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PED-EM-L  January 2009

PED-EM-L January 2009

Subject:

Re: JumpSTART Pediatrics

From:

Lou Romig <[log in to unmask]>

Reply-To:

Lou Romig <[log in to unmask]>

Date:

Sat, 31 Jan 2009 11:51:32 -0500

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (55 lines)

Hi all:

It's good to be back on the list! I signed off before a long trip quite some time 
ago and neglected to sign back on.

As Debra Mulligan mentioned, I'm the developer of JumpSTART (JS), which is 
currently considered the gold standard for pediatric MCI triage in the field in 
the US and also used in numerous EDs. JS is also taught in a number of areas 
around the world.

The paper from Israel that Debra made available to the list is from 2006. In it, 
a national-level consensus group recommended that JumpSTART be used by 
the national EMS service (Magan David Adom) for pediatric MCI triage. What 
the paper doesn't say is that very little triage is done in the field in Israel, 
primarily due to the risk of secondary blasts following primary suicide 
bombings. The paper's recommendation was great news for me, but I have no 
indication that the recommendation has been implemented.

From the beginning, I've been up-front about the fact that neither JS nor 
START (the precursor adult tool) have been clinically validated. In fact, the 
little research there is on START and START-based tools suggests that they 
are of questionable validity and have poor interrater reliability and 
reproducibility. The only study comparing pediatric applications (in a decent 
number of pediatric ED patients but under very limited parameters) showed 
START and JS to be inferior to the SMART Tape and the CareFlight tool in 
sensitivity. Research in the MCI triage field is very limited in that such 
incidents are relatively infrequent and documentation is usually poor during 
even smaller disasters. No existing adult or pediatric tool has been validated 
under true MCI-style triage conditions.

I've stated in the past that I would support other tools that had evidence 
backing their use for children in the (conventional trauma) disaster setting. 
Although I will continue teaching JumpSTART and supporting those who 
choose to use it, I have thrown my support behind the Sacco Triage Method 
(STM). You can read my rationale for supporting the STM on my JumpSTART 
website.

Everything I have on JumpSTART and MCI triage (including the STM) is 
available for download at no charge from my website at 
www.jumpstarttriage.com. Feel free to use the presentations, scenarios and 
other files as you like. I don't require that you obtain further permission to use 
the materials as long as they're used for educational and/or protocol purposes 
and not for profit.

If anyone has specific questions, I'd be delighted to field them. You can email 
me via the JumpSTART website or directly at [log in to unmask] 


Lou Romig MD, FAAP, FACEP
Miami Children's Hospital (FL)

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html

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