecessary steps, or failure to perform required steps, in the triage algorithm was associated with inaccuracy of triage designation or increased time to reach a triage decision.

Methods

Medical students participated in an MCI drill in which they triaged both live actors portraying patients and computer-based simulated patients to the four triage levels: minor, delayed, immediate, and expectant. Their performance was timed and compared to intended triage designations and a priori determined critical actions.

Results

Thirty-three students completed 363 scenarios. The overall accuracy was 85.7% and overall mean time to assign a triage designation was 70.4 seconds, with decreasing times as triage acuity level decreased. In over one-half of cases, the student omitted at least one action and/or performed at least one action that was not required. Each unnecessary action increased time to triage by a mean of 8.4 seconds and each omitted action increased time to triage by a mean of 5.5 seconds.

Discussion

Increasing triage level, performance of inappropriate actions, and omission of recommended actions were all associated with increasing time to perform triage.

ClaudiusI , KajiAH , SantillanesG , CiceroMX , DonofrioJJ , Gausche-HillM , SrinivasanS , ChangTP . Accuracy, Efficiency, and Inappropriate Actions Using JumpSTART Triage in MCI Simulations. Prehosp Disaster Med. 2015;30(5):457–460.

Keywords

emergency departmentmass-casualty incidenttriage
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 30 , Issue 5 , October 2015 , pp. 457 - 460
Copyright
© World Association for Disaster and Emergency Medicine 2015 

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