Klinisches Triage-Instrument in katastrophenmedizinischen Einsatzlagen – Verwendung des ESI-Algorithmus am Behandlungsplatz

Background

A Medical Task Force (MTF) can be deployed in disaster medical response situations and support disrupted hospital services, for example, by operating a self-sufficient treatment centre. Patients must be prioritised according to treatment needs to effectively provide medical care in disaster settings. Patient priority in the treatment centre is primarily assessed using one triage algorithm (e.g., PRIOR [“Primäres Ranking zur Initialen Orientierung im Rettungsdienst”]). However, other triage tools, such as the Emergency Severity Index (ESI) algorithm, which also define the time to physician contact, are used in a hospital setting.

Objectives

This work investigates whether a hospital triage tool, such as the ESI algorithm, can also be applied within a treatment centre of an MTF to improve patient care.

Materials and methods

A feasibility study was conducted in which MTF responders performed screening in two groups (physician and nonphysician) and two rounds, and compared the triage assessment results (correctness, speed), sensitivity and specificity. Overall the disease expression of the case vignettes was identical in both rounds.

Results

A total of 780 triage assessments (105 physician and 675 nonphysician) were included. Nonphysician staff were more likely to have correct triage results in the first round (PRIOR) compared to the physician group (75.71% [SD 4.70] vs 71.11% [SD 12.54]) than in the second round (ESI; 60.92% [SD 4.29] vs 76.67% [SD 11.29]).

Conclusions

Using a hospital triage tool in a treatment centre during a medical disaster event is feasible and especially relevant for continuing care in transfer cases to other medical settings (e.g., critical care centres or hospitals). Combining both algorithms may help bridge the prehospital and hospital care gap and improve resource allocation in medical emergencies.

Graphic abstract