Comparison of the Sacco Triage Method Versus START Triage Using a Virtual Reality Scenario in Advance Care Paramedic Students.

Since the time of the Napoleonic wars, health care providers have discussed, debated and invented multiple triage systems designed to rapidly triage victims in order to save the most lives. A key medical procedure in a mass casualty incident (MCI) is the rapid and accurate sorting of victims with life, limb, or serious injuries from those without. There are different triage methods proposed for use during a MCI, but few have been validated scientifically. Validation of field triage methods for MCI is difficult because of issues of rarity, reproducibility, study groups, logistics, and different processes using different methods. Most of the evidence to date has been based on simulation and post-event evaluations, rather than prospective trials. START (Simple Triage and Rapid Treatment) is now the most widely used method in the world, but there has been little scientific evaluation of this triage method. This method divides patients into ambulatory and nonambulatory, and then, using a set of basic physiologic parameters, sorts remaining patients into immediate, delayed, minor, or expectant categories, with each victim receiving a color code of red, yellow, green, or black. After the attacks on September 11th, 2001, in New York City, ThinkSharp Inc. began developing a commercial, evidence-based and outcome-driven approach called the Sacco Triage Method (STM). It is the only method evaluated for National Incident Management System compatibility in the United States (US). STM uses a simple physiologic score that predicts survival and deterioration, where patients are triaged to maximize expected survivors in consideration of the timing and availability of transport and resources. In addition to the START and STM triage systems having been derived using markedly different methods, an important difference between the two triage methods is that the START system is opensource and in the public domain, while the STM system is proprietary and licensed for commercial use only. The aim of this study was to use virtual reality (VR) simulation of actual historical train crash MCI victims to compare advance care paramedic students’ use of START and STM triage methods in terms of time to triage and assignment of severity order of MCI victims.