Leo LATASCH1, Mario DI GENNARO2 1Public Health Authority Frankfurt am Main; 2German Red Cross Frankfurt am Main

1. SOGRO
Lessons learned from an
MCI 550 exercise
(L. Latasch/M. Di Gennaro)

2. Lessons learned from an MCI 550 exercise
German Red Cross Frankfurt/Main
Atos
Andres Industries AG
Albert-Ludwigs-University/Freiburg im Breisgau
University of Paderborn
Universityof Stuttgart

3. Lessons learned from an MCI 550 exercise
MCI
Some of the major problems are:
1. Not enough doctors (triage and treatment)
2. EMT (permission to treat) not comparable f. i. between US and Germany
3. No permission for triage (since 12.2009 permission for „pre˝-triage from the
german doctors association)
4. Information about patients (location, medical status, numbers) is arriving late and
this delays a general overview.
5. Patients getting „lost˝.
6. Possible overload of medical data (BP, pulse, O2-saturation from 30 min ago)
Possible Solutions:
1. After a special training allow EMT to pre-triage patients
2. Allow emergency treatment
3. Give (pre-) permissiom for transportation according to triage-status even when a
doctor is not yet available.

4. Lessons learned from an MCI 550 exercise
Aside from the work of the EMT, further discussions lead us to
the following facts:
Faster transfer of data is only possible by „transmitting˝,
Reduce the workload of patient data to the absolut necessary (no looking for names,
no drawing of injuries, etc.),
Chose a simple triage method which can be taught to everybody,
Patients data needs to stay with patient.
We therefore chose START: Simple Triage And Rapid Treatment
Developed jointly by Newport Beach (CA) Fire and Marine Dept. and Hoag Hospital
Gold standard for field adult multiple casualty (MCI) triage in the US and numerous
countries around the world
Is START really the Best Tool?
No MCI primary triage tool has been validated by outcome data from MCIs.
(Mass-casualty triage: Time for an evidence-based approach. Jenkins JL, et. Al. 2008; 23 (1): 3–8.)

5. Lessons learned from an MCI 550 exercise

6. Lessons learned from an MCI 550 exercise

7. Lessons learned from an MCI 550 exercise

8. Lessons learned from an MCI 550 exercise

9. Lessons learned from an MCI 550 exercise

10. Lessons learned from an MCI 550 exercise

11. Lessons learned from an MCI 550 exercise

12. Lessons learned from an MCI 550 exercise

13. Lessons learned from an MCI 550 exercise

14. Lessons learned from an MCI 550 exercise

15. Lessons learned from an MCI 550 exercise

16. Lessons learned from an MCI 550 exercise

17. Lessons learned from an MCI 550 exercise
• The reason for the difference between 527 planned patients for triage
and actually 545 real triaged patients is, that 18 patients were triaged
twice.
• Some of the external doctors started retriaging.
• Further some of the patients were not triaged in the group
(according to START system) which they were supposed to be (f. i. green
instead of yellow).
The main reason for this was:
• 2 of the paramedics triaged (> 50) according to their experience instead
of sticking strict to the STaRT system. These 2 had a rate of failure
(wrong category) between 50-70%.
• Not enough training/information for the patients about behaviour
according to the injury.

18. Lessons learned from an MCI 550 exercise
• Real time exercise starting at 10:30
• First patient was triaged 12 min. later (through airport EMT)
• Triage took an average of 53 sec. (diagnose using START incl.
Datatransfer)
• Up to a max.of 20 EMT were triaging (exercise related no treatment)
• 42 min. after start, the first red patients left the scene.
• After 2hrs and 40 min. all 270 patients patients arrived at 16
hospitals
• Overall 82% were triaged correctly according to their group

19. Lessons learned from an MCI 550 exercise
• 95% in group red were correctly triaged (critical that 5 patients
group red were not correctly triaged)
• Overtriage of group yellow (25% into group red) and a few were
triaged into the group green! Only 70% in group yellow were
accurately triaged correctly .
• No difference in triage result of the EMT between those who
triaged 10 or 20 patients, so loss of concentration is not a key
element.
• Patients which were „diagnosed”as green (walking wounded)were
transported and triaged in a hall inside the airport. This way
(walking) 246 patients were triaged as green eventhough the
original figure was 242.

20. Lessons learned from an MCI 550 exercise
Merci vielmals
fürs zulose
Thank you very much for your attention
Prof. Dr. Leo Latasch – leo.latasch@drkfrankfurt.de
Mario Di Gennaro - mario.digennaro@drkfrankfurt.de