Issue

Vol. 1 No. 2 (2024)

Date Log

Submitted
February 19, 2026
Published
December 31, 2024

Copyright (c) 2024 Sharog awaidah Alrwaili, Ghanem Abdollah Ghanem AL Ghanem, Wafa Alturge Mklaf Al Gaigai, Salha Mohammed Al-Thrwy, Rehab Nasser Al-Hazmi, Shaker Dakheelallah S Alsharari, Ali Hadi Mohammed Bakkari, Mohammad Abdulrahman Alfahad, Fatimah Hussain Jary, Mohammed Jassar Mohammed Alsharari, Mohammed Raja Basheer Alsharari, Tawasif Ali Othman Hakmi

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Triage Accuracy at the Interface: The Interdependent Roles of Ambulance Crews, Emergency Nursing Assistants, and Medical Secretaries in Disaster Surge Management

https://doi.org/10.64483/202412658
Sharog awaidah Alrwaili
Women’s Maternity & Children Hospital,Ministry of Health, Saudi Arabia
Ghanem Abdollah Ghanem AL Ghanem
Badr First Health Center,Ministry of Health , Saudi Arabia
Wafa Alturge Mklaf Al Gaigai
Central Hospital, Hafr Al-Batin, Civil Service,Ministry of Health , Saudi Arabia
Salha Mohammed Al-Thrwy
Harob Phc, Ministry of Health , Saudi Arabia
Rehab Nasser Al-Hazmi
Al-Jahw Health Center,Ministry of Health , Saudi Arabia
Shaker Dakheelallah S Alsharari
Prince Mutaib Bin Abdulaziz Hospital, Sakaka, Al-Jawf Health Cluster,Ministry of Health , Saudi Arabia
Ali Hadi Mohammed Bakkari
Erada Hospital and Mental Health in Jazan, Jazan, Ministry of Health, Saudi Arabia
Mohammad Abdulrahman Alfahad
Prince Salman Bin Mohammed Hospital in Al-Dilam, Ministry of Health, Saudi Arabia
Fatimah Hussain Jary
Tuwaiq Western Health Center , Ministry of Health , Saudi Arabia
Mohammed Jassar Mohammed Alsharari
Montazah Health Center, Al-Jawf Health Cluster,Ministry of Health , Saudi Arabia
Mohammed Raja Basheer Alsharari
Tabuk, Al-Jawf Health Cluster,Ministry of Health , Saudi Arabia
Tawasif Ali Othman Hakmi
Al-Madaya Health Center,Ministry of Health , Saudi Arabia

Corresponding Author(s) : Sharog awaidah Alrwaili

sharogA@moh.gov.sa

Saudi Journal of Medicine and Public Health, Vol. 1 No. 2 (2024)

Abstract

Background: Mass casualty incidents (MCIs) and infectious disease surges place unprecedented stress on healthcare systems, with triage accuracy serving as the critical determinant of patient outcomes. Despite widespread adoption of standardized triage tools, the interprofessional nature of disaster triage—spanning pre-hospital ambulance crews, emergency nursing assistants, medical secretaries, and laboratory personnel—remains underexamined.


Aim: This narrative review synthesizes evidence on triage systems (START, SALT, JumpSTART) during MCIs and infectious disease surges, examining the distinct yet interdependent roles of frontline personnel and identifying communication failures that compromise disaster response.


Methods: A structured narrative review of English-language literature (2010-2024) was conducted using PubMed, CINAHL, and Scopus. 


Results: Evidence reveals significant variability in triage tool sensitivity (ranging from 0.45 to 0.76), with under-triage rates posing substantial patient safety risks. Interprofessional communication failures—particularly at the pre-hospital to emergency department interface—represent a latent threat to triage accuracy. Medical secretaries play an underappreciated role in patient tracking and family reunification, while laboratory surge capacity activation depends critically on real-time communication from triage personnel.


Conclusions: Optimizing disaster triage requires a systems-level approach that recognizes the interdependence of ambulance crews, nursing assistants, medical secretaries, and laboratory staff. Structured communication protocols, shared mental models, and integrated simulation training are essential for improving triage accuracy and surge response.

Keywords

mass casualty triage, interprofessional communication, disaster preparedness, surge capacity, patient tracking
Alrwaili, S. awaidah, Ghanem Abdollah Ghanem AL Ghanem, Wafa Alturge Mklaf Al Gaigai, Salha Mohammed Al-Thrwy, Rehab Nasser Al-Hazmi, Shaker Dakheelallah S Alsharari, … Tawasif Ali Othman Hakmi. (2024). Triage Accuracy at the Interface: The Interdependent Roles of Ambulance Crews, Emergency Nursing Assistants, and Medical Secretaries in Disaster Surge Management. Saudi Journal of Medicine and Public Health, 1(2), 2379–2388. https://doi.org/10.64483/202412658
Download Citation
Endnote/Zotero/Mendeley (RIS)
BibTeX
References
  1. Alruwaili, M. A., Shahbal, S., Almaliki, H. H., Abdullah, A. A., Alibrahim, I. M., Alshahrani, F. F., ... & Albalawi, R. S. (2023). Emergency Preparedness And Response Capacity Of Primary Health Care Centers In Saudi Arabia; A Systematic Review Based Study. Journal of Namibian Studies, 33.
  2. Avery, M. D., Mathiason, M., Andrighetti, T., Autry, A. M., Cammarano, D., Dau, K. Q., ... & Jennings, J. C. (2022). Improved self‐assessed collaboration through interprofessional education: midwifery students and obstetrics and gynecology residents learning together. Journal of midwifery & women's health, 67(5), 598-607. https://doi.org/10.1111/jmwh.13394
  3. Bazyar, J., Farrokhi, M., Salari, A., Safarpour, H., & Khankeh, H. R. (2022). Accuracy of triage systems in disasters and mass casualty incidents; a systematic review. Archives of academic emergency medicine, 10(1), e32. https://doi.org/10.22037/aaem.v10i1.1526
  4. Bennett, A. (2019). Methodologies utilized and lessons learned in high threat environments and mass casualty environments. SOMA 2019 scientific assembly study grant report. Journal of High Threat & Austere Medicine, 1(1), 1-7. https://search.informit.org/doi/10.3316/informit.358021188972496
  5. Cimellaro, G. P., Domaneschi, M., & Zamani Noori, A. (2020). Improving post-earthquake emergency response using indoor tracking. Earthquake Spectra, 36(3), 1208-1230. https://doi.org/10.1177/8755293020911163
  6. Di Delupis, F. D., Mancini, N., Di Nota, T., & Pisanelli, P. (2015). Pre-hospital/emergency department handover in Italy. Internal and emergency medicine, 10(1), 63-72. https://doi.org/10.1007/s11739-014-1136-x
  7. Dojmi Di Delupis, F., Mancini, N., Ruggeri, M., & Pisanelli, P. (2020). Perceptions of emergency department triage nurses about prehospital emergency rescuers in Italy: a latent threat to clinical handover. Journal of Patient Safety, 16(1), e34-e38. DOI: 10.1097/PTS.0000000000000249
  8. Donaldson, L. J., Panesar, S. S., & Darzi, A. (2014). Patient-safety-related hospital deaths in England: thematic analysis of incidents reported to a national database, 2010–2012. PLoS medicine, 11(6), e1001667. https://doi.org/10.1371/journal.pmed.1001667
  9. Ebert, L., Hoffman, K., Levett-Jones, T., & Gilligan, C. (2014). “They have no idea of what we do or what we know”: Australian graduates' perceptions of working in a health care team. Nurse education in practice, 14(5), 544-550. https://doi.org/10.1016/j.nepr.2014.06.005
  10. Erika, P., Andrea, V., Cillis, M. G., Ioannilli, E., Iannicelli, T., & Andrea, M. (2020). Triage decision-making at the time of COVID-19 infection: the Piacenza strategy. Internal and emergency medicine, 15(5), 879-882. https://doi.org/10.1007/s11739-020-02350-y
  11. Farra, S., Nicely, S., & Hodgson, E. (2014). Creation of a virtual triage exercise: An interprofessional communication strategy. CIN: Computers, Informatics, Nursing, 32(10), 492-496. DOI: 10.1097/CIN.0000000000000090
  12. Franc, J. M., Kirkland, S. W., Wisnesky, U. D., Campbell, S., & Rowe, B. H. (2022). METASTART: a systematic review and meta-analysis of the diagnostic accuracy of the Simple Triage and Rapid Treatment (START) algorithm for disaster triage. Prehospital and disaster medicine, 37(1), 106-116. doi:10.1017/S1049023X2100131X
  13. Freund, Y., Goulet, H., Bokobza, J., Ghanem, A., Carreira, S., Madec, D., ... & Hausfater, P. (2013). Factors associated with adverse events resulting from medical errors in the emergency department: two work better than one. The Journal of emergency medicine, 45(2), 157-162. https://doi.org/10.1016/j.jemermed.2012.11.061
  14. Frykberg, E. R. (2002). Medical management of disasters and mass casualties from terrorist bombings: how can we cope?. Journal of Trauma and Acute Care Surgery, 53(2), 201-212.
  15. Gao, M. C., Lim, Z. J., Freestone, M. B., Austin, M. K., & McManus, M. R. (2019). Tracking patients in an earthquake response: The bad, the better, and the best. Prehosp. Disaster Med, 34(1), s87-s88. doi:10.1017/S1049023X19001821
  16. Granheim, B. M., Shaw, J. M., & Mansah, M. (2018). The use of interprofessional learning and simulation in undergraduate nursing programs to address interprofessional communication and collaboration: An integrative review of the literature. Nurse education today, 62, 118-127. https://doi.org/10.1016/j.nedt.2017.12.021
  17. Guasconi, M., Bonacaro, A., Tamagnini, E., Biral, S., Brigliadori, L., Borioni, S., ... & Artioli, G. (2022). Handover methods between local emergency medical services and Accident and Emergency: is there a gold standard? A scoping review. Acta Bio Medica: Atenei Parmensis, 93(4), e2022288. https://doi.org/10.23750/abm.v93i4.13515
  18. Jakobsen, R. B., Gran, S. F., Grimsmo, B., Arntzen, K., Fosse, E., Frich, J. C., & Hjortdahl, P. (2018). Examining participant perceptions of an interprofessional simulation-based trauma team training for medical and nursing students. Journal of interprofessional care, 32(1), 80-88. https://doi.org/10.1080/13561820.2017.1376625
  19. Jerome, D., Savage, D. W., & Pietrosanu, M. (2023). An assessment of mass casualty triage systems using the Alberta trauma registry. Canadian journal of emergency medicine, 25(8), 659-666. https://doi.org/10.1007/s43678-023-00529-8
  20. Kahn, C. A., Schultz, C. H., Miller, K. T., & Anderson, C. L. (2009). Does START triage work? An outcomes assessment after a disaster. Annals of emergency medicine, 54(3), 424-430. https://doi.org/10.1016/j.annemergmed.2008.12.035
  21. Lerner, E. B., Schwartz, R. B., Coule, P. L., Weinstein, E. S., Cone, D. C., Hunt, R. C., ... & O'Connor, R. E. (2008). Mass casualty triage: an evaluation of the data and development of a proposed national guideline. Disaster medicine and public health preparedness, 2(S1), S25-S34. doi:10.1097/DMP.0b013e318182194e
  22. Lippi, G., & Plebani, M. (2020). The critical role of laboratory medicine during coronavirus disease 2019 (COVID-19) and other viral outbreaks. Clinical Chemistry and Laboratory Medicine (CCLM), 58(7), 1063-1069. https://doi.org/10.1515/cclm-2020-0240
  23. Mahdi, S. S., Jafri, H. A., Allana, R., Battineni, G., Khawaja, M., Sakina, S., ... & Amenta, F. (2023). Systematic review on the current state of disaster preparation Simulation Exercises (SimEx). BMC emergency medicine, 23(1), 52. https://doi.org/10.1186/s12873-023-00824-8
  24. Malik, N. S., Chernbumroong, S., Xu, Y., Vassallo, J., Lee, J., Bowley, D. M., ... & Gkoutos, G. V. (2021). The BCD triage sieve outperforms all existing major incident triage tools: comparative analysis using the UK national trauma registry population. EClinicalMedicine, 36. https://doi.org/10.1016/j.eclinm.2021.100888
  25. Marcussen, C. E., Braeuner, K. B., Alstrøm, H., & Møller, A. M. (2022). Accuracy of prehospital triage systems for mass casualty incidents in trauma register studies-A systematic review and meta-analysis of diagnostic test accuracy studies. Injury, 53(8), 2725-2733. https://doi.org/10.1016/j.injury.2022.05.006
  26. Nicely, S., & Farra, S. (2015). Fostering learning through interprofessional virtual reality simulation development. Nursing education perspectives, 36(5), 335-336. DOI: 10.5480/13-1240
  27. North-Samardzic, A., & de Witt, M. (2019). Designing a human resource management simulation to engage students. Journal of Management Education, 43(4), 359-395. https://doi.org/10.1177/1052562919841411
  28. Ouellet, S., Galliani, M. C., Gelinas, C., Fontaine, G., Archambault, P., Mercier, E., ... & Berube, M. (2023). Strategies to improve the quality of nurse triage in emergency departments: A realist review protocol. Nursing Open, 10(5), 2770-2779. https://doi.org/10.1002/nop2.1550
  29. Ratnayake, R., Finger, F., Edmunds, W. J., & Checchi, F. (2020). Early detection of cholera epidemics to support control in fragile states: estimation of delays and potential epidemic sizes. BMC medicine, 18(1), 397. https://doi.org/10.1186/s12916-020-01865-7
  30. Romig, L. E. (2002). Pediatric triage. A system to JumpSTART your triage of young patients at MCIs. JEMS: a journal of emergency medical services, 27(7), 52-8.
  31. Sigalet, E., Donnon, T., & Grant, V. (2012). Undergraduate students’ perceptions of and attitudes toward a simulation-based interprofessional curriculum: the KidSIM ATTITUDES questionnaire. Simulation in Healthcare, 7(6), 353-358. DOI: 10.1097/SIH.0b013e318264499e
  32. Streiner, D. L., & Kottner, J. (2014). Recommendations for reporting the results of studies of instrument and scale development and testing. Journal of advanced nursing, 70(9), 1970-1979. https://doi.org/10.1111/jan.12402
  33. Tervajärvi, L., Hutri-Kähönen, N., & Rautiola, A. M. (2021). Student-LED interprofessional sequential simulation improves communication and teamwork. Nurse education in practice, 51, 102983. https://doi.org/10.1016/j.nepr.2021.102983
  34. Vassallo, J., Beavis, J., Smith, J. E., & Wallis, L. A. (2017). Major incident triage: derivation and comparative analysis of the Modified Physiological Triage Tool (MPTT). Injury, 48(5), 992-999. https://doi.org/10.1016/j.injury.2017.01.038
  35. World Health Organization. (2022). WHO guidance on research methods for health emergency and disaster risk management, revised 2022. World Health Organization.
  36. Zeltyn, S., Marmor, Y. N., Mandelbaum, A., Carmeli, B., Greenshpan, O., Mesika, Y., ... & Basis, F. (2011). Simulation-based models of emergency departments: Operational, tactical, and strategic staffing. ACM Transactions on Modeling and Computer Simulation (TOMACS), 21(4), 1-25. https://doi.org/10.1145/2000494.2000497
Read More
Author biographies is not available.
Download
PDF
Statistic
Read Counter : 64 Download : 248