Introduction: During the 2016 Kumamoto earthquake, a grade 1–4 evacuation triage (Simple Triage and Rapid Treatment for Neonates, START-Neo) was used to determine the evacuation order at a tertiary neonatal intensive care unit (NICU). However, most newborns are classified as grade 2 or 3, which makes it difficult to determine the order of evacuation. A five-category, 0–12 scale (Neonatal Extrication Triage, NEXT) was developed to reflect the medical care provided. This retrospective observational study investigated whether the use of (i) a triage system (vs. random orders) and (ii) NEXT (vs. START-Neo) improved NICU evacuation efficiency. Methods: NEXT and START-Neo were assessed over 49 days. Given that the evacuation was performed in either ascending or descending order of patient severity, an efficient triage system was defined as one that precisely reflected patient severity. The severity of newborn patients at the time of triage assignment was determined using a Neonatal Therapeutic Intervention Scoring System (NTISS). The Total Evacuation Score (TES) was defined as the time integral of the NTISS scores of newborns waiting for evacuation and remaining within the NICU from the start to the completion of the evacuation. The TES was compared between (i) no triage, (ii) NEXT, and (iii) START-Neo. A computer-based evacuation simulation was conducted using all possible combinations of evacuation orders (NEXT and START-Neo) or randomly extracted combinations (no triage). Results: Compared to no-triage, both NEXT and START-Neo led to a reduction in TES throughout the study period. NEXT was superior to START-Neo on 34 of 49 days and showed no difference on 10 days. Conclusion: Triage systems are crucial for improving NICU evacuation efficiency. NEXT, an improved triage system, appears likely to reduce the overall risk of newborns remaining in a damaged NICU before transportation.
Imai et al. (Sun,) studied this question.