title: Testing the START Triage Protocol: Can It Improve the Ability of Nonmedical Personnel to Better Triage Patients During Disasters and Mass Casualties Incidents ?
abstract: START (Simple Triage and Rapid Treatment) triage is a tool that is available even to nonmedical rescue personnel in case of a disaster or mass casualty incident (MCI). In Italy, no data are available on whether application of the START protocol could improve patient outcomes during a disaster or MCI. We aimed to address whether "last-minute" START training of nonmedical personnel during a disaster or MCI would result in more effective triage of patients.
  
  
  
  In this case-control study, 400 nonmedical ambulance crew members were randomly assigned to a non-START or a START group (200 per group). The START group received last-minute START training. Each group examined 6000 patients, obtained from the Emergo Train System (ETS Italy, Bologna, Italy) victims database, and assigned patients a triage code (black-red-yellow-green) along with a reason for the assignment. Each rescuer triaged 30 patients within a 30-minute time frame. Results were analyzed according to Fisher's exact test for a P value<0.01. Under- and over-triage ratios were analyzed as well.
  
  
  
  The START group completed the evaluations in 15 minutes, whereas the non-START group took 30 minutes. The START group correctly triaged 94.2% of their patients, as opposed to 59.83% of the non-START group (P<0.01). Under- and over-triage were, respectively, 2.73% and 3.08% for the START group versus 13.67% and 26.5% for the non-START group. The non-START group had 458 "preventable deaths" on 6000 cases because of incorrect triage, whereas the START group had 91.
  
  
  
  Even a "last-minute" training on the START triage protocol allows nonmedical personnel to better identify and triage the victims of a disaster or MCI, resulting in more effective and efficient medical intervention. (Disaster Med Public Health Preparedness. 2017;11:305-309).
authors.affiliation: 1Bologna NHS Emergency Department,Bologna,Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Badiali
authors.affiliation: 1Bologna NHS Emergency Department,Bologna,Italy.
authors.forename: Aimone
authors.initials: A
authors.lastname: Giugni
authors.affiliation: 2Italian Red Cross Bologna Committee - Rizzoli Orthopedic Institute of Bologna,Bologna,Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Marcis
mesh_terms: D000465:Algorithms; D016022:Case-Control Studies; D004190:Disasters; D004632:Emergency Medical Services / Q000379:methods* / Q000592:standards; D006801:Humans; D007558:Italy; D054527:Mass Casualty Incidents; D014218:Triage / Q000379:methods* / Q000592:standards*; D000078329:Workforce
keywords: START triage; nonmedical first responders; triage accuracy; triage effectiveness