The Ten Second Triage Tool – a multi-disciplinary simulation-based field test to determine its speed, accuracy and practical on scene application

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Abstract
Background: Triage at major incidents has traditionally relied on assessing physiology, and in the UK, this role has usually been performed by healthcare responders. However, recent major incidents have shown that this approach, particularly in the initial phases, may be inappropriate due to potential delays in the delivery of key life-saving interventions (LSIs).The Ten Second Triage (TST) tool has been developed to expedite the triage process and the delivery of key LSIs. The aim of this study was to determine the performance characteristics of the TST, including the time to deliver LSIs, in a simulated major incident setting, by both healthcare and non-healthcare responders. Methods: A prospective observational study was conducted as part of a simulated major incident exercise, incorporating a variety of trauma pathologies. Responders from all three emergency services – Police, Fire, and Ambulance - participated. Eight simulations were conducted, each involving ten responders and a team leader from the respective single service groups. The NHS Major Incident Triage Tool (MITT), the TST alone, and a combination of both were assessed. Quantitative assessments for each simulation included overall triage time, time to delivery of LSI, and accuracy of triage tool categorisation. Results: Using the TST alone, the mean overall triage time was 377 s (10.2 s per casualty). In comparison, the mean overall triage time of the MITT alone was 1500 s (40.5 s per casualty). However, when the MITT was applied following the TST, it was completed more quickly, with a mean time of 960 s (25.9 s per casualty). When the TST was used, we observed a clinically significant reduction in the time to deliver key LSIs (491 s) compared to the MITT (1377 s). Overall triage accuracy was comparable between TST (80.3%) and MITT (79.3%), and TST performance was similar between healthcare and non-healthcare responders. Conclusion: This simulation study demonstrated that the TST is a rapid and accurate early scene triage method that enables the timely delivery of key lifesaving interventions. It facilitates the administration of these LSIs faster than existing physiological triage methods. These findings support the NHS England endorsement of the TST.

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