Open Access Highly Accessed Research article

A concept for major incident triage: full-scaled simulation feasibility study

Marius Rehn12*, Jan E Andersen1, Trond Vigerust3, Andreas J Krüger14 and Hans M Lossius15

Author Affiliations

1 Norwegian Air Ambulance Foundation, Drøbak, Norway

2 Akershus University Hospital, Lørenskog, Norway

3 Norwegian Air Ambulance, Drøbak, Norway

4 Department of Anaesthesia and Emergency Medicine, St. Olav University Hospital, Trondheim, Norway

5 Department of Surgical Sciences, University of Bergen, Bergen, Norway

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BMC Emergency Medicine 2010, 10:17  doi:10.1186/1471-227X-10-17

Published: 11 August 2010



Efficient management of major incidents involves triage, treatment and transport. In the absence of a standardised interdisciplinary major incident management approach, the Norwegian Air Ambulance Foundation developed Interdisciplinary Emergency Service Cooperation Course (TAS). The TAS-program was established in 1998 and by 2009, approximately 15 500 emergency service professionals have participated in one of more than 500 no-cost courses. The TAS-triage concept is based on the established triage Sieve and Paediatric Triage Tape models but modified with slap-wrap reflective triage tags and paediatric triage stretchers. We evaluated the feasibility and accuracy of the TAS-triage concept in full-scale simulated major incidents.


The learners participated in two standardised bus crash simulations: without and with competence of TAS-triage and access to TAS-triage equipment. The instructors calculated triage accuracy and measured time consumption while the learners participated in a self-reported before-after study. Each question was scored on a 7-point Likert scale with points labelled "Did not work" (1) through "Worked excellent" (7).


Among the 93 (85%) participating emergency service professionals, 48% confirmed the existence of a major incident triage system in their service, whereas 27% had access to triage tags. The simulations without TAS-triage resulted in a mean over- and undertriage of 12%. When TAS-Triage was used, no mistriage was found. The average time from "scene secured to all patients triaged" was 22 minutes (range 15-32) without TAS-triage vs. 10 minutes (range 5-21) with TAS-triage. The participants replied to "How did interdisciplinary cooperation of triage work?" with mean 4,9 (95% CI 4,7-5,2) before the course vs. mean 5,8 (95% CI 5,6-6,0) after the course, p < 0,001.


Our modified triage Sieve tool is feasible, time-efficient and accurate in allocating priority during simulated bus accidents and may serve as a candidate for a future national standard for major incident triage.