Need ideas for 3rd order triage in ACF setting

[DaveC]

We are not looking for recommendations for primary triage methodologies used in the field like SMART or START or MET TAGS. We are looking for an algorithm that captures the prioritization process similar to what a triage nurse in an ED would go through.

At a recent Table Top Exercise our MRC Unit was tasked with setting up an alternate care facility (ACF) that would receive self-presenting patients, no ambulance deliveries. The ACF was needed because none of the four local hospitals could accept any patients.

Our ACF would act like an emergency department or a freestanding emergency clinic, receiving patients who need to be evaluated to determine if they can be treated in our ACF or if they need to be transferred to other ACFs more geared to higher levels of definitive care (ex. DMAT's field hospital).

After that initial "ship or treat" sorting out is done, we need to classify our patients into treatment priority groups so the medical staff can focus on the higher priority patients, again like is done in a hospital ED.

There is a great comparative study in the online Agency for Healthcare Research and Quality (AHRQ Home>Quality Assesment>Measuring Healthcare Quality> Emergency Severity Index Version 4). The best contender I've found is the Emergency Severity Index (ESI) (Gilboy et al., 1999; Wuerz, Eitel, Travers & Gilboy, 2000). But we are really looking for actual field experiences of other MRC units not hypotheticals.

We are not looking for recommendations for primary triage methodologies used in the field like SMART or START or MET TAGS.

We are looking for an algorithm that captures the prioritization process similar to what a triage nurse in an ED would go through. We are looking for folks that will share their actual experiences with any system they have used, good, bad or otherwise.

THANKS Again !

David Courter, Advanced EMT

EMS Unit Lead

Capitol Region MRC

860-529-9098

decourter@cox.net

[WolfmanHarris]

The triage method used by our crews for regular calls and within the ED in this province is the Canadian Triage Acuity Scale. (CTAS) I'm not familar with any of the other methods so I can't speak to the relative merits of CTAS compared to those, but it may give you a starting point. I'll see what I have on my computer, I may have some of the training materials we were issued in school, if not the complete guide.

[Richard B the EMT]

If I understand the concept of an Alternate Care Facility, it sounds like a free-standing Emergency Room, as in "Walk in, be treated, walk back out again". I have heard of this concept, and have actually used the nickname of "Doc-in-a-box" for it. Normally, I don't like the concept.

However, under the "START" concept, this type facility, if used in a disaster, could probably take a bunch of Green tag (walking wounded) patients, taking some of the strain off a hospital connected ER, or even a "MASH" tent, treating all the other color coded categories.

[CBEMT]

If I understand the concept of an Alternate Care Facility, it sounds like a free-standing Emergency Room, as in "Walk in, be treated, walk back out again". I have heard of this concept, and have actually used the nickname of "Doc-in-a-box" for it. Normally, I don't like the concept.

I've been involved in a drill simulating the activation of an ACF during a pandemic flu crisis, so I got to see how the whole thing runs.

Here, ACFs will receive patients, including walk-ins, by bus from secondary collection points, and from EMS, during the crisis (my 911 department would transport patients meeting criteria to a nearby high school, by way of example). They will triage, treat, and if necessary, hold/admit for as long as necessary. Patients determined to be critical, become critical, or requiring more advanced diagnostics will be transferred to an actual hospital (each ACF will send their patients to a different pre-determined hospital) for further assessment and treatment. Private ambulances will have a staging area of units on-site for this purpose, thereby eliminating delays.

The ACFs are staffed, near as I can tell, by personnel assigned by pre-plan from the hospital that the ACF transfers their patients to- that way everyone is already on the same page in terms of treatment, equipment, supplies, etc. This would most likely be personnel called back as opposed to stripped from the hospital itself.