title: Randomized trial comparing two mass casualty triage systems (JumpSTART versus SALT) in a pediatric simulated mass casualty event.
abstract: OBJECTIVE
  Several field triage systems have been developed to rapidly sort patients following a mass casualty incident (MCI). JumpSTART (Simple Triage and Rapid Transport) is a pediatric-specific MCI triage system. SALT (Sort, Assess, Lifesaving interventions, Treat/Transport) has been proposed as a new national standard for MCI triage for both adult and pediatric patients, but it has not been tested in a pediatric population. This pilot study hypothesizes that SALT is at least as good as JumpSTART in triage accuracy, speed, and ease of use in a simulated pediatric MCI.
  
  
  METHODS
  Paramedics were invited and randomly assigned to either SALT or JumpSTART study groups. Following randomization, subjects viewed a 15-minute PowerPoint lecture on either JumpSTART or SALT. Subjects were provided with a triage algorithm card for reference and were asked to assign triage categories to 10 pediatric patients in a simulated building collapse. The scenario consisted of 4 children in moulage and 6 high-fidelity pediatric simulators. Injuries and triage categories were based on a previously published MCI scenario. One investigator followed each subject to record time and triage assignment. All subjects completed a post-test survey and structured interview following the simulated disaster.
  
  
  RESULTS
  Forty-three paramedics were enrolled. Seventeen were assigned to the SALT group with an overall triage accuracy of 66% ±15%, an overtriage mean rate of 22 ± 16%, and an undertriage rate of 10 ± 9%. Twenty-six participants were assigned to the JumpSTART group with an overall accuracy of 66 ± 12%, an overtriage mean of 23 ±16%, and an undertriage rate of 11.2 ± 11%. Ease of use was not statistically different between the two systems (median Likert value of both systems = 2, p = 0.39) Time to triage per patient was statistically faster in the JumpSTART group (SALT = 34 ± 23 seconds, JumpSTART = 26 ± 19 seconds, p = 0.02). Both systems were prone to cognitive and affective error.
  
  
  CONCLUSIONS
  SALT appears to be at least as good as JumpSTART in overall triage accuracy, overtriage, or undertriage rates in a simulated pediatric MCI. Both systems were considered easy to use. However, JumpSTART was 8 seconds faster per patient in time taken to assign triage designations.
authors.forename: Nicole
authors.initials: N
authors.lastname: Jones
authors.forename: Marjorie Lee
authors.initials: ML
authors.lastname: White
authors.forename: Nancy
authors.initials: N
authors.lastname: Tofil
authors.forename: MeKeisha
authors.initials: M
authors.lastname: Pickens
authors.forename: Amber
authors.initials: A
authors.lastname: Youngblood
authors.forename: Lynn
authors.initials: L
authors.lastname: Zinkan
authors.forename: Mark D
authors.initials: MD
authors.lastname: Baker
mesh_terms: D000407:Alabama; D000465:Algorithms; D000488:Allied Health Personnel; D002648:Child; D002675:Child, Preschool; D003198:Computer Simulation; D004632:Emergency Medical Services / Q000379:methods*; D004634:Emergency Medical Technicians; D005260:Female; D006801:Humans; D008297:Male; D054527:Mass Casualty Incidents; D010372:Pediatrics; D010865:Pilot Projects; D018709:Statistics, Nonparametric; D013647:Task Performance and Analysis; D014218:Triage / Q000379:methods*