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The influence of the proper triage choice on the early identification of life-threating conditions in tactical environment
DUCHOŇ, Jaroslav
The tactical environment is very unfriendly for trauma patients and the rescuers, themsel- ves. From the point of view of providing pre-hospital emergency care on a larger scale, which we are used to in a civilian environment, it is a very austere environment. With the deteriorating security situation in the world and, at the same time, on the European continent, the issue of tactical and combat medicine is increasingly coming to the foref- ront. It is no longer just a question of professional elements from the area of armed forces or armed security forces. The issue of triage of the patients in scenarios with mass casualty incidents connected not only with the most frequently rehearsed topic of an active shooter, but also bomb attacks of various natures, is increasingly coming to the forefront and is being sought by the professional public. However, thanks to historically ingrained dogmas, in our territory, unlike abroad, which faces more and more waves of terrorist attacks, it is not possible to break the barrier of prejudices regarding the tactical sorting systems that are already commonly used in the world. These include, for example, MASS, designed for security forces in the USA im- mediately after the September 1st terrorist attacks on the World Trade Center, or the TCCC Triage algorithm, used as a standard for combat conditions. This regressive thin- king still favors S.T.A.R.T as the only suitable candidate for all types of mass casualty incidents, regardless of the safety of the incident itself and the level of threat to the rescuers. What is neglected is that the first responders in these completely asymmetrical incidents will not be professional rescuers from the ranks of EMS, but only minimally educated armed forces or even the civilian population arriving at the scene of the incident itself. The aim of this diploma thesis was to compare the effectiveness of the three most widely used civilian and tactical triage sieves, where three criteria were compared during eight TECC (Tactical Emergency Casualty Care) and TCCC (Tactical Combat Casualty Care), tactical and combat medicine courses. Effectiveness: speed, accuracy and ability to re- member sorting algorithm without the need to use an auxiliary card for groups of profes- sional as well as lay rescuers. Students were always trained in a pre-determined time window and with the necessary equipment completed model scenarios in a simulated tactical environment with different climatic and lighting conditions, determining the ap- propriate sorting categories for each of the ten trauma patients. The data of the individual triage systems differed greatly during the subsequent compari- son not only in the area of memorability, but, also, in the speed of performing the primary triage. S.T.A.R.T demonstrated the worst results in comparison with the two other com- peting tactical systems MASS and TCCC Triage algorithm with values (average time for sorting ten of the injured was 3 minutes and 50 seconds, and an average of 35% of stu- dents demonstrated the ability to remember the classification scheme, n = 80). MASS, which with its resulting values of 100% memorability rate, average time of 2 minutes and 55 seconds and accuracy in determining the sorting category of 95.5%, n=80, finished second in the ranking. However, the best triage efficiency values with a 100% recall rate, 99.4% agreement and an average time of 1 minute and 59 seconds, n=80, were achieved by the TCCC Triage algorithm designed for the combat environment. Here, participants clearly demonstrated the easier usability of tactical sorting sieves from the point of view of primary triage not only for professional rescuers, but also for minimally trained mem- bers of the armed security forces and the general public.
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