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Comparison of the SALT and Smart triage systems using a virtual reality simulator with paramedic students

Cone, David C.a; Serra, Johnb; Kurland, Lisac

European Journal of Emergency Medicine: December 2011 - Volume 18 - Issue 6 - p 314–321
doi: 10.1097/MEJ.0b013e328345d6fd

Objectives Virtual reality systems may allow for organized study of mass casualty triage systems by allowing investigators to replicate the same mass casualty incident, with the same victims, for a large number of rescuers. The study objectives were to develop such a virtual reality system, and use it to assess the ability of trained paramedic students to triage simulated victims using two triage systems.

Methods Investigators created 25 patient scenarios for a highway bus crash in a virtual reality simulation system. Paramedic students were trained to proficiency on the new ‘Sort, Assess, Life saving interventions, Treat and Transport (SALT)’ triage system, and 22 students ran the simulation, applying the SALT algorithm to each victim. After a 3-month washout period, the students were retrained on the ‘Smart’ triage system, and each student ran the same crash simulation using the Smart system. Data inputs were recorded by the simulation software and analyzed with the paired t-tests.

Results The students had a mean triage accuracy of 70.0% with SALT versus 93.0% with Smart (P=0.0001). Mean overtriage was 6.8% with SALT versus 1.8% with Smart (P=0.0015), and mean undertriage was 23.2% with SALT versus 5.1% with Smart (P=0.0001). The average time for a student to triage the scene was 21 min 3 s for SALT versus 11 min 59 s for Smart (P=0.0001).

Conclusion The virtual reality platform seems to be a viable research tool for examining mass casualty triage. A small sample of trained paramedic students using the virtual reality system was able to triage simulated patients faster and with greater accuracy with ‘Smart’ triage than with ‘SALT’ triage.

aDepartment of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut

bDepartment of Emergency Medicine, University of California San Diego, San Diego, California, USA

cDepartment of Clinical Research and Education, Karolinska Institutet, Stockholm, Sweden

Correspondence to David C. Cone, MD, Yale University School of Medicine, Suite 260, 464 Congress Ave, New Haven 06519, CT, USA Tel: +1 203 785 4710; fax: +1 203 785 3196; e-mail:

Received August 11, 2010

Accepted February 16, 2011

© 2011 Lippincott Williams & Wilkins, Inc.