Ability of the Medical Students to Triage Multi-casualty Situations

摘要

Objective:Advanced Trauma Life Support (ATLS?) course is routinely taught to the students in medical schools. While the ATLS? training improves the ability of medical students to prioritize and manage individual patients1, data is lacking on the application of ATLS? principles in a multi-casualty incident. The aim of this paper is to analyze the effect of ATLS? training principles on medical students’ ability to effectively triage mass casualty scenarios.Materials and Methods:A total of 103 medical students participated in the study. A pre-ATLS lecture test and a post-ATLS lecture test were designed containing three scenarios of five patients each directly related to different components of ATLS? training. Students were asked to rank patients in order of priority from 1 to 5.Data:Comparison of data showed a significantly higher score in post-lecture test than pre-lecture test (73.3% vs. 37.8%). No correlation was noticed between any completed core rotation and BLS/ALS courses by the students and their triage scores.Conclusion:We found in this paper that teaching ATLS? principles to medical students improved the ability of medical students to effectively triage mass casualty patients. We also found that the students are easily distracted if a child or a pregnant woman is included in the test scenario and core rotations have no significant impact on the triage scores. Introduction Triage is defined as the sorting of and allocation of treatment to patients according to a system of priorities designed to maximize the number of survivors2. It is especially useful in mass casualty situations, when the number of victims is greater than the amount of resources. Until recently, the United States has been relatively inexperienced in mass casualty triage with notable exceptions including the World Trade Center bombing in 1993, the Oklahoma City bombing in 1995, the Centennial Olympic bombing in 1996, and the destruction of the World Trade Center in 2001. Terrorist attacks have become increasingly frequent over this past decade, and it is imperative that our nation’s healthcare professionals, both current and future, are sufficiently trained to triage severely injured patients3. The timely determination of patient priority has not been taught in standard curriculum; rather, it is an application of knowledge learned under different settings. There are two types of triage: triage of an individual patient and multicasualty triage. Individual patient triage is well represented in training programs (START?, etc.), whereas multicasualty triage methods comprise only a small portion of Advanced Trauma Life Support? (ATLS?) training. Materials and Methods A total of 103 medical students participated in the study. Before the lecture in ATLS? principles, the students were introduced to the objective of triage: to maximize the number of survivors by treating the greatest life-threatening injuries first. The students were then informed that the purpose of the study was to analyze the effectiveness of the training by conducting a pre-lecture and a post-lecture test. The students were also asked to fill out a questionnaire which included questions about the following: Age and gender Core/elective clerkships completed Specific prior experience in the health care field Prehospital Trauma Life Support, Basic Life Support, or Advanced Life Support? training and the year completed The pre-lecture test consisted of three multiple casualty scenarios (identified by numbers 1-3) consisting of five patients in each scenario, with various injuries directly relating to the primary survey portion of the ATLS?: one with an Airway problem , one with a Breathing problem, one with a Circulation problem, one with a Disability injury, and one with an Extremity issue. The first scenario was composed of five adults of either gender, the second scenario included a child, and the third scenario included a pregnant woman and a child. The students were asked to rank the patient