Impact of Ten Second Triage vs. Sieve on Triage Performance in Simulated Mass-Casualty Incidents

Stuby Loric200 enrolled

Overview

This study will compare two emergency triage algorithm - Ten Second Triage (TST) versus Sieve - to see which one works better during simulated mass-casualty incidents. Triage is the process of quickly deciding which patients need immediate care when there are many injured people. Making fast and accurate decisions is essential in these situations. Ambulance professionals and students in French-speaking Switzerland will be invited to take part. Participants will be randomly assigned to use either the TST method or the Sieve method. After a short introduction to the assigned method, each participant will complete two computer-based simulation scenarios involving 17 injured patients each (one scenario with penetrating injuries and one with blunt injuries). The simulated patients' conditions will change over time, similar to real-life emergencies using a physiological validated simulator (HUMAn). The main goal is to measure how accurately participants identify patients who need immediate treatment. For each correct triage decision, participants receive one point. A total score will be calculated across both scenarios. If a sufficient sample size could be reached, a mixed effect logistic regression model will be generated to answer to research question. The study will also measure how long participants take to make triage decisions, how often patients are over-triaged or under-triaged, and how easy participants find the method to use. The results will help determine which triage method may be more effective for use by ambulance personnel during major incidents.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

OTHER

Masking

TRIPLE

Enrollment

200

Conditions

Interventions

Ten Second Triage algorithmOTHER

Ten Second Triage (TST) is a rapid primary triage algorithm designed for use in mass-casualty incidents. It aims to allow rescuers to assess and categorize a patient in approximately 10 seconds based on a small number of immediately observable clinical signs. The algorithm focuses on key life-saving indicators such as ability to walk, presence of major external bleeding, airway status, breathing effectiveness, and level of consciousness. Based on these findings, patients are assigned to standard triage categories (e.g., immediate, urgent, delayed, or deceased). TST prioritizes speed and simplicity to support rapid decision-making when resources are limited and many victims require simultaneous assessment.

Sieve triage algorithmOTHER

Sieve (NARU) triage algorithm is a structured primary triage method used during mass-casualty incidents, developed and promoted by the National Ambulance Resilience Unit (NARU). It is designed to rapidly sort large numbers of patients based on simple physiological criteria. The Sieve algorithm follows a stepwise assessment focusing on the ability to walk, breathing status and rate, and circulation (including signs of life-threatening hemorrhage). Patients are then assigned to standard triage categories (immediate, urgent, delayed, or deceased). Sieve emphasizes consistency and reproducibility of triage decisions and is widely used in prehospital disaster response and training to support safe prioritization when resources are limited.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Prehospital care professionals (e.g., ambulance personnel) or paramedic students * Practicing or training in French-speaking Switzerland * Likely to be involved in the management of major incidents or mass-casualty events * Provided informed consent to participate Exclusion Criteria: * Participants who answered "No" to the statement confirming that their questionnaire responses reflect their usual personal practice * Participants who did not view the instructional video of the assigned triage algorithm (time spent on the video page is recorded), except participants randomized to the Sieve arm who routinely use the Sieve algorithm in their clinical practice

Outcomes

Primary Outcomes

Triage accuracy (triage score)

Triage accuracy is defined as the proportion of correct triage decisions made by each participant across two simulated mass-casualty scenarios (34 patients in total). For each simulated patient, participants receive: 1 point for a correct triage decision (0 points for an incorrect decision). A triage decision is considered correct if the assigned priority category matches the simulated patient's expected clinical evolution based on the HUMAn dynamic simulation model (i.e., correct identification of patients requiring immediate treatment versus those who do not, including appropriate classification of deceased patients). The primary endpoint is the total triage score per participant (range 0-34), calculated by summing correct decisions across both scenarios.