title: Triage decisions of United Kingdom police firearms officers using a multiple-casualty scenario paper exercise.
abstract: BACKGROUND
  British police officers authorized to carry firearms may need to make judgments about the severity of injury of individuals or the relative priority of clinical need of a group of injured patients in tactical and non-tactical situations. Most of these officers receive little or no medical training beyond basic first aid to enable them to make these clinical decisions. Therefore, the aim of this study is to determine the accuracy of triage decision-making of firearms-trained police officers with and without printed decision-support materials.
  
  
  METHODS
  Eighty-two police firearms officers attending a tactical medicine course (FASTAid) were recruited to the study. Data were collected using a paper-based triage exercise that contained brief, clinical details of 20 adults and 10 children. Subjects were asked to assign a clinical priority of immediate or priority 1 (P1); urgent or priority 2 (P2); delayed or priority 3 (P3); or dead, to each casualty. Then, they were provided with decision-making materials, but were not given any instruction as to how these materials should be used. Subjects then completed a second triage exercise, identical to the first, except this time using the decision-support materials. Data were analyzed using mixed between-within subjects analysis of variance. This allowed comparisons to be made between the scores for Exercise 1 (no decision-support material) and Exercise 2 (with decision-support material). It also allowed any differences between those students with previous triage training and those without previous training to be explored.
  
  
  RESULTS
  The use of triage decision-making materials resulted in a significant increase in correct responses (p < 0.001). Improvement in accuracy appears to result mainly from a reduction in the extent of under-triage. There were significant differences (p < 0.05) between those who had received previous triage training and those who had not, with those having received triage training doing slightly better.
  
  
  CONCLUSIONS
  It appears that significant improvements in the accuracy of triage decision-making by police firearms officers can be achieved with the use of appropriate triage decision-support materials. Training may offer additional improvements in accuracy, but this improvement is likely to be small when decision-support materials are provided. With basic clinical skills and appropriate decision-support materials, it is likely that the police officer can make accurate triage decisions in a multiple-casualty scenario or make judgments of the severity of injury of a given individual in both tactical and non-tactical situations.
authors.affiliation: Gloucestershire Ambulance Service NHS Trust, Triservice Emergency Center, Quedgeley, Gloucester, UK. t.kilner@virgin.net
authors.forename: Tim
authors.initials: T
authors.lastname: Kilner
authors.forename: F John
authors.initials: FJ
authors.lastname: Hall
mesh_terms: D002983:Clinical Competence; D003657:Decision Making; D004521:Educational Measurement / Q000379:methods*; D005389:Firearms; D006801:Humans; D016495:Police / Q000193:education*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D018635:Rescue Work / Q000379:methods* / Q000592:standards; D014218:Triage / Q000379:methods* / Q000592:standards; D006113:United Kingdom