Mass Casualty Incident: Do Tactical Tag Bracelets Improve Triage Performance by First Responders? A Randomized Controlled Mass Casualty Incident Simulation and Response of A French Gendarmerie Elite Unit

Julien Galant; Simon-Pierre Corcostegui; David Marrache; Luc Saint-Jean; Vincent Desrobert; Cédric Boutillier du Retail; François Lecomte

doi:10.1093/milmed/usac023

Mass Casualty Incident: Do Tactical Tag Bracelets Improve Triage Performance by First Responders? A Randomized Controlled Mass Casualty Incident Simulation and Response of A French Gendarmerie Elite Unit

Mil Med. 2022 Feb 17:usac023. doi: 10.1093/milmed/usac023. Online ahead of print.

Authors

Julien Galant^{1

2}, Simon-Pierre Corcostegui¹, David Marrache², Luc Saint-Jean¹, Vincent Desrobert¹, Cédric Boutillier du Retail^{2

3}, François Lecomte⁴

Affiliations

¹ 1ère Antenne Médicale Spécialisée, Versailles 78000, France.
² Centre d'Enseignement et de Simulation à la Médecine opérationnelle, Ecole du val de Grace, Paris 75005, France.
³ Service médical d'unité, Bataillon des marins pompiers de Marseille, Marseille 13003, France.
⁴ Service des urgences CHU Cochin, AP-HP, Université Paris-centre, Paris 75014, France.

PMID: 35253061
DOI: 10.1093/milmed/usac023

Abstract

Introduction: Tactical triage replaces primary triage in the exclusion zone in mass murder or terrorist events to prioritize victims requiring life-saving interventions (LSIs) and/or rapid extraction in an environment with a lack of resources and under active threat. French gendarmerie tactical unit medical teams use triage bracelets during mass casualty incidents (MCIs). This study assessed the value of these bracelets in the tactical triage performance of nonhealthcare combat rescue operators in an MCI simulation.

Objectives: To compare triage performance with and without the use of bracelets based on categorization accuracy, LSIs, and time to end triage.

Materials and methods: Two groups of operators were randomly assigned to participate in an MCI simulation alone (10 simulated patients) with (intervention group) or without (control) bracelets. The primary outcome was triage performance assessed by the mass casualty triage performance assessment tools. The results were measured based on the LSI required, triage category, and time of completion of the task. Secondary outcomes were operator-perceived stress and self-efficacy.

Results: Eleven operators (intervention group n = 5, control group n = 6) participated. Triage performance, based on a maximum score of 90, was better for the intervention group [72.200 (SD = 10.330) vs. 57.000 (SD = 12.961), P = .045]. Self-efficacy was increased after the simulation in the intervention group [45.00 47.2 (SD = 4.147) vs. 50.400 (SD = 5.505), P = .034)].

Conclusions: This is the first study to show the best triage performance among nonhealthcare combat rescuers using triage bracelets in an MCI simulation. The small sample size did not allow for external validity of the results. The initially calculated number of participants (N = 12) was not reached for operational reasons. The use of bracelets may have a place in the medico-organizational act of tactical triage during MCIs in exclusion zones. Further studies should be conducted to assess the value of triage bracelets by other first responders, including physician-nurse teams.