Impact of Inaccurate Pretriage Labeling at Advanced Medical Post Entry on Time-Critical Care Processes: A Pilot Simulation Study at the World Economic Forum
Manuel Walter, Sarah Thiel, Helge Junge, Nils Thöni, Dominic Schier, Armin Hess, Paolo RodiAbstract
Background and Importance
In mass-casualty incidents, inaccurate pretriage labeling at Advanced Medical Post (AMP) arrival, whether due to undertriage or clinical deterioration before arrival, may affect downstream workflow processes and delay recognition of critically injured patients. Although triage accuracy has been widely studied, the operational impact of inaccurate pretriage labelling at AMP entry on time-critical care processes within AMP systems remains poorly understood.
Objective
To evaluate the impact of inaccurate pretriage labeling at AMP entry on downstream time-critical care processes in simulated red-category patients.
Design, Setting, and Participants
Prospective, pilot simulation-based study conducted during 2 full-scale AMP exercises. The AMP reflected the real-world operational structure, personnel, and logistics of an AMP deployed during the World Economic Forum (WEF) 2026. Each simulation included 18 standardized patients; 10 met predefined red-triage criteria and constituted the analytic cohort. The primary objective was to compare time to predefined first critical action between correctly labeled and mislabeled patients.
Exposure
Mislabeled at AMP entry, defined as red patients entering the AMP undertriaged with a lower-acuity pretriage label (yellow instead of red).
Outcomes Measure and Analysis
The primary outcome was time from AMP entry to first predefined critical action. Secondary outcomes included reaching predefined case-specific deterioration or death thresholds prior to intervention and time to correction of triage category. Outcomes were analyzed descriptively using within-patient paired comparisons across simulation runs.
Main Results
Across 2 simulation runs, 6 paired observations were analyzed. In 4 of 5 comparisons in which a predefined critical action was performed, mislabeling was associated with longer time to predefined critical action, with delays ranging from 5 to 24 minutes. In 2 cases, these delays resulted in crossing of case-specific deterioration thresholds. In 1 additional mislabeled patient, the predefined critical action was not performed before the deterioration threshold was reached, and the patient subsequently progressed to the scripted death threshold. No correctly labelled red patient reached deterioration or death. Early correction of triage status mitigated delays, whereas delayed correction was associated with adverse progression.
Conclusion
In this pilot full-scale simulation study, inaccurate pretriage labeling at AMP entry was associated with delays in time-critical interventions. These findings highlight the importance of early and continuous structured reassessment and timely correction of triage categorization within AMP workflows. The results are hypothesis-generating and require confirmation in further simulation or real-world studies.