Page 67 - Journal of Special Operations Medicine - Spring 2016

Accuracy and Reliability of Triage
at the Point of Injury During Operation Enduring Freedom

Timothy P. Plackett, DO; Jamison S. Nielsen, DO, MBA;
Christina D. Hahn, MD; Jay M. Rames, RN, ACNP-BC

ABSTRACT

Background: Accurate point-of-injury reports and casu- hour to preserve life, limb, or eyesight. Priority II pa-
alty evacuation requests allow for optimal resource uti- tients also require intervention, but generally can wait up
lization. However, the accuracy of these reports has not to 4 hours, if needed, without concern for deterioration.
been previously studied. Methods: All trauma patients Priority III casualties are considered routine. These are
treated at one of three forward surgical elements (FSE) injured individuals whose condition is not expected to
in Western Afghanistan during May–August 2012 were deteriorate and can wait up to 24 hours for evacuation.
prospectively included. North American Treaty Organi- Finally, Priority IV patients are those for whom evacua-
zation (NATO) 9-line medical evacuation request and tion is a matter of convenience and not necessity. This tri-
mechanism, injuries, signs, and treatments (MIST) re- age is generally performed by a medical provider (often
ports were compared to the initial findings on arrival to a medic) at the point of injury and is part of the North
the FSE. Results: There were 179 casualty evacuation American Treaty Organization (NATO) 9-line request
reports and 298 patients. NATO 9-line and/or MIST for casualty evacuation (NATO 9-line). Although only
reports were available for 70% of these. Triage was ac- the number of patients and their priority are required to
curate for 77%, but there was 17% overtriage and 6% request an evacuation, a report of the mechanism, inju-
undertriage (k = .619). The number of patients was ac- ries, signs, and treatments (MIST) is often included.
curate in 95% of reports, the mechanism of injury was
accurate for 98%, and the body region involved was ac- Providing this information is meant to not only initi-
curate for 92% (k = .850, .943, and .870, respectively). ate the casualty evacuation but also provide the receiv-
There was no difference between the mean vital signs ing medical team with information about the incoming
at the point of injury or on arrival at the FSE. When casualties so they can prepare appropriately. Anecdotal
analyzed individually, however, there was no correla- experience has suggested that these reports can be in-
tion between each casualty’s pulse, mean arterial pres- accurate and serve as a source of dissatisfaction and
sure, or respiratory rate between the two time points. frustration among the receiving medical providers at the
Discussion: There was a high degree of correlation be- Role II and III facilities. However, these anecdotal re-
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tween the triage category of casualty evacuation reports ports have not qualified which portions of the casualty
and the patient’s actual medical needs. There was also evacuation reporting are inaccurate.
a highly significant association with the number of pa-
tients, mechanism of injury, and bodily injuries. How- In the present study, we tried to quantify, through a pro-
ever, there was discordance between the vital signs at an spective, observational study, the degree of correlation
individual level, which may represent regression toward between reports from the point of injury and the find-
the resuscitation threshold. ings on arrival at a Role II facility. The primary objec-
tive was to determine the accuracy of the current triage
Keywords: triage; trauma; war; Afghanistan; combat; accuracy protocol. The secondary objective was to determine the
accuracy of the number of patients reported to be com-
ing, mechanism of injury, bodily injuries, and vital signs
between the point of injury report and on arrival at the
Introduction
Role II facility.
Triage is designed around maximizing survival by pri-
oritizing the care and transport of injured patients. Methods
Currently, casualties are categorized into one of four
priorities. Priority I patients are considered urgent and Information was prospectively collected on all trauma
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need medical and/or surgical intervention within an patients cared for at three separate Role II forward

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