SOGROLessons learned from an MCI 550 exercise (L. Latasch/M. Di Gennaro)
Lessons learned from an MCI 550 exerciseGerman Red Cross Frankfurt/MainAtosAndres Industries AGAlbert-Ludwigs-University/Freiburg im BreisgauUniversity of PaderbornUniversityof Stuttgart
Lessons learned from an MCI 550 exercise MCI Some of the major problems are:1. Not enough doctors (triage and treatment)2. EMT (permission to treat) not comparable f. i. between US and Germany3. No permission for triage (since 12.2009 permission for „pre˝-triage from the german doctors association)4. Information about patients (location, medical status, numbers) is arriving late and this delays a general overview.5. Patients getting „lost˝.6. Possible overload of medical data (BP, pulse, O2-saturation from 30 min ago) Possible Solutions:1. After a special training allow EMT to pre-triage patients2. Allow emergency treatment3. Give (pre-) permissiom for transportation according to triage-status even when a doctor is not yet available.
Lessons learned from an MCI 550 exercise Aside from the work of the EMT, further discussions lead us to the following facts: Faster transfer of data is only possible by „transmitting˝, Reduce the workload of patient data to the absolut necessary (no looking for names, no drawing of injuries, etc.), Chose a simple triage method which can be taught to everybody, Patients data needs to stay with patient. We therefore chose START: Simple Triage And Rapid Treatment Developed jointly by Newport Beach (CA) Fire and Marine Dept. and Hoag Hospital Gold standard for field adult multiple casualty (MCI) triage in the US and numerous countries around the world Is START really the Best Tool? No MCI primary triage tool has been validated by outcome data from MCIs. (Mass-casualty triage: Time for an evidence-based approach. Jenkins JL, et. Al. 2008; 23 (1): 3–8.)
Lessons learned from an MCI 550 exercise• The reason for the difference between 527 planned patients for triage and actually 545 real triaged patients is, that 18 patients were triaged twice.• Some of the external doctors started retriaging.• Further some of the patients were not triaged in the group (according to START system) which they were supposed to be (f. i. green instead of yellow).The main reason for this was:• 2 of the paramedics triaged (> 50) according to their experience instead of sticking strict to the STaRT system. These 2 had a rate of failure (wrong category) between 50-70%.• Not enough training/information for the patients about behaviour according to the injury.
Lessons learned from an MCI 550 exercise• Real time exercise starting at 10:30• First patient was triaged 12 min. later (through airport EMT)• Triage took an average of 53 sec. (diagnose using START incl. Datatransfer)• Up to a max.of 20 EMT were triaging (exercise related no treatment)• 42 min. after start, the first red patients left the scene.• After 2hrs and 40 min. all 270 patients patients arrived at 16 hospitals• Overall 82% were triaged correctly according to their group
Lessons learned from an MCI 550 exercise• 95% in group red were correctly triaged (critical that 5 patients group red were not correctly triaged)• Overtriage of group yellow (25% into group red) and a few were triaged into the group green! Only 70% in group yellow were accurately triaged correctly .• No difference in triage result of the EMT between those who triaged 10 or 20 patients, so loss of concentration is not a key element.• Patients which were „diagnosed”as green (walking wounded)were transported and triaged in a hall inside the airport. This way (walking) 246 patients were triaged as green eventhough the original figure was 242.
Lessons learned from an MCI 550 exercise Merci vielmals fürs zulose Thank you very much for your attention Prof. Dr. Leo Latasch – firstname.lastname@example.org Mario Di Gennaro - email@example.com