title: Reliability of the primary triage process after the Volendam fire disaster.
abstract: In a major incident, correct triage is crucial to emergency treatment and transportation priority. The aim of this study was to evaluate the triage process pursued at the site of the fire disaster in Volendam, the Netherlands on January 1, 2001. On-site (OS) and Emergency Department (ED) data regarding total body surface area burned (TBSA) and inhalation injury (INH) were compared with the final (FIN) assessment of these two parameters after hospital admission. Finally, the effect of OS intubation and the time of arrival at a hospital were evaluated. There were 245 injured. Mean age was 17.3 years. Final median TBSA was 12%; 96 patients (39%) had inhalation injury. Agreement between TBSA-OS (n = 46) and TBSA-FIN was poor (Pearson's correlations coefficient [PCC] = 0.77; R(2) = 0.60). TBSA-ED (n = 78) was more accurate (PCC = 0.96; R(2) = 0.93). INH-OS (n = 79, sensitivity 100%, specificity 24%) and INH-ED (n = 198, sensitivity 99%, specificity 36%) were sensitive but not specific. Eight patients were intubated on-site. No differences in outcome were found between this group and the patients who were intubated in the hospital. There was no difference in time of arrival at a hospital (p = 0.55). TBSA was not estimated reliably in a non-clinical environment. The diagnosis of inhalation injury was adequate but resulted in over-triage on-site and at the ED. Triage did not lead to transport priorities for the severely wounded. In a major burn accident, a field triage protocol for rapid evaluation of burn injuries may be useful. Detailed assessment of injuries of burn casualties is practical only in a specialized clinical setting.
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Lieke
authors.initials: L
authors.lastname: Welling
authors.forename: Sabine M
authors.initials: SM
authors.lastname: van Harten
authors.forename: C Pieter
authors.initials: CP
authors.lastname: Henny
authors.forename: Dave P
authors.initials: DP
authors.lastname: Mackie
authors.forename: Dirk T
authors.initials: DT
authors.lastname: Ubbink
authors.forename: Robert W
authors.initials: RW
authors.lastname: Kreis
authors.forename: Ad
authors.initials: A
authors.lastname: Trouwborst
mesh_terms: D000293:Adolescent; D000328:Adult; D002059:Burns, Inhalation / Q000145:classification / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D005390:Fires; D006801:Humans; D008297:Male; D008485:Medical Audit; D009426:Netherlands; D015599:Trauma Severity Indices; D014218:Triage