The reality of multiple casualty triage: putting triage theory into practice at the scene of multiple casualty vehicular accidents

Objectives: The project investigated the experiences of ambulance paramedics in applying the principles and protocols of prehospital multiple casualty triage at the scene of motor vehicle accidents. Key objectives included investigation of the situational cues and other contextual factors influencing triage practice and the development of recommendations for the future education of ambulance paramedics.

Methods: A triangulated approach was used incorporating demographic data, the use of focus groups and in-depth interviews. A thematic analysis was undertaken following the well established practices of human science research.

Results and conclusions: The research describes an extended and broadened triage process returning to a more authentic definition of triage as the practice of sorting of casualties to determine priority. The findings highlight the need to consider triage as an extended and complex process that incorporates evidence based physiological cues to assist decision making and the management of the process of triage from call out to conclusion including assessment of contextual and situational variables.

Arbon P, Zeitz K, Ranse J, Wren H, Driscoll K, Elliott R. The reality of multiple casualty triage: putting triage theory into practice at the scene of multiple casualty vehicular accidents. Emergency Medicine Journal. 2008;25(4):230-234.

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Impact of a pandemic triage tool on intensive care admissions

Bailey A, Ranse J, Leditschke A, Grove K. Impact of a pandemic triage tool on intensive care admissions; poster presented at the Asia Pacific Critical Care Congress. Sydney, Australia, 30th October – 2nd November 2008.

Bailey A, Leditschke A, Ranse J, Grove K. Impact of a pandemic triage tool on intensive care admissions; poster presented at the 28th International Symposium on Intensive Care and Emergency Medicine. Brussels, Belgium, 18th – 21st March 2008.

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Graduate nurses’ lived experience of in-hospital resuscitation: A hermeneutic phenomenological approach

Free full-text article is available here (PDF) 

Aim: The purpose of this research was to explore, describe and interpret the lived experience of graduate [junior] Registered Nurses who have participated in an inhospital resuscitation event within the non-critical care environment.

Method: Using a hermeneutic phenomenological design, a convenience sample was recruited from a population of graduate Registered Nurses with less than 12 months experience. Focus groups were employed as a means of data collection. Thematic analysis of the focus group narrative was undertaken using a well-established human science approach.

Findings: Responses from participants were analysed and grouped into four main themes: needing to decide, having to act, feeling connected and being supported. The findings illustrate a decision-making process resulting in participants seeking assistance from a medical emergency team based on previous experience, education and the perceived needs of the patient. Following this decision, participants are indecisive, questioning their decision. Participants view themselves as learners of the resuscitation process being educationally prepared to undertake basic life support, but not prepared for roles in a resuscitation event expected of the Registered Nurse, such as scribe. With minimal direction participants identified, implemented and evaluated their own coping strategies. Participants desire an environment that promotes a team approach, fostering involvement in the ongoing management of the patient within a ‘safe zone’.

Conclusion: Similarities are identifiable between the graduate nurses’ experience and the experience of bystanders and other healthcare professional cohorts, such as the chaotic resuscitation environment, having too many or not enough participants involved in a resuscitation event, being publicly tested, having a decreased physical and emotional reaction with increased resuscitation exposure and having a lack of an opportunity to participate in debriefing sessions. Strategies should be implemented to provide non-critical care nurses with the confidence and competence to remain involved in the resuscitation process, firstly to provide support for less experienced staff and secondly to participate in the ongoing management of the patient. Additionally, the need for education to be contextualised and mimic the realities of a resuscitation event was emphasised.

Ranse J, Arbon P. Graduate nurses’ lived experience of in-hospital resuscitation – a hermeneutic phenomenological approach. Australian Critical Care. 2008;21(1):38-47

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