Primary Trauma Triage Performed by Bystanders: An Observation Study

Prehospital Triage by Lay Person First Responders: A Scoping Review and Proposal for a new Prehospital Triage Tool

OBJECTIVE

The primary aim of this study is to review the available tools for prehospital triage in case of mass casualty incidents and secondly, to develop a tool which enables lay person first responders (LPFRs) to perform triage and start basic life support in mass casualty incidents.

METHODS

In July 2019, online databases were consulted. Studies addressing prehospital triage methods for lay people were analyzed. Secondly, a new prehospital triage tool for LPFRs was developed. Therefore, a search for prehospital triage models available in literature was conducted and triage actions were extracted.

RESULTS

The search resulted in 6188 articles, and after screening, a scoping review of 4 articles was conducted. All articles stated that there is great potential to provide accurate prehospital triage by people with no healthcare experience. Based on these findings, and combined with the pre-existing prehospital triage tools, we developed a, not-yet validated, prehospital triage tool for lay people, which may improve disaster awareness and preparedness and might positively contribute to community resilience.

CONCLUSION

The prehospital triage tool for lay person first responders may be useful and may help professional medical first responders to determine faster, which casualties most urgently need help in a mass casualty incident.

Emergency service experience following the terrorist attack in Mogadishu, 14 October 2017, a scene of lay rescuer triage

BACKGROUND

A suicide bomber attack occurred in Somalia's capital city of Mogadishu on October 14, 2017. Over 500 people died, making it the third largest suicide bombing attack in world history. In this study, we aimed to share our experience and to discuss the importance of triage and prehospital care systems.

METHODS

These retrospective data included data from patients who suffered from severe explosions. Patient triage was performed using the START (Simple Triage and Rapid Treatment) triage algorithm at the entrance of the hospital. The patients included in the study were classified according to their age, sex, triage code, location of their major injury, department to which they were admitted, and discharge and/or exit status.

RESULTS

The patients included 188 (74.6%) males, and the mean age was 30.94 ± 12.23 years (range, 1-80 years). Eighty-six (34.1%) patients were marked with a red code indicating major injury, and 138 (54.8%) patients had superficial injuries. A total of 173 (68.7%) patients were managed in the emergency department (ED), and 7 (2.8%) patients died in the first 24 h. Multiple trauma injuries were detected in 43 (17.1%) patients, and 31 (12.3%) patients were admitted to the orthopedics department.

CONCLUSION

Disaster management in a terrorist event requires rapid transport, appropriate triage, effective surgical approaches, and specific postoperative care. In this event, almost all patients were brought to the ED by lay rescuers. Appropriate triage algorithms for the public can be designed; for instance, green code: walking patient; yellow code: patient who is moving and asking for help; red code: unmoving or less mobile patient who is breathing; black code: nonbreathing patient.

Primary Trauma Triage Performed by Bystanders: An Observation Study

OBJECTIVE

The aim of this study was to evaluate whether bystanders with no training in triage can correctly prioritize three injured patients by using a triage instrument.

METHOD

An observational study was conducted. Participants performed a primary triage on three paper-based patient cases and answered 11 questions during a public event in the center of Stockholm, Sweden.

RESULTS

A total of 69 persons participated in the study. The success rate among all the participants for correct triage of the three patient cases was 52 percent. The female participants and younger participants (<55 years of age) performed correct triage to a greater extent. The over-triage was 12.5 percent and under-triage was 6.3 percent.

CONCLUSION

Participants with no prior knowledge of triage instruments may be capable of triaging injured patients with the help of an easy triage instrument. The over- and under-triage percentages were low, and this may indicate that the developed triage instrument is relatively easy to use. It may also indicate that bystanders can identify a severely injured patient. Nordberg M , Castrén M , Lindström V . Primary trauma triage performed by bystanders: an observation study. Prehosp Disaster Med. 2016;31(4):353-357.