Telemedicine communication using instant messaging technology improves pre-hospital triage in high mountain train disasters

Background: Differences between pre-hospital triage by an emergency medical technician and Simple Triage and Rapid Treatment triage (START) by emergency staffs often affect manpower management and aggravate the chaos condition of emergency room. Objectives: Under the assistance of instant messaging, the authors aimed to identify ways of improving triage differences between emergency medical technician triage grading and Simple Triage and Rapid Treatment triage grading by emergency staffs. Methods: Recorded photographs of all patients were reviewed by a smartphone. We categorized patients according to three triage conditions: group 1, accident scene on-site or instantaneous Simple Triage and Rapid Treatment triage by the emergency medical technician; group 2, triage under Simple Triage and Rapid Treatment grading by emergency staffs; group 3, re-triage with START grading using recorded photographs, Glasgow Coma Scale, and vital signs when these patients were arrived in emergency room. The Wilcoxon Signed-Rank test, Spearman rank correlations, and Kruskal–Wallis test are employed to test differences among the groups. We used risk estimates with odds ratios and the chi-square test to statistically analyze the differences in triage grading. Results: Statistical analysis found conflicting results among Wilcoxon Signed-Rank test, Spearman rank correlations, and Kruskal–Wallis test. The difference in triage grading between groups 2 and 1 was greater than that between groups 2 and 3 (odds ratio, 6.473; 95% confidence interval, 1.693–24.470; p-value < 0.05). Conclusion: Transferred photographs combined with Glasgow Coma Scale and vital signs can help us to understand the real situations of patients. With instant messaging applications, it is possible to make more precise pre-hospital or instantaneous triage.