Usefulness and instructiveness of the disaster training for START method using the PDCA cycle

Objective: The present study aimed to clarify the usefulness and instructiveness of disaster training for the START (simple triage and rapid treatment) method for MCI (multi-casualty incidents) using the PDCA (plan-do-check-act) cycle.<BR>Subjects and Methods: A total of 282 participants, including 136 registered nurses, 124 emergency medical service personnel, and 22 doctors, were recruited from seven disaster training courses. In a training session, the participants were divided into five groups after receiving a review about triage using the START method and participating in a skill check activity in pairs; one group played the role of triage officers and the other groups played the role of affected people. The participants took turns playing each role through five rotations. Training drills consisting of a 1-minute briefing as the ‘plan and act’ phase, a 2-minute performance as the ‘do’ phase, and a 2-minute evaluation period as the ‘check’ phase were carried out after each rotation. Participants' performance was evaluated based on the triage performance and accuracy. In addition, the proportion of immediate victims among un-triaged people was added to these two measurements starting with the third rotation. After the evaluations of each drill, trainers gave the participants feedback in order to improve their performance. Participants playing the role of the next triage officers planned and implemented solutions by themselves.<BR>Results: The median performance rates of triage were 40.0% (range, 30.5-50.0) for the first rotation, 65.0% (range, 62.1-78.5) for the second, 83.3% (range, 48.8-96.6) for the third, 84.5% (range, 86.8-96.4) for the fourth, and 89.3% (range, 69.9-100.0) for the fifth. The median accuracy of triage was 25.4% (range 6.9-37.5) in the first rotation, 51.7% (range 43.8-57.1) in the second, 62.7% (range 41.9-89.7) in the third, 75.0% (range 54.7-81.8) in the fourth, and 78.1% (range 46.0-93.8) in the fifth. The performance rate and accuracy of triage both showed significant differences among the first, second, and third rotations. Participants accomplished the following goals for improving the benefit of first triage for MCI: (i) improve the accuracy of triage; (ii) reduce the number of un-triaged people; (iii) give priority to immediate victims; and (iv) gather information about triaged people with respect to their treatment and transport.<BR>Conclusion: The present results suggest that a triage training method using the PDCA cycle is effective for developing additional ways to carry out first triage and improving the performance rate and accuracy of first triage for MCI.