Vol 4 | Issue 3 | Sept-Dec 2018 | page: 6-10 | Nandkishor B. Goyal, Sayyadshadab S. Jafri, Ashish Vinayak Patil, Aashish Babanrao Ghodke.
Author: Muhammad Qasim Ali , Muhammad Muzzammil , Zehra Batool , Muhammad Saeed Minhas .
 Intern MBBS, Orthopedics ward 17, Jinnah Postgraduate Medical Centre, Karachi, Pakistan,
 Department of Orthopedics Ward 17, Jinnah Postgraduate Medical Centre, Karachi, Pakistan,
 Department of Orthopaedics, Medical Student Jinnah Sind Medical University, Karachi, Pakistan.
Address of Correspondence
Dr. Muhammad Qasim Ali,
Orthopedics ward 17, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
Background and Objectives:
Trauma is the major concern of the modern world. The ever-intensifying number of causalities being presented with the scarcity of resources, heavily burdens the emergency departments, which are the fundamental centers of a hospital. For a smooth flow and an efficient ER, implementation of a strong triage system with trained emergency staff personnel remains a dire necessity. The present study is aimed to review the awareness and implication of triage among emergency personnel, to evaluate the preparedness of emergency staff involved in the management of massive trauma casualties and highlight the self-identified deficiencies of the hospital and pre-hospital system.
Methods: A cross-sectional study was conducted to evaluate the preparedness, knowledge, and implication of triage by emergency room personnel at Accident and Emergency Department, Jinnah Postgraduate Medical Center, Karachi. The target population for the survey included casualty medical officers (CMOs), assistant casualty medical officers (ACMOs), nursing staff, and casualty operation theatre staff working in all three shifts morning, evening and night from December 2016 to February 2017.
Results: Of the 126 respondents questioned, 32% had no concept of triage. 70% of the respondents mentioned that they have never witnessed any patient already triaged brought to their ER indicating a poor onsite triage system. Only 23% (n = 29) received any training for triage before in past 5 years. Therefore, 97.61% emphasized the need of refresher training programs. On testing with standard scenarios of triage, it was investigated that 27 out of 126 participants answered all the questions correctly. No training drill or courses had been conducted for disaster management of the surveyed hospital.
Conclusion: Effective and early disposal of patients from accident and emergency needs trained triage team. Thus, it is imperative that training of ER personnel to be conducted as a continuous process. This study finding will be useful for planning future triage awareness programs in the form of classroom courses and hospital drills to curb mass casualties.
Keywords: Triage, Emergency personnel, Trauma, Bomb blast, Mass incidents.
1. “Triage.” Merriam-Webster, Merriam-Webster. Available from: http://www.merriam-webster.com/dictionary/triage. Last Accessed date: 21st Feb 2017.
2. Rignault D, Wherry D. And finally: Lessons from the past worth remembering: Larrey and triage. Trauma 1999;1:85-9.
3. Weinerman ER, Ratner RS, Robbins A, Lavenhar MA. Yale studies in ambulatory medical care. V. Determinants of use of hospital emergency services. Am J Public Health Nations Health 1966;56:1037-56.
4. Iserson KV, Moskop JC. Triage in medicine part I: concept, history, and types. Ann Emerg Med 2007;49:275-81.
5. Dahlberg LL, Krug EG. Violence-a global public health problem. In: Krug EG, Dahlberg LL, Mercy GA, Zwi AB, Lozano R, editors. World Report on Violence and Health. Geneva: World Health Organization; 2002. p. 1-20.
6. WHO|Road Traffic Injuries. Available from: http://www.who.int/violence_injury_prevention/road_traffic/en/. Last Accessed on 5thFeb 2017
7. WHO|Injuries and Violence. Available from: http://www.who.int/violence_injury_prevention/key_facts/VIP_k ey_facts.pdf?ua=1. Last Accessed on5thFeb 2017
8. Pakistan Institute of Peace Studies: PIPS Security Report 2016. Available from: https://www.pakpips.com/article/book/pakistansecurity-report-2016 [Last accessed on 2017 25th Jan].
9. Centre for Research and Security Studies: CRSS Annual Security Report 2016. Available from: http://www.crss.pk/wpcontent/uploads/2010/07/Annual-report-2016.pdf. (Last accessed on 25th Jan 2017)
10. Gazder, Uneb & Ahmed, Muhammad & Adnan, Muhammad. (2015). Spatial & Temporal Investigation of Road Accidents in Karachi.
11. Pre-hospital Trauma Life Support. 2nd ed. Patient Assessment and Management. 1990. p. 42.
12. Tanabe PG, Travers DA, Rosenau AM, Eitel DR. Index Emergency
Severity Index. Version 4: Implementation Handbook. A.H.R.Q Publication No. 05 – 00462. Rockville, MD: Agency for Healthcare Research and Quality; 2005.
13. Siddiqui MA, Jawad A, Minhas S, Ansari A, Siddiqui A, Mehtab S. Pakistan: The new target of terrorism. Are Karachi’s emergency medical response systems adequately prepared? J Pak Med Assoc 2009;59:441-5.
14. At Least 17 Die in Karachi Train crash in Pakistan. BBC. 3 November 2016. Available from url : https://www.bbc.com/news/world-asia-37856299 [Last accessed on 2016 Nov 06].
15. Atleast 22 Killed and 65 Injured from Train Collision: Available from: https://www.geo.tv/latest/119554-Several-hurt-as-twotrains-collide-in-Karachi. (Last accessed on 2016 Nov 6)
16. Pakistan Shah Noorani Shrine Bomb Kills 52” BBC. Available from: http://www.bbc.com/news/37962741. [Last accessed on 2016 Nov 12].
17. Ashkenazi I, Kessel B, Khashan T, Khashan T, Oren M, Haspel J, et al. Precision of in-hospital triage in mass-casualty incidents after terror attacks. Prehosp Disaster Med 2006;21:20-3.
18. Malik ZU, Hanif MS, Tariq M, Aslam R, Munir AJ, Zaidi H, et al. Mass casualty management after a suicidal terrorist attack on a religious procession in Quetta, Pakistan. J Coll Phys Surg Pak 2006;16:253-6.
19. Zafar H, Jawad A, Shamim MS, Memon AA, Hameed A, Effendi MS, et al. Terrorist bombings: Medical response in a developing country. J Pak Med Assoc 2011;61:561-6.
20. YouTube. Bomb blast in Karachi (Benazir’s Return). Available from: http://www.youtube.com/watch?v=Gq95MA2FB0o. [Last added on 2007 Oct 19].
21. Dawn News: KARACHI: ‘Lapses’ at Civil Hospital on Ashura Blast Day. Available from: http://www.dawn.com/wps/wcm/connect/dawn-contentlibrary/dawn/the-newspaper/local/karachi-lapses-at-civil-hospital-on-ashura-blast-day-410. [Last cited on 2010 Jan 04].
22. Jonathan LB, David H. Disaster Medicine. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2007. p. 25.
23. Minhas MS, Mahmood K, Effendi J, Kumar R, Bhatti A. Terrorist bomb blasts: Emergency department management of multiple incidents. Trauma Int 2015;1:36-40.
24. Rehmani R. Disaster drill at a university hospital. J Pak Med Assoc 2005;55:28-32. 25. Anteau CM, Williams LA. The Oklahoma bombing-lesson learned. Crit Care Nurs Clin North Am 1997;9:231-6.
26. Ashkenazi I, Kessel B, Olsha O, Khashan T, Oren M, Haspel J, et al. Defining the problem, main objective, and strategies of medical management in masscasualty incidents caused by terrorist events. Prehosp Disaster Med 2008;23:83-9.
27. Leiba A, Blumenfeld A, Hourvitz A, Weiss G, Peres M, Laor D, et al. Lessons learned from cross-border medical response to the terrorist bombings in Tabba and Rasel-satan, Egypt, on 07 October 2004. Prehosp Disaster Med 2005;20:253-7.
|How to Cite this article: Ali M Q, Muzzammil M, Batool Z, Minhas M S. Triage in Mass Casualty Incidents: Our Preparedness and Response – A Cross-sectional Study from a Tertiary Care Hospital, Karachi, Pakistan. Trauma International Sep-Dec 2018;4(3):6-10.