Pediatric Disaster Triage Knowledge Levels of Pediatric Emergency Department Health Care Workers

Öz

Objective: Triage in disasters aims to benefit as many people as possible. This study aimed to measure the knowledge level of healthcare personnel working in pediatric emergency departments about child triage in the disaster area, to evaluate the effectiveness of the training provided and to determine the factors affecting this training. Material and Method: This study is cross-sectional research conducted at the Pediatric Emergency Department of A University affiliated Training and Research Hospital between April and July 2023. Healthcare personnel working in the Pediatric Emergency Department participated in the study. Participants received training based on the JumpSTART triage system. Pre- and post-training knowledge tests (KT) and scenario-based tests (SBT) were administered. The theoretical knowledge of disaster triage (maximum score of 15) and triage decisions based on three different scenarios (maximum score of 60) of doctors and nurses working in the pediatric emergency department were measured. Following this, training based on the JumpSTART triage system was provided. The effectiveness of the training was evaluated with a post-test conducted one week later. Results: A total of 44 participants (7 doctors and 37 nurses) were included in the study. The median age was 35.5 years (IQR=28-43.7), with 36 participants (40.9%) being female. The difference in participants' scores between the pre- and post-training knowledge tests (KT) (median 4 vs. 11; p<0.001) and scenario-based tests (SBT) (36.8±4.6 vs. 40.8±4.6; p=0.031) was significant. As the duration of working in the pediatric emergency triage unit increased, the posttest KT scores showed a significant increase (p=0.047; r=0.448). The training was particularly beneficial for triaging patients with red codes (p=0.010). Conclusion: This study successfully enhanced the disaster triage knowledge and skill levels of healthcare personnel in the pediatric emergency department. The training program effectively improved the participants' knowledge and skills. Practical experience played a significant role in the increase of knowledge. Future research should involve larger sample sizes and assess the long-term effects of such training programs.

Anahtar Kelimeler

• JumpSTART
• Disaster Triage
• Healthcare Personnel Training
• Triage Skills

Çocuk Acil Servis Sağlık Çalışanlarının Pediatrik Afet Triyajı Bilgi Düzeyleri

Öz

Amaç: Afetlerde yapılan triyajın, mümkün olan en fazla sayıda insana fayda sağlamayı hedeflediği bilinmektedir. Bu çalışmanın amacı, çocuk acil serviste görev yapan sağlık personelinin afet alanında çocuk triyajı konusundaki bilgi düzeylerini ölçmek, verilen eğitimin etkinliğini değerlendirmek ve bu eğitimi etkileyen faktörleri belirlemektir. Materyal ve Metot: Bu çalışma, bir üniversite ile afiliye Eğitim ve Araştırma Hastanesi Çocuk Acil Servisi'nde Nisan-Temmuz 2023 tarihleri arasında yürütülen kesitsel bir çalışmadır. Çalışmaya Çocuk Acil servisinde çalışan sağlık personelleri katılmıştır. Katılımcılara jumpSTART triyaj temelli eğitim verilmiştir. Eğitim öncesi ve sonrası bilgi sınavı (BS) ve olgu senaryosu sınavı (OSS) uygulanmıştır. Çocuk acil servisinde çalışan doktor ve hemşirelerin afet triyajı konusundaki teorik bilgileri (maksimum puan 15) ve üç farklı senaryo üzerinden triyaj kararları (maksimum puan 60) ölçülmüştür. Ardından jumpSTART triyaj temelli eğitim verilmiştir. Bir hafta sonra son test ile eğitimin etkinliği değerlendirilmiştir. Bulgular: Çalışmaya toplam 44 kişi (7 doktor, 37 hemşire) katılmıştır. Ortanca yaş: 35,5 (ÇDA=28-43,7) olup; 36’sı (%40,9) kadındır. Katılımcıların bilgi sınavı (ortanca 4’e karşılık 11; p<0,001) ve olgu sınavı (36,8±4,6’e karşılık 40,8±4,6; p=0,031) eğitim öncesi ve sonrası arasındaki fark anlamlıdır. Çocuk acil servisi triyaj biriminde çalışılan süre arttıkça son test BS puanı anlamlı düzeyde artış göstermiştir (p=0,047; r=0,448). Özellikle kırmızı kodlu hastaların triyajları konusundaki eğitimden daha çok fayda sağlanmıştır (p=0,010). Sonuç: Bu çalışma, çocuk acil serviste görev yapan sağlık çalışanlarının afet triyajı bilgi ve beceri seviyelerini arttırmada başarıya ulaşmıştır. Eğitim programı, katılımcıların bilgi ve becerilerini geliştirmiştir. Pratik deneyimin bilgi artışında önemli bir rol oynadığı görülmüştür. Gelecek araştırmalarda daha geniş örneklemlerle çalışılması ve uzun vadeli etkilerin değerlendirilmesi önerilmektedir.

Anahtar Kelimeler

• JumpSTART
• Afet Triyajı
• Sağlık Personeli Eğitimi
• Triyaj Becerileri

Kaynakça

1. [1] Yalçın, G., Anıl, M. 2022. Pediatric Disaster Triage System. Forbes J Med, 3(2), 99-105.
2. [2] Gebbie, K. M., Qureshi, K. 2002. Emergency and disaster preparedness: core competencies for nurses. Am J Nurs, 102(1), 46-51.
3. [3] Ghanbari, V., Ardalan, A., Zareiyan, A., Nejati, A., Hanfling, D., Bagheri, A, Rostamnia, L. 2021. Fair prioritization of casualties in disaster triage: a qualitative study. BMC Emerg Med, 21(1), 119.
4. [4] Mills, A. F., Argon, N. T., Ziya, S. 2013. Resource-based patient prioritization in mass-casualty incidents. Manuf Serv Oper Manag, 15(3), 361-77.
5. [5] Andersson, A. K,, Omberg, M., Svedlund, M. 2006. Triage in the emergency department–a qualitative study of the factors which nurses consider when making decisions. Nurs Crit Care, 11(3), 136-45.
6. [6] Petrini, C. 2010. Triage in public health emergencies: ethical issues. Intern Emerg Med, 5(2), 137-44.
7. [7] Chegini, Z., Arab-Zozani, M., Kakemam, E., Lotfi, M., Nobakht, A., Aziz, K.H. 2022. Disaster preparedness and core competencies among emergency nurses: A cross-sectional study. Nurs Open, 1-9.
8. [8] Schneider, B. C. 2019. An investigation of the relationships between and among disaster preparedness knowledge, perceived use of intuition, and triage decision making of emergency Department Registered Nurses in Acute Care Hospitals Using Benner’ s Novice to Expert Theory.

9. [9] Hosseini, M. M., Hosseini, S. T. M., Qayumi, K., Hosseinzadeh, S., Ahmady, S. 2023. Crossover design in triage education: the effectiveness of simulated interactive vs. routine training on student nurses' performance in a disaster situation. BMC Res Notes, 16(1), 313.
10. [10] Garner, A., Lee, A , Harrison, K., Schultz, C. H. 2001. Comparative analysis of multiple-casualty incident triage algorithms. Ann Emerg Med, 38(5), 541-48.
11. [11] Koziel, J. R., Meckler, G., Brown, L., Acker, D. 2015. Barriers to pediatric disaster triage: a qualitative investigation. Prehosp Emerg Care, 19(2), 279-86.
12. [12] Tan, Y. T., Shin, C. K. J., Park, B., Bharath, A., Wing, R., Monteilh, C., Sanseau. E., Boswell, B., Pearce, J. I., Luetje, M., Enriquez, B., Cicero, M., Thomas, A. 2023. Pediatric Emergency Medicine Didactics and Simulation: JumpSTART Secondary Triage for Mass Casualty Incidents. Cureus, 15(6), e40009.
13. [13] Brinjee, D., Al Thobaity, A., Almalki, M., Alahmari, W. 2021. Identify the disaster nursing training and education needs for nurses in Taif City, Saudi Arabia. Risk Manag Healthc Policy, 14, 2301–10.
14. [14] Aitsi-Selmi, A., Egawa, S., Sasaki, H., Wannous, C., Murray, V. 2015. The Sendai framework for disaster risk reduction: renewing the global commitment to people’s resilience, health, and well-being. Int J Disaster Risk Sci, 6, 164-76.
15. [15] Abuadas, M. H., Albikawi, Z. F. 2022. Predictors of disaster preparedness among registered nurses in Saudi Arabia: A structural equation modelling analysis. Australas Emerg Care, 25(2), 132-39.
16. [16] Christian, M. D., Hamielec, C., Lazar, N. M., Wax, R. S., Griffith, L., Herridge, M. S., Lee, D., Cook, D. J. 2009. A retrospective cohort pilot study to evaluate a triage tool for use in a pandemic. Crit Care, 13(5), R170.
17. [17] Cicero, M. X., Overly, F., Brown, L., Yarzebski, J., Walsh, B., Shabanova, V., Auerbach, M., Riera, A., Adelgais, K., Meckler, G., Cone, D. C., Baum, C. R. 2016. Comparing the Accuracy of Three Pediatric Disaster Triage Strategies: A Simulation-Based Investigation. Disaster Med Public Health Prep, 10(2), 253-60.
18. [18] Kouliev, T. 2016. Objective triage in the disaster setting: will children and expecting mothers be treated like others? Open Access Emerg Med, 27, 77-86.
19. [19] Desmond, M., Schwengel, D., Chilson, K., Rusy, D., Ingram, K., Ambardekar, A., Greenberg, R. S., Belani, K., Perate, A., Gangadharan, M. 2022. Society for Pediatric Anesthesia Disaster Preparedness Special Interest Group. Paediatric patients in mass casualty incidents: A comprehensive review and call to action. Br J Anaesth, 128(2), 109-19.
20. [20] Baack, S., Alfred, D. 2013. Nurses’ preparedness and perceived competence in managing disasters. J Nurs Sch, 45(3), 281-87.
21. [21] Hasankhani, H., Abdollahzadeh, F., Vahdati shams, S., Dehghannejad, J. 2012, Educational needs of emergency nurses according to the emergency condition preparedness criteria in hospitals of tabriz university of medical sciences. Iran J Crit Care Nurs, 5(3), 159-65.
22. [22] Ghazi, B. O. 2021. Preparedness assessment for managing disasters among nurses in an international setting: Implications for nurses. Int Emerg Nurs, 56, 100993.
23. [23] Labrague, L. J., Yboa, B. C., Mcenroe-Petitte, D. M., Lobrino, L. R., Geronima, M., Brennan, B. 2016. Disaster preparedness in Philippine nurses. Wiley Online Libr, 48(1), 98-105.
24. [24] Pandit, K., Healy, E., Todman, R., Kingon, A., Wright, M., Raymond, M., JHill, J., Jeffrey, J., Papanagnou, D., Tedeschi, C. 2023. Disaster Triage Skills Training: An ıntroductory virtual simulation for medical students. Cureus, 15(5), e39417.
25. [25] Azizpour, I., Mehri, S., Soola, A. H. 2022, Disaster preparedness knowledge and its relationship with triage decision-making among hospital and pre-hospital emergency nurses - Ardabil, Iran. BMC Health Serv Res, 22(1), 934.
26. [26] Bijani, M., Abedi, S., Karimi, S., Tehranineshat, B. 2021. Major challenges and barriers in clinical decision-making as perceived by emergency medical services personnel: a qualitative content analysis. BMC Emerg Med, 21(1), 1-12.
27. [27] Şen, G. 2018. Sağlık profesyonellerinin afet triajı yapabilme ve etik karar verebilme düzeyleri: İzmir ili örneği. Sdü Sağlık Bilimleri Enstitüsü Dergisi, 9(1), 57-66.
28. [28] Hodge, A., Miller, E. 2017. Nursing self-perceptions of emergency preparedness at a rural hospital. J Emerg Nurs, 43(1), 10-4.
29. [29] Sanddal, T. L., Loyacono, T., Sanddal, N. D. 2004. Effect of JumpSTART training on immediate and short-term pediatric triage performance. Pediatr Emerg Care, 20(11), 749-53.
30. [30] Cicero, M. X., Whitfill, T., Overly, F., Baird, J., Walsh, B., Yarzebski, J., Riera, A., Adelgais, K., Meckler, G. D., Baum, C., Cone, D. C., MAuerbach, M. 2017. Pediatric Disaster Triage: multiple simulation curriculum ımproves prehospital care providers' assessment skills. Prehosp Emerg Care, 21(2), 201-208.