To increase field-friendliness, we designed weather-proof action card (figure ​(figure1)1) and slap wrap reflective triage tags (figure ​(figure22). Figure 1 Modified triage sieve action card. Adult (>140 cm) triage sieve. Figure 2 Reflective slap wrap triage tags. (P1) immediate (red); (P2) urgent (yellow); (P3) delayed (green) and deceased (white/black). The PTT relates a child’s supine length to age-related changes in physiological values to overcome the overtriage that occurs when children are subject to the adult triage Sieve algorithm

[5]. We designed a tape that presents vital data intervals along the side of stretchers to ensure field-friendly Inhibitors,research,lifescience,medical access to the paediatric triage algorithm (figure ​(figure3).3). All children in need of stretchers are allocated (P2) urgent (yellow), but are LY2157299 manufacturer upgraded to (P1) immediate (red) priority when vital signs lie outside their length-related reference values [8]. Figure 3 Paediatric triage tape stretcher. Details: paediatric vital signs reference Inhibitors,research,lifescience,medical values. The study hypothesis was that learners would improve in speed, triage accuracy and self-efficacy after the TAS-course. We describe the feasibility Inhibitors,research,lifescience,medical of a concept for major incident triage and present the accuracy of the modified triage Sieve in full-scaled simulated major incidents. Methods TAS-course In the period March-May 2010, Inhibitors,research,lifescience,medical TAS-courses were conducted in

4 municipalities with mixed urban/rural and coastal/inland characteristics. Local emergency service personnel (healthcare, police, fire and rescue technicians) were taught major incident self-safety, triage, patient evacuation, extrication techniques and cooperation during a no-cost two-day course. The didactic programme combines theoretical and practical sessions and is tailored to groups of various size and professional composition. A major incident was simulated outdoors using a standardised bus crash scenario

including approximately 20 patients (range 17-21) and a real-size bus wreck. Every patient was given 17-DMAG (Alvespimycin) HCl an information card (additional Inhibitors,research,lifescience,medical file 1) with injury descriptions as well as numeric vital signs for triage purposes. Physiological parameters were dynamic to mimic de-compensation and to visualize the need for re-triage. The patients were equally distributed between the four priorities (all categories had 25% representation). Paediatric patients were simulated with mannequins for ethical reasons. The bus-crash scenario was simulated once at the beginning of the course (no formal triage Sieve competence/no access to TAS-triage equipment) and once at the end of the course (with formal triage Sieve competence/access to TAS-triage action cards, triage tags and paediatric triage stretcher). The didactic program was piloted and refined through 43 TAS-courses prior to the study.