Objective evaluation in a disaster drill: accuracy of triage operations


P.L. Ingrassia,A. Geddo,F. Lombardi,S. Calligaro,F. Prato,M. Tengattini,M. Morin,J. Jenvald,F. Della Corte


Objective: quantitative evaluation of the triage operations (predicted vs real performance, time flows from different settings) performed by European Master in Disaster Medicine students during the full-size exercise held in Casalvolone (Italy) as a final test at the end of the residential course.

Methods: The storyboard of the exercise was a terrorist attack, a double explosion during the inauguration of the new building (two floors) of the public school. The number of moulaged casualties was 104, all undergraduate students of the Faculty of Medicine of the Università del Piemonte Orientale who had a 24 hours course on Disaster Medicine and were taught to play a specific storyboard with physical parameters that could change following different kind of medical treatment.

Each mock victim was provided with a patient data card with an identification number and the basic vital parameter (heart rate and respiratory rate). The triage system used was START.Casualties were divided in 10 black, 15 red, 36 yellow and 43 green codes.The out-of-hospital drill site was organized into four different treatment areas: the crash area, the collecting area, the advanced medical post and the hospital. Inside the crash area there were three observers on the ground floor and two observers on the first floor, to accurately record: the triage data as colour code and timing and care performed by the EMDM students.All the observers were member of the EMDM staff and were properly trained and instructed several days before the exercise. The data collection has been done on specific cards.Data have been integrated in the software CITE® that can monitor the path through the different treatment areas, the clinical history and the cares delivered until the final arrival at the hospital for each victim. CITE® uses data collected, including pictures and videos, to construct a time-synchronised, discrete-event representation of the course of events of the rescue operations. The resulting model can be presented in a visualisation tool, CITE Explorer®, which supports time-based navigation and animation using multiple views.The triage tags assigned by the EMDM students were compared to the predicted ones. The percentage of over/under triage was calculated.

Results: The triage procedures on the crash area (160 mq2 on two floors) were completed in 37 minutes. The triage error percentage concerning the pre-assigned reds and yellows tags causalities was 60% (9/15 red) (21/35 yellow). Black and green tag causalities were all correctly triaged.

Conclusions: The correct rate of triage for red and yellow code was quite good in relation to the complexity of the full size exercise. Time to complete triage was very good.

EMDM: European Master in Disaster Medicine
START: Simple Triage and Rapid Treatment