title: First Responder Accuracy Using SALT during Mass-casualty Incident Simulation.
abstract: BACKGROUND
  During mass-casualty incidents (MCIs), patient volume often overwhelms available Emergency Medical Services (EMS) personnel. First responders are expected to triage, treat, and transport patients in a timely fashion. If other responders could triage accurately, prehospital EMS resources could be focused more directly on patients that require immediate medical attention and transport.
  
  
  OBJECTIVE
  Triage accuracy, error patterns, and time to triage completion are similar between second-year primary care paramedic (PCP) and fire science (FS) students participating in a simulated MCI using the Sort, Assess, Life-saving interventions, Treatment/Transport (SALT) triage algorithm.
  
  
  METHODS
  All students in the second-year PCP program and FS program at two separate community colleges were invited to participate in this study. Immediately following a 30-minute didactic session on SALT, participants were given a standardized briefing and asked to triage an eight-victim, mock MCI using SALT. The scenario consisted of a four-car motor vehicle collision with each victim portrayed by volunteer actors given appropriate moulage and symptom coaching for their pattern of injury. The total number and acuity of victims were unknown to participants prior to arrival to the mock scenario.
  
  
  RESULTS
  Thirty-eight PCP and 29 FS students completed the simulation. Overall triage accuracy was 79.9% for PCP and 72.0% for FS (∆ 7.9%; 95% CI, 1.2-14.7) students. No significant difference was found between the groups regarding types of triage errors. Over-triage, under-triage, and critical errors occurred in 10.2%, 7.6%, and 2.3% of PCP triage assignments, respectively. Fire science students had a similar pattern with 15.2% over-triaged, 8.7% under-triaged, and 4.3% critical errors. The median [IQR] time to triage completion for PCPs and FSs were 142.1 [52.6] seconds and 159.0 [40.5] seconds, respectively (P=.19; Mann-Whitney Test).
  
  
  CONCLUSIONS
  Primary care paramedics performed MCI triage more accurately than FS students after brief SALT training, but no difference was found regarding types of error or time to triage completion. The clinical importance of this difference in triage accuracy likely is minimal, suggesting that fire services personnel could be considered for MCI triage depending on the availability of prehospital medical resources and appropriate training.
authors: 1Division of Emergency Medicine,Department of Medicine,Schulich School of Medicine and Dentistry,Western University,London,Ontario,Canada.
authors: Christopher W C
authors: CW
authors: Lee
authors: 1Division of Emergency Medicine,Department of Medicine,Schulich School of Medicine and Dentistry,Western University,London,Ontario,Canada.
authors: Shelley L
authors: SL
authors: McLeod
authors: 1Division of Emergency Medicine,Department of Medicine,Schulich School of Medicine and Dentistry,Western University,London,Ontario,Canada.
authors: Kristine
authors: K
authors: Van Aarsen
authors: 1Division of Emergency Medicine,Department of Medicine,Schulich School of Medicine and Dentistry,Western University,London,Ontario,Canada.
authors: Michelle
authors: M
authors: Klingel
authors: 2Department of Emergency Medicine, Faculty of Medicine and Dentistry,University of Alberta,Edmonton,Alberta,Canada.
authors: Jeffrey M
authors: JM
authors: Franc
authors: 1Division of Emergency Medicine,Department of Medicine,Schulich School of Medicine and Dentistry,Western University,London,Ontario,Canada.
authors: Michael B
authors: MB
authors: Peddle
mesh_terms: D000465:Algorithms; D000488:Allied Health Personnel / Q000193:education*; D002983:Clinical Competence / Q000706:statistics & numerical data; D015331:Cohort Studies; D003198:Computer Simulation; D004189:Disaster Planning / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods*; D060731:Emergency Responders / Q000193:education*; D006801:Humans; D054527:Mass Casualty Incidents; D011446:Prospective Studies; D014218:Triage / Q000379:methods*
keywords: Assess; EMS Emergency Medical Services; Emergency Medical Services; FS fire science; LSI life-saving intervention; 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; triage