The effect of training and experience on mass casualty incident triage performance: Evidence from emergency personnel in a high complexity university hospital


  • Juan P. Vargas, MD, MSc
  • Ives Hubloue, MD, PhD
  • Jazmín J. Pinzón, MD
  • Alejandra Caycedo Duque, MD



MCI, mass casualty incident, training, triage, experience, trauma


Mass casualty incident (MCI) can occur at any time and place and health care institutions must be prepared to deal with these incidents. Emergency department staff rarely learn how to triage MCI patients during their medical or nurse degrees, or through on-the-job training. This study aims to evaluate the effect of training and experience on the MCI triage performance of emergency personnel.

Methodology: This was a cross-sectional prospective study that analyzed the performance of 94 emergency department staff on the triage classifications of 50 trauma patients, before and after a short training in MCI triage, while taking into account their academic background and work experience.

Results: The participants were assigned initially to one of two groups: low experience if they had less than 5 years of practice, and high experience if they had more than 5 years of practice. In the low experience group, the initial accuracy was 45.76 percent, over triage 45.84 percent, and subtriage 8.38 percent. In the high experience group, the initial accuracy was 53.80 percent, over triage 37.66 percent, and sub triage 8.57 percent.

Postintervention Results: In the low experience group, the post intervention accuracy was 63.57 percent, over triage 21.15 percent, and subtriage 15.30 percentage. In the high experience group, the post-intervention accuracy was 67.66 percentage, over triage 15.19 percentage, and subtriage 17.14 percentage.  

Conclusion: Upon completion of this study, it can be concluded that MCI triage training significantly improved the performance of all those involved in the workshop and that experience plays an important role in MCI triage performance.

Author Biographies

Juan P. Vargas, MD, MSc

Emergency Physician, Universidad del Rosario, Universidad de los Andes, Fundación Santa fe de Bogotá, Bogota, Colombia; European Master in Disaster Medicine, Vrije Universiteit, Brussel, Belgium; Universita Piemonte Orientale, Novara, Italy

Ives Hubloue, MD, PhD

Department of Emergency Medicine, Universitair Ziekenhuis Brussel, Research Group on Emergency and Disaster Medicine, Vrije Universiteit Brussel, Brussels, Belgium

Jazmín J. Pinzón, MD

Epidemiologist, Clínica, Universidad de la Sabana, Bogota, Colombia

Alejandra Caycedo Duque, MD

Emergency Physician, Universidad del Rosario, Fundación Santa fe de Bogotá, Bogota, Colombia


Guha-Sapir D, Hargitt D, Hoyois P: Thirty Years of Natural Disasters 1974-2003: The Numbers. Louvain-la-Neuve, Belgium: Presses Universitaires de Louvain, 2004.

Iserson K, Moskop J: Triage in medicine, part I: Concept, history, and types. Ann Emerg Med. 2007; 49(3): 282-287.

Hoey B, Schwab C: Level I center triage and mass casualties. Clin Orthop Relat Res. 2004; 422: 23-29.

Janet T. Ihlenfeld: A primer on triage and mass casualty events. Dimensions Crit Care Nurs. 2003; 22(5): 204-207.

Koenig KL, Steven Lim HC, Shin-Han T: Crisis standard of care: Refocusing health care goals during catastrophic disasters and emergencies. J Exp Clin Med. 2011; 3(4): 159-165.

Kennedy K, Aghababian R: Techniques and applications in decision- making. Ann Emerg Med. 1996; 28(2): 136-144.

Hupert N, Hollingsworth E, Xiong W: Is over triage associated with increased mortality? Insights from a simulation model of mass casualty trauma care. Disaster Med Publ Health Preparedness. 2007; 1(suppl 1): S1-S24.

Hirshberg A, Frykberg E, Mattox K, et al.: Triage and trauma workload in mass casualty: A computer model trauma. J Trauma. 2010; 69(5): 1074-1108.

Cicero M, Blake E, Noelle G, et al.: Impact of an educational intervention on residents’ knowledge of pediatric disaster medicine. Pediatric Emerg Care. 2009; 25: 447-451.

Galante J, Jacoby R, Anderson J: Are surgical residents prepared for mass casualty incidents? J Surg Res. 2006; 132(1): 85-91.

Leow J, Brundage S, Kushner A, et al.: Mass casualty incident training in a resource-limited environment. Br J Surg. 2012; 99(3): 356–361.

Markenson D, DiMaggio C: Preparing health professions students for terrorism, disaster, and public health emergencies: Core competencies. Acad Med. 2005; 80(6): 517-526.

Risavi B, Salen, P, Heller M, et al.: A two-hour intervention using START improves prehospital triage of mass casualty incidents. Care. 2001; 5(2): 197–199.

Sanddal T, Loyacono T, Sanddal N: Effect of JumpSTART training on immediate and short-term pediatric triage performance. Pediatric Emerg Care. 2004; 20(11): 749-753.

Navin D, Sacco, W, Waddell R: Operational comparison of the simple triage and rapid treatment method and the Sacco triage method in mass casualty exercises. J Trauma Inj, Infect, Crit Care. 2010; 69(1): 215-225.

Knight J. F. et al.: Serious gaming technology in major incident triage training: A pragmatic controlled trial. Resuscitation. 2010; 81(2010): 1175–1179.

King D, Patel M, Feinstein A, et al.: Simulation training for a mass casualty incident: Two-year experience at the army trauma training center. J Trauma. 2006; 61: 943–948.

Gonzalez C, Brunstein A: Training for emergencies. J Trauma. 2009; 67: S100–S105.