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Tabletop Exercise on Mass Casualty Incident Triage, Does it Work?

Keebat Khan

Background: The triage is the first step in medical hierarchy for better management before treatment and transport in mass casualty incident (MCI). Therefore, an accurate, valid and timely triage will safe life and limbs, especially, when done by expert and experienced staff in MCI triage. This study planned to evaluate the MCI triage skills of the medical staff like doctors and nurses at Hamad General Hospital Emergency Department (HGH ED). They were provided a table top exercise (TTX) about MCI triage to improve the skills and knowledge followed by impact assessment. The study trial was planned and performed at emergency department of (tertiary hospital) Hamad general hospital at Doha Qatar. Methods: The study includes both intervention and control groups. The selected sample of ED medical and nursing staff was randomly divided into two groups. The intervention group performed the table top exercise and the control group followed written paper based instructions about MCI triage. The both groups were asked to triage 20 standardized cases as per simple triage and rapid treatment (START) triage. The study evaluated the triage accuracy and time to triage as primary outcome as well as over and under triaging for both groups as secondary outcomes. Results: The study results report 90% triage accuracy in the intervention group and 70% in control group with a difference of 20% to 30%. The time to triage for 20 standardized cases was 5.4 minutes in intervention group and 8.2 minutes in control group, so participants in the intervention group triaged their patients more quickly than participants in the control group mean difference 2.8 minutes 98.5% confident interval 5.4 to 8.2 minutes. The over and under triaging were 5% for both in the intervention side but 20%, 10% respectively in the control side. The reliability was also found better at intervention side due to repeated training. The validity is not measured because the nature of work is simulation and only one triage system is used. Conclusion: The table top exercise (TTX) on triage for one hour improved the triaging skills of the ED medical staff up to 20% to 30% in comparison to written paper based instruction technique as well as the time to triage was also near to the half. The study suggests future studies to validate these findings which may also confirm other triage related findings like accuracy, over and under triage, validity, reliability and time to triage.