Triage Accuracy of START Method in Traumatic Mass Casualty Incidents (MCI)

Introduction: In traumatic mass casualty incidents (MCIs), accurate triage is essential for prioritizing care and managing resources effectively. This study assesses the accuracy of the START (Simple Triage and Rapid Treatment) method across different responder variables, including occupation, experience, gender, and unit. Additionally, it compares the accuracy rates for each triage category and the time spent. The study further evaluates the execution rate of critical interventions, such as hemorrhage control and airway opening, which are essential steps within the START method. Methods: This study utilized AI-generated realistic images of injured patients to create a high-fidelity simulation environment. Participants included physicians, nurses, and emergency medical technicians (EMTs) with varying levels of experience (5 years) and from different units (emergency department, non emergency, and fire stations). During the simulation, evaluators interacted face-to-face with participants, acting as standardized patients (SPs) to support the triage decision-making process. Participants assessed 30 simulated patients within a 30-minute timeframe, making triage color judgments based on START criteria. Bleeding control materials and nasopharyngeal airways were provided for simulated interventions. Results: On average, participants correctly assessed 28.04 cases, achieving a mean accuracy rate of 93.71%. The average time spent on triage was 845.28 seconds. Triage accuracy by color category was as follows: green (94%), yellow (96%), red (89%), and black (100%). Analysis by occupation and experience indicated that experienced participants and those in emergency-related roles performed more accurately, particularly in the red and black categories. Conclusion: This study highlights variability in START triage accuracy based on responder occupation and experience. The use of AI-generated injury images facilitated realistic training, suggesting that such simulations could enhance competency in triage skills, especially in hemorrhage and airway management. Enhanced training for responders from non-emergency units or with limited experience may lead to more consistent triage accuracy and improved MCI response.