Page 69 - Journal of Special Operations Medicine - Spring 2016

Figure 1 Overtriage and undertriage as a function of the Figure 2 Comparison of the pulse between the point-of-
actual medical need. injury reports and the Role II facility.
A

point of injury and the number of casualties who arrived
at the Role II facility (Table 2). Only once did more pa-
tients arrive than were initially reported. If the request
was for one or two patients to be evacuated, this was B
accurate 99% of the time. However, if evacuation was
requested for more than two patients, the request was an
overestimate 26% of the time. The mechanism of injury
was extremely accurate (k = .943), as was the region of
the body that was injured (k = .870).

Table 2 Comparison of Casualty Information Between
Point-of-Injury Reports and the Role II Facility
Point-of-Injury
Category Reports, n No. (%)
Anticipated number of patients a pulse of 100 bpm or higher at the point of injury
dropped from 112.3 ± 10.6 to 105.2 ± 14.3 bpm.
1–2 patients 152
Accurate 151 (99) The mean arterial pressure (MAP) was similar be-
Overestimate 1 (1) tween the point of injury and Role II facility (93.0 ±
Underestimate 0 (0) 13.7mmHg versus 91.0 ± 13.9mmHg). However, there
was no correlation between an individual’s MAP at the
>2 patients 24
point of injury versus at the Role II facility (p = .030)
Accurate 17 (74) (Figure 3A). As with the pulse, when comparing the
Overestimate 6 (26) change in MAP over time as a function of the MAP at
Underestimate 1 (4) the point of injury, there was a general trend toward
reaching a MAP of 90mmHg. Casualties with a MAP of
Mechanism of injury (n = 216 patients)
less than 90mmHg at the point of injury rose from 78.8
Accurate 212 (98)
± 7.5mmHg to 87.3 ± 14.5mmHg. Casualties with a
Inaccurate 4 (2) MAP of 90mmHg or higher at the point of injury had a
Body region injured (n = 193 patients) decrease from 101.4 ± 8.9mmHg to 93.2 ± 13.0mmHg.
Accurate 178 (92)
The respiratory rate also showed a general association
Inaccurate 15 (8)
between the two time points (18.0 ± 8.9 versus 17.7 ±
6.3 breaths per minute), but no correlation between an
Vital signs were compared between the point of injury individual’s respiratory rate at the two time point (p =
and the Role II facility. The mean pulse was similar be- .002) (Figure 4A). As with the pulse and MAP, when
tween the two time points (92.4 ± 20.2 versus 97.0 ± comparing the change in respiratory rate over time as
21.5 beats per minute [bpm]), but there was no correla- a function of the respiratory rate at the point of in-
tion between an individual’s pulse at the point of injury jury, there was a general trend toward reaching 16–20
versus at the Role II facility (p = .002) (Figure 2A). When breaths per minute. Casualties with a respiratory rate of
examining the change in pulse over time as a function fewer than 21 breaths per minute at the point of injury
of the pulse at the point of injury, there was a general rose from a mean of 14.0 ± 6.0 to 16.7 ± 6.8 breaths
trend during transport toward reaching a mean pulse of per minute. Casualties with a respiratory rate of more
90–105 bpm (Figure 2B). Casualties with a pulse less than 21 breaths per minute at the point of injury had a
than 100 bpm at the point of injury rose from a mean decrease from a mean of 28.3 ± 6.6 to 20.2 ± 3.7 breaths
of 78.4 ± 11.9 to 91.2 ± 23.8 bpm, and casualties with per minute.

Triage Accuracy and Reliability During OEF 53