Comparación de los sistemas de triaje META y START en un ejercicio simulado de múltiples víctimas

Abstract

Objectives. The main purpose of this simulation of a multiple-casualty event was to compare the performance of 2 triage methods: the Simple Triage and Rapid Treatment (START) system and the Prehospital Advanced Triage Model (META in its Spanish acronym). The secondary objectives were to analyze times, order of evacuations, and appropriateness of treatments. Methods. Cluster randomized trial that included 16 groups assigned to use either the START system or the META for managing casualties in a simulated event (an airline crash). Each group had 4 members. We recorded times, order ofevacuation, and appropriateness of treatment. Results. The mean (SD) evacuation time was 48 minutes and 39 seconds (15 minutes, 52 seconds) in the START arm and 48 minutes and 4 seconds (17 minutes, 21 seconds) in the META arm (P=.829). The patients with greatest need of immediate care were evacuated more quickly in the META arm (31 minutes and 36 seconds [8 minutes, 27 seconds]) than in the START arm (41 minutes and 6 seconds [10 minutes, 39 seconds]) (P=.024). Evacuation of the subgroup of patients requiring emergency surgery was also faster in the META arm (24 minutes and 12 seconds [4 minutes] than in the START arm (44 minutes and 49 seconds [8 minutes, 36 seconds]) (P=.001). Analysis of the order of evacuation under the 2 triage systems revealed that 14 of the first 19 patients evacuated required immediate medical care and 5 of the first 14 evacuated required priority surgical treatment in the START arm. In the META arm, all of the first 14 patients evacuated required immediate medical care and 5 of the first 7 patients evacuated required priority surgical treatment. The rate of appropriate treatment was 92% in the META arm and 63% in the START arm (P=.023). Conclusions. Use of the META system might improve prehospital times and the order of evacuation of patients, particularly patients who need immediate medical care or urgent surgery. The META might also increase the likelihood of appropriate treatment in multiple-casualty events.