Scholarly Project Instructions The scholarly paper ultimately accounts for 20% of your grade. Graduate level, scholarly writing is the priority. In addition, faculty members pay attention to the mechanics of APA style and paper construction. Remember that this is a *scholarly paper. - Cite references often and correctly. You must ground your paper in the literature. - The emphasis is on facts and factual information (thus the need to cite references). - Avoid inserting your opinion. Unless you are a published author or field expert, your opinions have no place in a scholarly paper If you are a field expert, you may add your thoughts to the paper, but only if you can support those thoughts with current literature. - Avoid gross exaggeration words like "exponential" and "every day." - Avoid personal pronouns like me, I, you etc. Stay in the third person. If you find yourself using those personal pronouns, you are straying outside the bounds of scholarly work. - Don‘t mix singular words like “first responder” with plural words “they.” Paper length should be approximately 3000 words, but substance is more important than volume. Use recent articles (5-10 years depending on the subject) from peer-reviewed journals as well as textbooks. Texts are often out of date soon after published. Expect to use no fewer than 10 references. THE TOPIC * A comparison of US and international disaster response. (Are there differences? Similarities? You may want to choose one or two examples from the US and compare with non-US events). Focus on key elements. Outline your paper so you have an objective idea about what those key elements should be. Read the literature and annotate the articles. (Annotation is the process of summarizing an article in 2-3 sentences. Doing so forces you to distill all the verbiage into cogent thought). Also remember that the paper / project is divided into two parts. The Syllabus gives guidance. Refer to the Rubric in the Course Documents so you know what a masters-level paper should include. Running Head: Disaster Triage for Mass Casualty Incidents Disaster Triage for Mass Casualty Incidents: Present Status and Future Implementation Carlyn M. Christensen-Szalanski Philadelphia University Disaster Triage for Mass Casualty Incidents 2 Abstract The author surveyed literature about disaster triage systems for managing the chaos of mass casualty incidents (MCIs) and concluded that no system is yet sufficiently validated, reliable, and accepted as an official standard for disaster triage. Effective disaster triage rapidly identifies which victims require immediate resuscitation, which victims can safely wait for treatment, and which victims require so many resources to survive that they receive medical help last, rather than first. In disasters, needs surpass resources, so the paradigm of disaster triage differs from that of triage at an emergency department with plentiful resources; there, the most severely injured or ill patients receive treatment first, not last. In the United States literature three disaster triage systems predominate: START (Simple Triage And Rapid Treatment) and its pediatric variant, JumpSTART; the Sacco Triage Method, and SALT (Sort, Assess, Lifesaving intervention, Triage/Transport). Little research exists about the use of disaster triage in actual MCIs, largely because first responders have not systematically used disaster triage and documented their use of it. Researchers have often evaluated these systems retrospectively with “singleton” paper victims listed in a trauma registry and less commonly in MCI disaster drill scenarios. Most researchers lament the lack of data from reallife use of disaster triage systems in actual MCIs. The author describes these three disaster triage methods, their strengths, weaknesses, and reported use. The author briefly discusses training bystanders to triage victims and the importance of EMS responders using disaster triage routinely to become better prepared for future MCIs. Key words: disaster triage, mass casualty incidents(MCIs) Disaster Triage for Mass Casualty Incidents 3 The three major endeavors of initial mass casualty and disaster management for medical providers are medical triage, transport, and definitive medical care. Effective disaster medical triage gives responders the best opportunity “to do the greatest good for the greatest number” of victims in a mass casualty incident (MCI). Multiple proposed systems of disaster triage have emerged over the past 30 years, all variants of the task to sort surviving disaster victims into at least three groups: those who need immediate help, those who can wait for help, and those who are “beyond help” – all because their needs exceed the resources in a disaster. This approach runs counter to the usual model of triage for urgent and emergency care facilities. Three disaster triage systems predominate the ongoing discussion in the US literature of which are more valid and reliable. Researchers have usually evaluated the validity and reliability of these consensus-based systems by applying their approach to “singleton” trauma victims from historical registries or pretend victims in MCI disaster exercises. These experimental circumstances do not encompass the overwhelming chaos and danger of an actual MCI or the fear and other vulnerabilities of responders acting as triageurs. The author sought definitive evidence in the literature that one triage system is superior, but found none. Few articles exist about the use of disaster triage in actual MCIs, largely because first responders have not systematically used disaster triage and documented their use of it. Implementing the metrics of a disaster triage system is not yet a universally practiced, “automatic” skill of the disaster responders. This paper briefly mentions training first responders and others to practice using disaster triage in routine circumstances to prepare better for MCIs . Disaster Triage for Mass Casualty Incidents 4 Brief Overview of Disaster Triage Triage comes from the French verb “trier” meaning to sort. Disaster triage is an important tool to use in sorting the victims of a mass casualty incident when needs for medical care outstrip the resources available. This type of triage differs from routine medical triage when resources are sufficient to meet every need, as in a well-equipped urban Emergency Department. Historically disaster triage originated on the battlefield. Two hundred years ago Baron Dominique Jean Larrey, the chief French surgeon with Napoleon’s Grande Armée, first established a disaster triage system where soldiers (independent of their rank) received initial medical treatment on the field before their transport via his “flying ambulances” (ambulances volantes) to a field hospital (also his idea). Some military leaders used triage to increase their combatant manpower by treating preferentially the soldiers with minor injuries. Others recommended that the most seriously wounded should receive treatment first, since they were most likely to benefit (Foley, page 337). In the past century, military medicine dramatically improved its capability for rapid transport and evacuation by air-ambulances to sophisticated surgical field units. It also devised field triage decision rules, paralleling progress in civilian systems for individual trauma victims. (Mitchell, 2008, pp. S4-S6) The MASS (Move-Assess-Sort and Send) triage system was used in the military setting for many years. Since the 1980s, other disaster triage systems have evolved. Most disaster triage sorts victims into four categories: Priority 1~ Immediate~ Red: Victims whose lives are in danger who require immediate treatment to improve their survival. Disaster Triage for Mass Casualty Incidents 5 Priority 2~Delayed~Yellow: Victims whose lives are not in immediate danger who can safely wait for urgent care. Priority 3~Minimal~Green: Victims with minor injuries that will eventually need attention. Priority 4~Expectant~Black: Victims who are either dead or whose injuries are so devastating that they will probably die since only limited resources are available. The main hazards of using a triage system are “undertriage” and “overtriage”. Undertriage is underestimating the severity of a victim’s injury, such that the victim may not get help soon enough to survive. Overtriage is overestimating the severity of the victim’s injury, resulting in unnecessary crowding of noncritical victims at the receiving medical center (Foley & Reisner, pp. 339-341). The double check on this system is secondary triage at the receiving hospital, where a physician may note deteriorating vital signs. Hence researchers often assess the validity of a triage system by its rates of undertriage (sensitivity) and overtriage (specificity). Three Disaster Triage Systems This paper focuses on three disaster triage systems which US researchers have examined for their validity and reliability: START /JumpSTART, the Sacco Triage Method, and SALT. START/JumpSTART Triage In the early 1980s the Newport Beach Fire and Marine Department and Hoag Hospital developed the START (Simple Triage and Rapid Transport) triage system (Kahn, Lerner & Cone, p. 209). Initially triageurs ask victims who can walk to move to another area. These Disaster Triage for Mass Casualty Incidents 6 walkers are the Priority 3 ~ Minimal ~Green victims. Triageurs later reassess the Green victims after evaluating other victims by their breathing, circulation and mental status. As they rapidly sort them by this simple process, triageurs tag them with identifying information and move them to three colored areas according to their status. Triageurs tag Black victims who have died. Triageurs also tag Black the victims whose injuries are so devastating that they likely cannot survive with the relatively scant resources available. Triageurs may later reassess these living “Expectant” victims after assessing all others. Until then they receive only comfort care. In 1995 Dr. Lou Romig developed the pediatric variant JumpSTART, noting that the START algorithm was designed for people weighing at least 100 pounds who could walk (the first decision point of START). She addressed physiologic differences of children so that normal Disaster Triage for Mass Casualty Incidents 7 younger children would not be triaged as an Immediate because of their respiratory rate. Intended for children younger than 8, Dr. Romig advised, “If the victim looks like a child, use JumpSTART. If the victim looks like a young adult, use START” (Romig, 2002, pp.54-63). START (and JumpSTART) triage has been the most commonly used civilian disaster triage system in the United States since the 1980s. Strengths of START/JumpSTART. The potential strengths of the START/JumpSTART algorithms are their simplicity, rapid assessment of each victim, and availability of materials. The Newport Beach Fire Department and Dr. Romig offer free of charge their triage algorithms and all other files on their START and JumpSTART websites. Numerous other triage system variants are based on START. Weaknesses of START/JumpSTART. One criticized weakness of START is overtriage. To decrease the rate of overtriage in using START triage, the New York City Fire Department (NYFD) added a fifth category, “Orange”, between Red and Yellow. This more reliably prioritizes a subgroup of delayed non-critical nonambulatory patients (Yellow) who do not need the immediate lifesaving resuscitation of the most critically injured (Red), but are not stable enough to wait as long to receive medical intervention as a typical Yellow patient (Arshad, et al., 2015). A second criticized weakness of START is undertriage. Cross, Petry & Cicero (2015) noted from their retrospective application of START to patients of a trauma registry, older age was the primary predictor for undertriaging. They recommended that triageurs upgrade the severity especially for adults older than 75. Farris (2015) also reported that START triage undertriaged Disaster Triage for Mass Casualty Incidents 8 the elderly. Viewing this undertriage as a phenomenon larger than just START triage, she recommended developing a separate triage system for the elderly, paralleling JumpSTART’s variation for the pediatric population. These criticisms are not based on triage in actual MCIs. A third potential practical weakness of START is the relative lack of mandated life-saving interventions. This triage algorithm focuses on triage, not treatment. For adults, triageurs open airway to reassess breathing, and for children they also give five rescue breaths. The NYFD modified the JumpSTART algorithm to accommodate the importance of ventilatory support for pediatric victims by expediting the off-site transport of all Red and Yellow pediatric victims (Cooper, Foltin, Tunik & Kaufman, 2012, p. 94). Use of START/JumpSTART Triage. Experience using triage in actual events is invaluable. The NYFD noted from actual experience (Kaufman et al., 2013) that “infants at a mass-casualty incident tend to be difficult to accurately assess and even when in a low-priority triage category occupy a disproportionate amount of EMS resources. By immediately categorizing infants with red tags, we strive to quickly transport them from the scene. Although this may be an overtriage for the infant’s medical condition, it allows maximum efficiency for the overall scene management and is therefore consistent with the overarching goal of saving the most lives.” Several reports exist about using START triage in actual MCIs. Hogan, Waeckerle, Dire & Lillibridge(1999) reported on the response to the Oklahoma City bombing in 1995 by examining Disaster Triage for Mass Casualty Incidents 9 all available disaster triage tags and hospital medical records for 388 patients. They reported that at least ninety (23.1%) had documentation of prehospital EMS triage and transport. Hogan et al. (1999, p.164) commented, “Unfortunately documentation of the process behind the triage decisions made in Oklahoma City was practically nonexistent, similar to other mass casualty disasters.” Kahn, Schultz, Miller & Anderson (2003) evaluated the successful performance of START triage at a 2002 head-on train collision in California, reviewing 148 records of victims. They hypothesized that START would 1) ensure that the most critical patients would be transported first and 2) achieve at least 90% sensitivity and 90% specificity for each triage level. They found that START did prioritize well the transport of the most critically injured, but that no triage level met both levels that they hypothesized. Nonetheless the sensitivity of the Red triage was 100% and the specificity of Green was 89.3%. The National Transportation Safety Board stated “the emergency response to this incident was timely, effective, and appropriate to the incident. (National Transportation Safety Board, 2003).” Kaplowitz, Reece, Hershey, Gilbert & Subbarao (2007) reported on the successful START triage and transport of 25/26 victims to rural regional hospitals after the Virginia Tech active shooter mass casualty event of 2007. After two tactical medics ensured scene safety, additional EMS providers from two different Rescue Squads assisted with triage and transport and treated the mobile Green victims at the scene. The one Green victim who bypassed triage arrived first at a hospital -- via public transportation. EMS providers transported most Red and Yellow victims to the level III trauma center ED three miles away where a triage officer directed Green and Disaster Triage for Mass Casualty Incidents 10 Yellow victims to the waiting room and Red victims to an operating theater where a code team reassessed them. They transferred three Red victims to the closest level 1 Trauma center, 45 miles away. The over-triage rate was 69% (11/16). Only one victim was under-triaged; ED secondary triageurs noted a bullet entry wound in his flank so he was retriaged as Red instead of Yellow. Kaplowitz et al. (2007, p. S12) emphasized that this was a “rural health system response with significantly impeded access to level 1 trauma center.” Their success resulted from prior “regional collaborative planning, training, and exercising” deliberately pursued in Virginia after the 2001 attacks on the Pentagon and the World Trade Center. Strommen, Waterman, Mitchell & Grogan (2015) reported on the response to the Fort Hood active shooter event in 2014. First responders applied tourniquets at initial triage in using the SMART triage variant of START that adds a “control bleeding” decision point after both prolonged capillary refill and “No” response after “follow simple commands”. Eighteen victims arrived at the Level III trauma center 2 miles away within 2 hours. The undertriage rate was 5%: only one victim was triaged as Delayed, but he was quickly reassessed as Immediate at the secondary triage point. The overtriage of 10% related to two victims who died despite rapid transport to the hospital and ongoing CPR early in the response. Sacco Triage Method The Sacco Triage Method (STM) is a mathematical model extrapolated from trauma registry patients and estimated rates of their dying to predict mortality, by which it determines triage in a numerical order, giving each victim a Sacco Score. Its outcome measure is mortality. In 2005 mathematician Dr. William Sacco and colleagues at ThinkSmart developed the STM by using a Disaster Triage for Mass Casualty Incidents 11 logistic regression analysis of data obtained from large statewide trauma registries to confirm that their mathematical “method” could stratify each victim’s mortality risk based on the victim’s respiratory rate, pulse, and motor response. They obtained estimated rates of dying from a consensus of six experts. This complicated method requires computer software. (Sacco et al, 2007). Strengths of Sacco Triage Method. Sacco et al. (2007) of ThinkSmart claim that STM is superior to START: “It mitigates the limitations of START … STM’s goal to maximize the expected number of survivors is explicit, measurable, and outcome driven … It can evaluate EMS performance… It promotes better use of scene medical resources.” They laud its attention to the circumstances of the MCI including transport and resources. Disaster Triage for Mass Casualty Incidents 12 Weaknesses of Sacco Triage Method. One weakness of STM is its complexity. The authors acknowledge that its triage takes longer that START. A second weakness is that all researchers before 2012 who praised its excellence belonged to ThinkSmart. A third weakness is that “STM requires software support, communication to incident command or central dispatch, and resource availability information.” The STM is a proprietary tool that is “part of a package that includes training” and the “purchase of computer software…” (Romig, 2012). In 2007 Sacco et al. acknowledged that the STM is suboptimal without functioning computer software and telecommunications. They wrote: Rule-based versions are offered as a back-up for non-existent or failed communications technology. The performance of this rule-based adaptation exceeds that of current triage methods , and will be the subject of future publications. It is mentioned here to allay concerns that a technology failure would rend STM ineffective (Sacco et al. 2007, p. 325). Despite a careful search the author has found no article describing this rule-based version. In seeking more information about the price and details of implementation, the author could not locate a functioning STM or ThinkSmart website or contact a representative by e-mail or phone. Serendipitously Dr. Romig of JumpSTART provided more details. In 2011 she wrote: “I’ve decided to my throw my support behind efforts to put the STM into common practice in order to validate it in a prospective fashion in both daily and disaster triage settings …. I continue to support those who choose to use JumpSTART… I ask Disaster Triage for Mass Casualty Incidents 13 those who currently use it to please carefully consider the current and future evidence, whether for or against JumpSTART or the STM” (Romig, 2012). Dr. Romig listed two incentives for her support: “the chance to contribute to the science of disaster medicine, rather than simply perpetuating dogma”; and ThinkSharp’s agreement that she could distribute for free the STM electronic pocket card on the JumpSTART website so that “anyone” could use it for triage– with the caution that it would not include the entire STM System (Romig, 2012). These indistinct diagrams about STM are from the JumpSTART website. Use of Sacco Triage Method. No reports exist of using the STM in actual disasters. Cross and Cicero are the first researchers unassociated with ThinkSharp who examined the STM by assigning Sacco Scores to more than 90,000 records of pediatric trauma patients in a national trauma data base. They concluded that the Sacco Score “was a highly accurate predictor of mortality in pediatric trauma Disaster Triage for Mass Casualty Incidents 14 patients in this registry database …(and the) triage method appears to be a valid strategy for the prioritization of injured children ” (Cross & Cicero, 2012, p. 306). Cross & Cicero followed this analysis with another study of more than 530,000 pediatric, adult, and geriatric trauma patient records from the National Trauma Data Bank, this time using computers to assign triage Score”), START, New York City Fire Department, CareFlight, and Glasgow Coma Scale. The outcome measure was mortality. Even the Glasgow Coma Scale predicted mortality similarly to disaster triage systems. The Sacco Score (STM) predicted mortality most accurately. (Cross & Cicero, 2013, p. 668). One should expect this result since the STM is a mathematical model derived from patient registries, and the method of this second study mirrored its derivation. Schultz (2013, p. 642) commented on the methodology of this study: “mortality …may not be the most valid metric for comparing triage algorithms destined for field use in the initial assessment of disaster victims. With the exception of Sacco triage, field triage algorithms are not designed to predict mortality. They are designed to predict acuity. Although related, they are not the same. … Although mortality is easier to measure, its real value is harder to discern … this is not to say that predicting mortality is not a worthwhile endeavor. The ability to estimate mortality is a very important goal, just not for field triage. SALT Triage The Centers for Disease Control and Prevention (CDC) funded a workgroup of experts to examine the science supporting the existing mass casualty triage systems and to recommend one to serve as a national standard. After their careful review, they concluded that no existing system Disaster Triage for Mass Casualty Incidents 15 had sufficient supporting evidence. They incorporated the “best features” of the existing systems in developing SALT (Sort-Assess-Lifesaving intervention-Triage/Transport . In 2008 they described SALT triage as a “first step in developing a national guideline for mass casualty triage”. Rather than mandate all US communities adopt the SALT triage, they opted to list “Model Uniform Core Criteria for Mass Casualty Triage” that described the key components of a triage system to meet the proposed national guideline. Lerner et al. (2011, p. 130) wrote: “Although SALT Triage will remain a freely available triage system that meets all the components of the core criteria … others also could develop or modify other existing triage systems to meet the Core Criteria. This allows for local flexibility but will ensure baseline interoperability between jurisdictions.” Disaster Triage for Mass Casualty Incidents 16 SALT triageurs first Sort victims by first asking them to walk to another area. Next, they ask them to wave. They then Assess the victims who neither walked nor waved and those with obvious life-threatening injuries. Triageurs then give Lifesaving interventions that can significantly improve survival, like controlling hemorrhage, opening airways, and chest decompression. The triageurs next Triage victims into five categories: with the expectant group being further divided into dead (Black) or expectant (gray). Finally they Transport victims. Strengths of SALT Triage. Two strengths of SALT are its relative simplicity and rapidity. In creating a Gray-Expectant category, it may also decrease the difficulty for a triageur in assigning a victim to the BlackExpectant category when the victim is still alive. Another theoretical strength is its promoting Weaknesses of SALT Triage. SALT is not a system strictly limited to triage. With lifesaving interventions, it postpones the triage designation, but it also theoretically improves both the acuity and survival of its victims. The main weakness is absence of studies about its use in a disaster Use of SALT Triage. Cone et al. (2008) reported on a pilot drill to assess the accuracy and speed of trained paramedics in using SALT. They created 50 patient scenarios for moulaged victims. Two paramedics had 78% accuracy with an overtriage rate of 13.5% and undertriage rate of 3.8%. The mean triage time was 15 seconds per patient ( range of 5-57 seconds). Cone, Serra, and Kurland (2011) next trained paramedic students in SALT to triage “25 victim scenarios for a Disaster Triage for Mass Casualty Incidents 17 highway bus crash in a virtual reality simulation system”. Three months later, they trained them in SMART (START plus hemorrhage control) to triage the victims. The participants triaged the simulated patients faster and with greater accuracy with SMART than SALT. Lee et al (2015) demonstrated that 67 community college students learned the SALT algorithm well enough in a 30-minute didactic session to perform SALT triage accurately on 8. moulaged victims in a mock scenario of a 4-car motor vehicle collision. Lee, McLeod & Peddle (2015) also demonstrated that 464 first-year responder students learned the SALT algorithm well enough after a 30-minute didactic session that they retained their understanding three months later. These studies show that SALT is easy to remember, and that EMS could teach SALT triage to others. Perhaps such civilian help would enable prehospital EMS personnel to focus on treating and transporting Immediate victims. Nordberg, Castren & Lindstrom (2016) and Badiali, Giugni & Marcis (2017) have investigated the use of bystanders to perform triage. Bobko, Harris & Thomas (2016) promote training of civilians as First Care Responders to help with triage and other needs at the disaster. Triageurs and first responders need more studies about the validity and reliability of SALT. Researchers like Cross & Cicero could apply SALT to the 530,000+ trauma registry patients of their 2013 study, and innovative simulation experts could apply SALT triage to moulaged victims and computerized victims on a virtual reality screen. Eventually trained triageurs will use triage regularly at the scene of a disaster. Disaster Triage for Mass Casualty Incidents 18 Conclusion Effective disaster triage aims to “do the greatest good for the greatest number of people.” These three triage systems represent simplicity, mathematical rigor, and eclecticism. As we seek to refine a standard of disaster triage, we need greater experience with using triage in actual disasters to generate data to report and analyze. Few articles exist about using a disaster triage in the chaos of actual MCIs, largely because implementing disaster triage is not a universally practiced, “automatic” skill of the disaster responders. Checking for “scene safety” is an automatic habit for every trained Emergency Medical Services (EMS) responder because it is repetitively drilled in their training and approach to every “scene. When EMS personnel, other first responders, and medical personnel use a triage method in the regular evaluation of “routine” patients, they more likely will easily use the same triage skill in disasters. This practice will result in their (our) gaining invaluable expertise in disaster triage. 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Mass casualty triage: An evaluation of the science and refinement of a national guideline. Disaster Medicine and Public Health Preparedness, 5: 129-137. doi: 10.1001/dmp.2011.39 Massachusetts Emergency Management Agency, Massachusetts of Public Health, City of Boston, City of Cambridge, Town of Watertown, Massachusetts Bay Transportation Authority Transit Police Department, Massachusetts National Guard, Massachusetts State Police. (2014, December). After Action Report for the Response to the 2013 Boston Marathon Bombings. Retrieved from: http://www.mass.gov/eopss/docs/mema/afteraction-report-for-the-response-to-the-2013-boston-marathon-bombings.pdf Mitchell, G.W. (2008). A brief history of triage. Disaster Medicine and Public Health Preparedness, 2, S4-S6. doi: 10.1097/DMP.0b013e3181844d43 Moskop, J.C., & Iverson, K.V. (2007). Triage in medicine, part II: Underlying values and principles. 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Lessons from the Boston Marathon bombing: An orthopaedic perspective on preparing for high-volume trauma in an urban academic center. Journal of Orthopaedic Trauma, 29: S7-S10. doi: 10.1097/BOT.000000000000413 Vayer, J.S., Ten Eyck, R.P. & Cowan, M.L. (1986). New concepts in triage. Annals of Emergency Medicine, 15: 927-930. Waddell, B. ThinkSharp (2011). Sacco Triage Method. Retrieved from: http://www.jumpstarttriage.com/uploads/STM_Factsheet.pdf Addendum: The limited length of this paper prohibits highlighting different ingenious methods of “tagging” triaged victims to transmit information about them and facilitate the proper order of their transport to definitive medical care; different technological gadgets and software that might enhance disaster triage; and considerations in applying a standard triage system to a variety of disasters, including earthquakes, terrorist attacks, explosions, and hazardous chemical, biological, radiological, and nuclear events. The reader will find these sources in the References section above. Paper Rubric – 20 points Point value Content Max 16 Key elements of the assignment are substantive. See detail of assignment. Points Earned Comments Includes all applicable areas for a scholarly paper and focuses on what you need to say. 5 It is not uncommon for students to ignore the assignment and write about something completely different! Introduction: purpose of the paper identified; introduction provides sufficient background on the topic; major points in the introduction match the assignment; author creates a focus and context for the subject; author previews the content 1 Note that APA does NOT use an Introduction heading. The first paragraph or two after your title are the introduction. Body of paper: ideas are consistent and flow in logical sequence; major points are organized using appropriate headings; points are supported with appropriate research and references; ideas are stated clearly and concisely; transitions are used to bridge topics EVERY paper needs an introduction. Remember, in APA you don’t use the heading Introduction. The first few paragraphs of your paper will be considered the introduction. Briefly tell us what you are going to tell us. 3 APA has specific requirements for headings. Your paper should be readable. Try reading it out loud. There should be a story that makes sense. Conclusion: flows logically from the material presented; insights are drawn from summarized major points 2 Every paper needs a conclusion. Tell us what you told us. Don’t include any NEW information in your conclusion. The conclusion should start with a level 1 heading called CONCLUSION. 2 Assignment length 2500-3750 words (7-10 pages – NOT counting title page, abstract, or references). YOUR PAPER = XXXXX The Introduction says “here is what I am going to tell you”, the conclusion should say “here is what I told you”. The intro and conclusion should be in alignment. Don’t add new material, references, or thoughts in your conclusion. Organization of ideas:correct and varied sentence structure; paragraphs well structured with logical and effective transitions; paper reviews relevant concepts and creates a coherent theoretical framework for the subject Assignment specifies 10 references: YOUR PAPER = XXXXX Scholarship: research adequate and timely; appropriate depth and quality of research (scholarly literature); research presented objectively 3 Assignment specifies that a majority of your references be within the last 5 years. Concentrate on scholarly, peer reviewed journals. Avoid the popular press and general web sites. Search for as much current support (within last 5 years) as possible. Try to tell BOTH sides of every story, and present conflicting research when it exists. Mechanics, Readability and Style Max This is an aggregate grade that includes all areas below. 4 Points Earned Comments: Transitions from section to section and paragraph to paragraph are present and logical. Grammar: subject-verb agreement; proper voice (active vs. passive) and person used; pronouns are unambiguous and congruent; plurals correct; appropriate hyphenation of terms. Turn on your grammar checker in MS Word. It isn’t always correct, but you need to pay attention to anything that it points out. If you still haven’t learned basic punctuation, it is time to start. Sentences: complete, clear, and concise and do not contain redundancies and excessive complex words; do not contain hidden verbs, wordy phrases or clichés; sentence transitions are present and maintain the flow of thought APA frowns upon colloquialisms and trendy terms. Don’t try too hard to sound smart. Language usage: language appropriate for the audience; nonbiased language used; contractions avoided; colloquial expressions, slang and jargon avoided; language clear, concise, precise and unambiguous; parallel construction; proper word choice; tone appropriate to the content and assignment Sentence and paragraph structure: sentence well constructed, consistently strong and varied; paragraphs well constructed and contain a minimum of three sentences The “three sentence rule” is not set in stone, but many scholars consider a paragraph of less than 3 sentences to be underdeveloped. Other style issues: appropriate use of personal pronouns; paper neat and well presented; ellipsis points used properly to indicate omitted material; text does not contain widows or orphans. Text: Times Roman 12-point font used; document double-spaced throughout; margins at least 1 inch on all sides and ragged right edge; paragraphs indented 5-7 spaces; headings and subheadings properly formatted; no end-of-line hyphenation; only one space after punctuation; no bold type used for emphasis; italics used instead of Be careful about extra spaces between words. underlining If you don’t have an APA template, set one up. There is no reason that you should be using manual tabs or spaces to indent your paragraphs. In-text citations: all outside ideas properly cited; citations complete and properly formatted; electronic sources properly cited; personal communications cited in text only; page numbers included for direct quotations; indirect or secondary sources properly cited Reference list: references in correct alphabetical order with author’s initials; electronic references properly cited and formatted; format of references conforms to APA requirements; in-text and reference list citations correspond . Punctuation: used correctly; the word “and” and the ampersand are used correctly; punctuation correctly placed with quotation marks Spelling is correct: misspellings or typos are not acceptable in graduate work. USE YOUR SPELL CHECKER BEFORE SUBMITTING WORK. Total Total 100 Percent 20 100 The Basic Outline of a Paper The following outline shows a basic format for most academic papers. No matter what length the paper needs to be, it should still follow the format of having an introduction, body, and conclusion. Read over what typically goes in each section of the paper. Use the back of this handout to outline information for your specific paper. I. Introduction The introduction should have some of the following elements, depending on the type of paper: Start with an attention grabber: a short story, example, statistic, or historical context that introduces the paper topic Give an overview of any issues involved with the subject Define of any key terminology need to understand the topic Quote or paraphrase sources revealing the controversial nature of the subject (argumentative papers only) Highlight background information on the topic needed to understand the direction of the paper Write an antithesis paragraph, presenting the primary opposing views (argumentative paper only) II.The introduction must end with a THESIS statement (a 1 to 2 sentences in length): Tell what the overall paper will focus on Briefly outline the main points in the paper II. Body Clearly present the main points of the paper as listed in the thesis Give strong examples, details, and explanations to support each main points If an argumentative paper, address any counterarguments and refute those arguments If a research paper, use strong evidence from sources—paraphrases, summaries, and quotations that support the main points III. Conclusion Restate your thesis from the introduction in different words Briefly summarize each main point found in the body of the paper (avoid going over 2 sentences for each point) Give a statement of the consequences of not embracing the position (argumentative paper only) End with a strong clincher statement: an appropriate, meaningful final sentence that ties the whole point of the paper together (may refer back to the attention grabber) Additional Tips Decide on the thesis and main points first You do not need to start writing your paper with the introduction Try writing the thesis and body first; then go back and figure out how to best introduce the body and conclude the paper Use transitions between main points and between examples within the main points Always keep your thesis in the forefront of your mind while writing; everything in your paper must point back to the thesis Paper Topic:____________________________________________________ Audience:__________ I. Introduction Possible ideas for the introduction (see front side of handout for suggestions): _______________________________ _______________________________ _______________________________ Thesis Statement (Usually the last sentence(s) in the introduction): _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ II. Body (A paper may have a few or many main points; decide how many your paper will need) Main Point: ___________________________________________________________________ Examples/Details/Explanations: a. ______________________________________________________________________ b. ______________________________________________________________________ c. ______________________________________________________________________ Main Point: ___________________________________________________________________ Examples/Details/Explanations: a. ______________________________________________________________________ b. ______________________________________________________________________ c. ______________________________________________________________________ Main Point: ___________________________________________________________________ Examples/Details/Explanations: a. ______________________________________________________________________ b. ______________________________________________________________________ c. ______________________________________________________________________ Main Point: ___________________________________________________________________ Examples/Details/Explanations: a. ______________________________________________________________________ b. ______________________________________________________________________ c. ______________________________________________________________________ III. Conclusion Reworded Thesis (Usually found near the beginning of the conclusion): _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Other Ideas to Conclude: ________________________________ ________________________________ Clincher Ideas: _________________________________________________________________
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