title: Use of a Novel, Portable, LED-Based Capillary Refill Time Simulator within a Disaster Triage Context.
abstract: Introduction A simple, portable capillary refill time (CRT) simulator is not commercially available. This device would be useful in mass-casualty simulations with multiple volunteers or mannequins depicting a variety of clinical findings and CRTs. The objective of this study was to develop and evaluate a prototype CRT simulator in a disaster simulation context.
  
  
  METHODS
  A CRT prototype simulator was developed by embedding a pressure-sensitive piezo crystal, and a single red light-emitting diode (LED) light was embedded, within a flesh-toned resin. The LED light was programmed to turn white proportionate to the pressure applied, and gradually to return to red on release. The time to color return was adjustable with an external dial. The prototype was tested for feasibility among two cohorts: emergency medicine physicians in a tabletop exercise and second year medical students within an actual disaster triage drill. The realism of the simulator was compared to video-based CRT, and participants used a Visual Analog Scale (VAS) ranging from "completely artificial" to "as if on a real patient." The VAS evaluated both the visual realism and the functional (eg, tactile) realism. Accuracy of CRT was evaluated only by the physician cohort. Data were analyzed using parametric and non-parametric statistics, and mean Cohen's Kappas were used to describe inter-rater reliability.
  
  
  RESULTS
  The CRT simulator was generally well received by the participants. The simulator was perceived to have slightly higher functional realism (P=.06, P=.01) but lower visual realism (P=.002, P=.11) than the video-based CRT. Emergency medicine physicians had higher accuracy on portrayed CRT on the simulator than the videos (92.6% versus 71.1%; P<.001). Inter-rater reliability was higher for the simulator (0.78 versus 0.27; P<.001).
  
  
  CONCLUSIONS
  A simple, LED-based CRT simulator was well received in both settings. Prior to widespread use for disaster triage training, validation on participants' ability to accurately triage disaster victims using CRT simulators and video-based CRT simulations should be performed. Chang TP , Santillanes G , Claudius I , Pham PK , Koved J , Cheyne J , Gausche-Hill M , Kaji AH , Srinivasan S , Donofrio JJ , Bir C . Use of a novel, portable, LED-based capillary refill time simulator within a disaster triage context. Prehosp Disaster Med. 2017;32(4):451-456.
authors.affiliation: 1Division of Emergency Medicine and Transport,Children's Hospital Los Angeles;Keck School of Medicine,University of Southern California,Los Angeles,CaliforniaUSA.
authors.forename: Todd P
authors.identifier: http://orcid.org/0000-0002-4508-2551
authors.initials: TP
authors.lastname: Chang
authors.affiliation: 2Department of Emergency Medicine,Los Angeles County + University of Southern California Hospital;Keck School of Medicine,University of Southern California,Los Angeles,CaliforniaUSA.
authors.forename: Genevieve
authors.initials: G
authors.lastname: Santillanes
authors.affiliation: 2Department of Emergency Medicine,Los Angeles County + University of Southern California Hospital;Keck School of Medicine,University of Southern California,Los Angeles,CaliforniaUSA.
authors.forename: Ilene
authors.initials: I
authors.lastname: Claudius
authors.affiliation: 1Division of Emergency Medicine and Transport,Children's Hospital Los Angeles;Keck School of Medicine,University of Southern California,Los Angeles,CaliforniaUSA.
authors.forename: Phung K
authors.initials: PK
authors.lastname: Pham
authors.affiliation: 4Department of Psychiatry and Behavioral Sciences,University of Washington Medical Center,Seattle,WashingtonUSA.
authors.forename: James
authors.initials: J
authors.lastname: Koved
authors.affiliation: 5Crash Lab Support;Howell,MichiganUSA.
authors.forename: John
authors.initials: J
authors.lastname: Cheyne
authors.affiliation: 6Department of Emergency Medicine,Harbor-UCLA Medical Center;David Geffen School of Medicine,University of California Los Angeles,Los Angeles,CaliforniaUSA.
authors.forename: Marianne
authors.initials: M
authors.lastname: Gausche-Hill
authors.affiliation: 6Department of Emergency Medicine,Harbor-UCLA Medical Center;David Geffen School of Medicine,University of California Los Angeles,Los Angeles,CaliforniaUSA.
authors.forename: Amy H
authors.initials: AH
authors.lastname: Kaji
authors.affiliation: 7Division of Emergency Medicine,Texas Children's Hospital;Baylor College of Medicine,Houston,TexasUSA.
authors.forename: Saranya
authors.initials: S
authors.lastname: Srinivasan
authors.affiliation: 8Division of Emergency Medicine,Rady Children's Hospital of San Diego;UCSD School of Medicine,San Diego,CaliforniaUSA.
authors.forename: J Joelle
authors.initials: JJ
authors.lastname: Donofrio
authors.affiliation: 2Department of Emergency Medicine,Los Angeles County + University of Southern California Hospital;Keck School of Medicine,University of Southern California,Los Angeles,CaliforniaUSA.
authors.forename: Cynthia
authors.identifier: http://orcid.org/0000-0002-5110-9052
authors.initials: C
authors.lastname: Bir
mesh_terms: D004190:Disasters; D004867:Equipment Design; D006801:Humans; D054527:Mass Casualty Incidents; D010092:Oximetry / Q000295:instrumentation*; D016544:Patient Simulation; D010865:Pilot Projects; D014218:Triage; D014741:Video Recording
keywords:  CRT capillary refill time;  LED light-emitting diode;  START Simple Triage and Rapid Treatment;  VAS Visual Analog Scale; capillary refill time; disaster simulation; mass-casualty simulation