Institutional capacity in disaster triage practice during mass casualty incidents: a case of Kisii county

Abstract

The purpose of this study was to establish if there is a practise of Disaster Triage in Kisii County. The main focus was to determine if there were Rapid Response Teams in Kisii County, to analyse their structures and systems and to examine the practise of disaster/ medical triage by the paramedics/ EMTs in Kisii County. The study was undertaken in Kisii Town, Kisii County. It adopted an exploratory research design which utilised the census method that aimed at contacting all the 18 paramedics and non probability (purposive) sampling method for the key informants. Structured interviews, in-depth interview guides and an observation checklist were used as key data collection instruments. The raw data from the field was analysed using excel and presented in frequency tables. On establishing the existence of Rapid Response Teams, the study revealed that they have different roles that they are expected to play in terms of response to mass casualty incidents. Worth noting is that the county does not have an ambulance service of its own and therefore it subcontracted Kenya Red Cross to provide ambulance services and to act as first responders. The incentive to hire subcontractors is either to reduce costs or to mitigate project risks. In this way the general contractor could have provided by itself, at lower overall risk. In regard to structures and systems of the Rapid Response Teams in Kisii County; the study established that the institutions had structures and systems that they operated under. The study however notes that, there is need for the county to formulate a structure that encompasses the institutions who act as first responders and come up with systems that are tailored to suit emergency response. As for the practice of Disaster Triage in Kisii County, it was established that all the respondents knew the basics of a disaster triage that it was a process of sorting casualties in order of the extent of their injuries in mass casualty incidents to do the most good for all. Among the RRTS there are the paramedics/ EMTs who sort the casualties and begin initial treatment. It was established that out of the 9 units (ambulances) that the total emergency medical technicians worked with. The EMTs had on one occasion or another participated in the practice of triage. Disaster Triage/medical triage involves color codes. Because of the magnitude of the casualties, they are tagged, according to the extent of injury they suffered. 88.89% of the total respondents were aware of the correct tagging process/colour coding while the rest 11.11% were not aware of this. It was noted that not all respondents had participated in drill exercises 77.78% of the respondents had participated in drills, while 22.22% had not. In conclusion, though there are RRTs in Kisii County with specific internal structures and systems. Their is need for the different institutions to have an official working relationship, with a common structure clearly outlining the role that each would be expected to play in case a mass casualty incident was to occur. There is also need to constantly train the paramedics/ EMTS on triaging through regular drill exercises. The study therefore recommends that the county should have an ambulance service and paramedics of its own. It further on recommends that an official audit of the county equipment and personnel to be audited for better response in case disaster strikes.