title: First Responder Accuracy Using SALT after Brief Initial Training.
abstract: BACKGROUND
  Mass-casualty incidents (MCIs) present a unique challenge with regards to triage as patient volume often outweighs the number of available Emergency Medical Services (EMS) providers. A possible strategy to optimize existing triage systems includes the use of other first responder groups, namely fire and police, to decrease the triage time during MCIs, allowing for more rapid initiation of life-saving treatment and prioritization of patient transport. Hypothesis First-year primary care paramedic (PCP), fire, and police trainees can apply with similar accuracy an internationally recognized MCI triage tool, Sort, Assess, Life-saving interventions, Treatment/transport (SALT), immediately following a brief training session, and again three months later.
  
  
  METHODS
  All students enrolled in the PCP, fire, and police foundation programs at two community colleges were invited to participate in a 30-minute didactic session on SALT. Immediately following this session, a 17-item, paper-based test was administered to assess the students' ability to understand and apply SALT. Three months later, the same test was given to assess knowledge retention.
  
  
  RESULTS
  Of the 464 trainees who completed the initial test, 364 (78.4%) completed the three month follow-up test. Initial test scores were higher (P<.05) for PCPs (87.0%) compared to fire (80.2%) and police (68.0%) trainees. The mean test score for all respondents was higher following the initial didactic session compared to the three month follow-up test (75% vs 64.7%; Δ 10.3%; 95% CI, 8.0%-12.6%). Three month test scores for PCPs (75.4%) were similar to fire (71.4%) students (Δ 4.0%; 95% CI, -2.1% to 10.1%). Both PCP and fire trainees significantly outperformed police (57.8%) trainees. Over-triage errors were the most common, followed by under-triage and then critical errors, for both the initial and follow-up tests.
  
  
  CONCLUSIONS
  Amongst first responder trainees, PCPs were able to apply the SALT triage tool with the most accuracy, followed by fire, then police. Over-triage was the most frequent error, while critical errors were rare.
authors.affiliation: 1Division of Emergency Medicine,Department of Medicine,Schulich School of Medicine and Dentistry,Western University,London,Ontario,Canada.
authors.forename: Christopher W C
authors.initials: CW
authors.lastname: Lee
authors.affiliation: 1Division of Emergency Medicine,Department of Medicine,Schulich School of Medicine and Dentistry,Western University,London,Ontario,Canada.
authors.forename: Shelley L
authors.initials: SL
authors.lastname: McLeod
authors.affiliation: 1Division of Emergency Medicine,Department of Medicine,Schulich School of Medicine and Dentistry,Western University,London,Ontario,Canada.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Peddle
mesh_terms: D015331:Cohort Studies; D004189:Disaster Planning / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods*; D060731:Emergency Responders / Q000193:education*; D006801:Humans; D054527:Mass Casualty Incidents; D011361:Professional Competence / Q000706:statistics & numerical data*; D011446:Prospective Studies; D014218:Triage / Q000379:methods*
keywords: Assess; EMS Emergency Medical Services; Emergency Medical Services; Life-saving interventions; MCI mass-casualty incident; PCP primary care paramedic; SALT Sort; START Simple Triage and Rapid Treatment; Treatment/transport; fire and rescue personnel; mass-casualty incidents; police; triage