Evaluation of Nurse-Led Sono-Triage in Identifying the Under-Triage Rate Among Yellow-Triage Patients During Mass Casualty Incidents at a Level 1 Trauma Center in India.

BACKGROUND

Triage is critical during mass casualty incidents (MCIs). Under-triage during MCIs using existing triage tools may lead to errors in making critical treatment decisions. The point-of-care ultrasound has been used during MCIs to diagnose hemoperitoneum, pneumothorax, long bone fractures, cardiac tamponade, and inferior vena cava (IVC), with good sensitivity and specificity.

OBJECTIVE

We explored the impact of nurse-led sono-triage in identifying the under-triage rate among yellow triage patients and inter-rater agreement among nurse performers during MCIs.

METHODS

This was a retrospective observational study of four MCIs during Holi festivals encountered at the emergency department of a level one trauma centre in India. After undergoing training, 10 nurses performed extended focused assessment by sonography in trauma (E-FAST) of yellow triaged patients. The findings were recorded and analyzed.

RESULTS

Sono triage was done in 438 patients. Eight patients were E-FAST positive, and 430 E-FAST negative patients. These eight patients (1.8%) were then triaged as red and categorized as under-triaged. The interrater agreement between the nurse performers and the radiologist was 100%.

CONCLUSION

Sono-triage was able to estimate the under-triage rate among yellow triage patients during MCIs. The nurses who performed sono-triage had a good inter-rater agreement with the radiologist. Nurses may be utilized as a task-sharing model to do sono-triage during MCIs.