title: Attitudes Towards and Experience of the Use of Triage Tags in Major Incidents: A Mixed Method Study.
abstract: Introduction Disaster triage is the allocation of limited medical resources in order to optimize patient outcome. There are several studies showing the poor use of triage tagging, but there are few studies that have investigated the reasons behind this. The aim of this study was to explore ambulance personnel attitude towards, and experiences of, practicing triage tagging during day-to-day management of trauma patients, as well as in major incidents (MIs).
  
  
  METHODS
  A mixed method design was used. The first part of the study was in the form of a web-survey of attitudes answered by ambulance personnel. The question explored was: Is it likely that systems that are not used in everyday practice will be used during MIs? Two identical web-based surveys were conducted, before and after implementing a new strategy for triage tagging. This strategy consisted of a time-limited triage routine where ambulance services assigned triage category and applied triage tags in day-to-day trauma incidents in order to improve field triage. The second part comprised three focus group interviews (FGIs) in order to provide a deeper insight into the attitudes towards, and experience of, the use of triage tags. Data were analyzed using qualitative content analysis.
  
  
  RESULTS
  The overall finding was the need for daily routine when failure in practice. Analysis of the web-survey revealed three changes: ambulance personnel were more prone to use tags in minor accidents, the sort scoring system was considered to be more valuable, but it also was more time consuming after the intervention. In the analysis of FGIs, four categories emerged that describe the construction of the overall category: perceived usability, daily routine, documentation, and need for organizational strategies.
  
  
  CONCLUSIONS
  Triage is part of the foundation of ambulance skills, but even so, ambulance personnel seldom use this in routine practice. They fully understand the benefit of accurate triage decisions, and also that the use of a triage algorithm and color coded tags is intended to make it easier and more secure to perform triage. However, despite the knowledge and understanding of these benefits, sparse incidents and infrequent exercises lead to ambulance personnel's uncertainty concerning the use of triage tagging during a MI and will therefore, most likely, avoid using them. Rådestad M , Lennquist Montán K , Rüter A , Castrén M , Svensson L , Gryth D , Fossum B . Attitudes towards and experience of the use of triage tags in major incidents: a mixed method study. Prehosp Disaster Med. 2016;31(4):376-385.
authors.affiliation: 1Karolinska Institutet,Department of Clinical Science and Education,Södersjukhuset,Stockholm,Sweden.
authors.forename: Monica
authors.initials: M
authors.lastname: Rådestad
authors.affiliation: 2University of Gothenburg,Institute of Clinical Science,Department of Surgery,Gothenburg,Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Lennquist Montán
authors.affiliation: 1Karolinska Institutet,Department of Clinical Science and Education,Södersjukhuset,Stockholm,Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Rüter
authors.affiliation: 1Karolinska Institutet,Department of Clinical Science and Education,Södersjukhuset,Stockholm,Sweden.
authors.forename: Maaret
authors.initials: M
authors.lastname: Castrén
authors.affiliation: 1Karolinska Institutet,Department of Clinical Science and Education,Södersjukhuset,Stockholm,Sweden.
authors.forename: Leif
authors.initials: L
authors.lastname: Svensson
authors.affiliation: 5Karolinska Institutet,Department of Physiology and Pharmacology,Section of Anaesthesiology and Intensive Care Medicine,Stockholm,Sweden.
authors.forename: Dan
authors.initials: D
authors.lastname: Gryth
authors.affiliation: 6Sophiahemmet University,Stockholm Sweden and Karolinska Institutet,Department of Clinical Sciences,Danderyds sjukhus,Stockholm,Sweden.
authors.forename: Bjöörn
authors.initials: B
authors.lastname: Fossum
mesh_terms: D000552:Ambulances / Q000458:organization & administration / Q000592:standards*; D001291:Attitude of Health Personnel; D004634:Emergency Medical Technicians / Q000193:education* / Q000523:psychology / Q000592:standards; D005260:Female; D017144:Focus Groups; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D054527:Mass Casualty Incidents; D013548:Sweden; D014218:Triage / Q000379:methods / Q000458:organization & administration / Q000592:standards*; D000078329:Workforce
keywords: AN ambulance nurse; EMS Emergency Medical Services; EMT emergency medical technician; FGI focus group interview; MCI mass-casualty incident; MI major incident; MIMMS Major Incident Medical Management and Support; RETTS rapid emergency triage and treatment system; SCC Stockholm County Council; attitudes; disaster; major incident; mass-casualty incident; triage