Tools for HEMS units: A concept for major incident triage

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Fig. 1: HEMS units are regularly involved in the management of major incidents that need structuring and standardising – given the multitude of responders (Photographs: Norwegian Air Ambulance Foundation)

Authors: Marius Rehn Norwegian Air Ambulance Foundation Dpt. of Anaesthesia and Intensive Care, Akershus University Hospital,Lørenskog marius.rehn@ norskluftambulanse.no Trond Vigerust Norwegian Air Ambulance Drøbak Jan E. Andersen Norwegian Air Ambulance Foundation Drøbak Andreas J. Krüger Norwegian Air Ambulance Foundation Drøbak & St. Olav University Hospital, Department of Anesthesia and Emergency Medicine, Trondheim, Norway Hans M. Lossius Norwegian Air Ambulance Foundation Drøbak & University of Bergen, Department of Surgical Sciences Bergen, Norway

Tools for HEMS units: a concept for major incident triage HEMS units are regularly involved in the immediate response during major incidents. Efficient management of these incidents involves triage, treatment and transport. HEMS units often operate in several regions and must adapt to local systems for incident management, when national standards are lacking. In the absence of a standardised interdisciplinary major incident management approach, the Norwegian Air Ambulance Foundation developed the Interdisciplinary Emergency Service Cooperation Course (TAS). The TAS-program was established in 1998 and by 2011, approx. 17,000 emergency service professionals had participated in one of more than 600 courses free of charge. The TAS-triage concept has modified the established triage sieve, as slap-wrap reflective triage tags and paediatric triage stretchers have been integrated. Feasibility and accuracy of the TAS-triage concept by the Norwegian Air Ambulance Foundation were evaluated through full-scale bus crash simulations. Learners participated in a self-report survey – as a before-after study – in which triage accuracy as well as time consumption were measured. The modified triage sieve tool was found to be feasible, time-efficient and accurate in allocating priority during simulated bus accidents and may be a candidate for a future national standard for major incident triage.

Major incidents are heterogeneous in nature and their unexpectedness favours an “all-hazards” approach. Since rescue capacity varies within systems, the conditions of a major incident that may be relevant for a rural emergency service, may not apply to a larger urban emergency service (1). Rapid access to advanced major incident management has proven to optimize resource use and improve patient outcome (2). Major incident management traverses geographical and jurisdictional boundaries and involves responders from multiple rescue services. Furthermore, it involves multiple tasks such as leadership, preparation, risk-evaluation, triage, treatment and trans-

1 · 2012 I Vol. 2 I AirRescue I 16


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