title: A modified simple triage and rapid treatment algorithm from the New York City (USA) Fire Department.
abstract: BACKGROUND
  The objective of this study was to determine if modification of the Simple Triage and Rapid Treatment (START) system by the addition of an Orange category, intermediate between the most critically injured (Red) and the non-critical, non-ambulatory injured (Yellow), would reduce over- and under-triage rates in a simulated mass-casualty incident (MCI) exercise.
  
  
  METHODS
  A computer-simulation exercise of identical presentations of an MCI scenario involving a 2-train collision, with 28 case scenarios, was provided for triaging to two groups: the Fire Department of the City of New York (FDNY; n=1,347) using modified START, and the Emergency Medical Services (EMS) providers from the Eagles 2012 EMS conference (Lafayette, Louisiana USA; n=110) using unmodified START. Percent correct by triage category was calculated for each group. Performance was then compared between the two EMS groups on the five cases where Orange was the correct answer under the modified START system.
  
  
  RESULTS
  Overall, FDNY-EMS providers correctly triaged 91.2% of cases using FDNY-START whereas non-FDNY-Eagles providers correctly triaged 87.1% of cases using unmodified START. In analysis of the five Orange cases (chest pain or dyspnea without obvious trauma), FDNY-EMS performed significantly better using FDNY-START, correctly triaging 86.3% of cases (over-triage 1.5%; under-triage 12.2%), whereas the non-FDNY-Eagles group using unmodified START correctly triaged 81.5% of cases (over-triage 17.3%; under-triage 1.3%), a difference of 4.9% (95% CI, 1.5-8.2).
  
  
  CONCLUSIONS
  The FDNY-START system may allow providers to prioritize casualties using an intermediate category (Orange) more properly aligned to meet patient needs, and as such, may reduce the rates of over-triage compared with START. The FDNY-START system decreases the variability in patient sorting while maintaining high field utility without needing computer assistance or extensive retraining. Comparison of triage algorithms at actual MCIs is needed; however, initial feedback is promising, suggesting that FDNY-START can improve triage with minimal additional training and cost.
authors: 1Fire Department of the City of New York,Office of Medical Affairs,Brooklyn, New YorkUSA.
authors: Faizan H
authors: FH
authors: Arshad
authors: 1Fire Department of the City of New York,Office of Medical Affairs,Brooklyn, New YorkUSA.
authors: Alan
authors: A
authors: Williams
authors: 1Fire Department of the City of New York,Office of Medical Affairs,Brooklyn, New YorkUSA.
authors: Glenn
authors: G
authors: Asaeda
authors: 1Fire Department of the City of New York,Office of Medical Affairs,Brooklyn, New YorkUSA.
authors: Douglas
authors: D
authors: Isaacs
authors: 1Fire Department of the City of New York,Office of Medical Affairs,Brooklyn, New YorkUSA.
authors: Bradley
authors: B
authors: Kaufman
authors: 1Fire Department of the City of New York,Office of Medical Affairs,Brooklyn, New YorkUSA.
authors: David
authors: D
authors: Ben-Eli
authors: 1Fire Department of the City of New York,Office of Medical Affairs,Brooklyn, New YorkUSA.
authors: Dario
authors: D
authors: Gonzalez
authors: 1Fire Department of the City of New York,Office of Medical Affairs,Brooklyn, New YorkUSA.
authors: John P
authors: JP
authors: Freese
authors: 1Fire Department of the City of New York,Office of Medical Affairs,Brooklyn, New YorkUSA.
authors: Joan
authors: J
authors: Hillgardner
authors: 1Fire Department of the City of New York,Office of Medical Affairs,Brooklyn, New YorkUSA.
authors: Jessica
authors: J
authors: Weakley
authors: 1Fire Department of the City of New York,Office of Medical Affairs,Brooklyn, New YorkUSA.
authors: Charles B
authors: CB
authors: Hall
authors: 1Fire Department of the City of New York,Office of Medical Affairs,Brooklyn, New YorkUSA.
authors: Mayris P
authors: MP
authors: Webber
authors: 1Fire Department of the City of New York,Office of Medical Affairs,Brooklyn, New YorkUSA.
authors: David J
authors: DJ
authors: Prezant
mesh_terms: D000465:Algorithms; D000488:Allied Health Personnel / Q000193:education*; D003198:Computer Simulation; D004632:Emergency Medical Services / Q000458:organization & administration*; D006801:Humans; D007318:Inservice Training; D054527:Mass Casualty Incidents; D009519:New York City; D014218:Triage / Q000379:methods*
keywords: EMS Emergency Medical Services; EMT emergency medical technician; FDNY Fire Department of the City of New York; MCI mass-casualty incident; START Simple Triage and Rapid Treatment; triage