The frequency of natural disasters is increasing globally every year. with an increase in disaster incidence by 13% in 2021 compared to the previous year (O.H.C.A., 2022). Based on the 2022 report of the National Disaster Management Agency (B.N.P.B., 2022). the Java Island region in Indonesia experiences the highest frequency of disasters. One of the most vulnerable areas in Java Island is the Special Region of Yogyakarta (DIY). where 68% of the area is at risk of disaster. The Indonesia Disaster Risk Index (IRBI) in 2020 ranked DIY 20th in Indonesia with a high risk classification. The main threat in DIY is the eruption of Mount Merapi in Sleman Regency which is classified as high risk.

The eruption of Mount Merapi in 2010. one of the largest eruptions in the last century. resulted in hot clouds and incandescent lava avalanches dominating the southern slopes and impacting 4 districts. including Sleman Regency (R.. & Wasino, 2021). Based on the disaster-prone map of Sleman Regency. there are 3 districts at risk due to the eruption of Mount Merapi: Cangkringan District. Pakem District. and Turi District.

The eruption of Mount Merapi has two main categories of impacts: primary impacts. which have a direct impact on the population at the time of eruption. and secondary impacts. which occur after the eruption. Key impacts include damage from hot clouds. lahars. ash. sand. and gas eruptions. which can have toxic effects. Secondary impacts such as the loss of cold lava occur in the area around the river originating from Mount Merapi (J.. & J, 2015)

Some of the impacts of the Merapi disaster that occurred illustrate the importance of carrying out disaster preparedness to reduce errors in management when conducting disaster triage (C.. & L, 2014). Medical personnel are given priority in handling emergencies because of the limited number available. Emergency management is in place to minimize the increase in fatalities. In the event of a disaster. the responsibility of medical personnel and health workers of the Puskesmas is to group victims based on the severity of their condition (Widayatun & Z, 2013).

Triage involves categorizing individuals based on their degree of injury or condition in terms of airway. respiratory. and circulatory (ABC). The START method. a commonly used and easy-toimplement triage system. sorts victims into red. yellow. green. and black categories based on their condition. According to research by (M.. & G, 2022). the Simple Triage and Rapid Treatment model is often used in hospitals to assess patients efficiently and accurately. One of the advantages of using the Simple Triage and Rapid Treatment system is its simplicity. as it combines the principles of breathing. perfusion. and mental status to categorize patients into red. yellow. green. or black (M.. & J, 2022).

Failure to properly and effectively implement Simple Triage and Rapid Treatment can lead to delays in transporting victims to healthcare facilities. potentially resulting in high mortality and disability rates (M.. & A, 2019). In addition. if Simple Triage and Rapid Treatment is not performed accurately. it can lead to errors in determining patient priorities. causing delays in providing assistance to victims and ultimately resulting in higher mortality (C.. & L, 2014).

Improving disaster victim management can help reduce the time between injury and medical care. ultimately reducing morbidity and mortality. Triage is essential in disaster situations to prioritize and promptly assess injured individuals. In cases where resources are limited. it is important to focus on the treatment of survivors (O.. & A, 2018).

Disaster triage involves many parties and has a positive impact in handling mass victims or largescale disasters. Various journals have highlighted the promising potential of triage methods such as Modified SALT, which can reduce health worker error rates by 22% and has an average patient assessment time of 4-5 seconds (Laksono, 2024). START triage is simpler and faster in handling mass casualties. Overall, START disaster triage as stated by the American Medical Association Journal of Ethics, is considered effective in dealing with disaster victims.

Disaster triage is performed by a first responder. specifically someone who first arrives at the disaster site and is an expert in triage techniques (M.. & M, 2013). Medical personnel and health workers are part of the first responders who lead disaster management efforts (T, 2021). Health policy emphasizes the importance of the role of medical personnel and health workers in disaster response. with the aim of preparing them effectively to cope with disasters on both a local and global scale (M.. & I, 2014).

It is important for medical personnel and healthcare workers to have the key competencies required to implement Simple Triage and Rapid Treatment which includes knowledge and attitudes. Therefore, there is a need to create an assessment tool to measure their knowledge and attitudes towards Simple Triage and Rapid Treatment. The purpose of this study was to evaluate the accuracy and consistency of assessment tools for medical and healthcare personnel involved in Simple Triage and Rapid Treatment.

The preparation of the instrument is based on literature research that has been carried out through references from the research of (Kamaluddin et al., 2019). The framework of the knowledge instrument includes: (1) disaster definition. ( 2 4) Simple Triage and Rapid Treatment procedures. At the initial stage of instrument preparation. 10 question items on knowledge and 10 question items on attitude are compiled. Once the instrument items are compiled. the validity of the contents is assessed through expert assessment from academic and clinical experts in the field of emergency and disaster. The expert judgment process is carried out by three experts in the field of emergency and disaster. and the results are used for validity analysis by scaling each item using Aiken's V content coefficient so that a value of 0.89-1.00 is obtained on the knowledge instrument and 1.00 on the attitude instrument. Content analysis showed that all items had a V value of > 0.8. including 10 knowledge items and 10 attitude items. After the validity of the quantitative content. the validity and reliability of the instrument were tested on 100 individual medical and health workers. The inclusion criteria for your respondents are: have never attended training, work as a medical worker or health worker, are willing to be a respondent. Exclusion criteria were: not completing the questionnaire to the end. This research has received ethical clearance with publication number KE/FK/1534/EC.

To validate the instrument quantitatively. a cross-sectional study was conducted on 100 participants who were medical personnel and health workers from the ngemplak 1 and ngemplak 2 health centers. Each puskesmas with 50 medical and health workers. Questionnaires are distributed using gform.

Data collection will take place in July 2023. Initially. the research team hired a research assistant to assist in the data collection process. The research protocol is then explained to the assistant to ensure a shared understanding of the data collection process. Furthermore. permission was obtained from the local government. and data collection was carried out by sending a questionnaire gform to one of the officers at the puskesmas to be distributed to all medical and health workers.

Data analysis was performed using SPSS for Windows version 22.0. Before analysis. all data are checked for accuracy and missing values are identified. Descriptive analysis is used to describe the demographics of the data. The validity of knowledge instruments was assessed using a biserial correlation test and the validity of attitude instruments was assessed using the Pearson Product Moment test.

In Table 1. it is known that the number of respondents in this study was 100 respondents. Almost all respondents were female (78%) and the average age of respondents was 36 years. The majority of respondents have never attended training (77%) and have an S1 education (60%). The items in this instrument are in accordance with the aim of preparing the instrument, namely discussing knowledge and attitudes about triage start.

Validity assessment was performed using biserial correlation on knowledge instruments and Pearson Product Moments on attitude instruments. Analysis is performed to correlate each item score with the total score. which is the sum of all item scores. Any question item whose calculated r value is greater than or equal to the table r value of 0.195 is considered to correlate significantly with the total score. After a validity test. all items are declared valid based on a comparison of the calculated r and r values of the table. The general consensus is that an instrument is considered to have good reliability if its value is equal to or greater than 0.700. The reliability of knowledge instruments was assessed using Kuder Richardson formula 20 (KR-20) and attitude instruments were assessed using Cronbach alpha. The range of reliability values of knowledge instruments using Kuder Richardson Formula 20 (KR-20) obtained ranges from 0.70 – 0.73. while attitude instruments using Chronbach alpha obtained r-Count values ranging from 0.86 – 0.90. which indicates that all items of knowledge and attitude instruments are considered reliable. The results of the validity and reliability test can be seen in Table 2.

Some competencies in conducting Simple Triage and Rapid Treatment that must be mastered by medical and health workers such as understanding the definition of disaster. triage. and triage start. principles in conducting Simple Triage and Rapid Treatment. Simple Triage and Rapid Treatment indicators. Simple Triage and Rapid Treatment classification. and Simple Triage and Rapid Treatment implementation procedures. In the knowledge instrument. there are 10 items of statement regarding the Simple Triage and Rapid Treatment. There are 2 statements regarding the definition of disaster and Simple Triage and Rapid Treatment. 1 statement item regarding the principles of conducting Simple Triage and Rapid Treatment. 1 statement item regarding the Simple Triage and Rapid Treatment indicator. 2 statement items regarding the Simple Triage and Rapid Treatment classification. and 2 statement items regarding the Simple Triage and Rapid Treatment implementation procedure. Triage START plays an important role in emergency management by efficiently grouping and prioritizing victims based on their medical conditions. determining the most urgent need for immediate care (J.. & R, 2014).

Knowledge of triage possessed by medical and health personnel will be very helpful in identifying emergency cases when a disaster occurs to prevent death and additional complications. In the event of a disaster. It allows all health workers to be able to become first responders to sort victims according to emergency conditions (L.. & Y, 2021).

In the attitude instrument there are 10 statement items regarding the Simple Triage and Rapid Treatment. The statement consists of 1 item statement about the disaster. 1 item statement regarding the purpose of the Simple Triage and Rapid Treatment. 6 items statement on the principles of the Simple Triage and Rapid Treatment. and 2 items statement on the procedure for implementing the Simple Triage and Rapid Treatment. Attitude is a reflection of the perception of medical personnel and health workers regarding the importance of the role of health workers in carrying out disaster triage. The higher the value of the attitude of medical and health personnel. the more it will increase the behavior of health workers in doing the Simple Triage and Rapid Treatment. A positive attitude is accepting. obedient. and in accordance with applicable rules (S.. & A, 2019).

Health workers' confidence in their abilities is one factor in behavior change. This is in accordance with social cognitive theory. stating that positive interactions are expected to cause feelings or willingness to change. According to (Bandura, 2019) a person with a high level of self-confidence tends to have control over the events around him. Individuals will try harder and be more persistent in carrying out tasks compared to individuals who consider their abilities low. A medical and health professional who has knowledge and confidence has greater potential to be able to act positively. This is because medical and health personnel are the front line when a disaster occurs. Therefore. the ability of medical and health personnel to perform triage is needed to prevent disability and death.

In the event of a disaster. it is critical to implement Simple Triage and Rapid Treatment to set priorities and decide which victims will receive assistance first. This is necessary to improve the effectiveness and accuracy of services provided to disaster victims (M.. et al., 2020). Victims with a green symbol or minor injuries can be transferred by non-medical transport after all victims with a red symbol or acute injuries have been evacuated. Upon arrival at a health facility. any injured individuals must undergo re-examination. reassessment. stabilization. and definitive treatment by medical and health personnel who must be aware of these protocols (G, 2018).

The development of knowledge instruments and attitudes in triaging START is considered to be still limited. Medical and healthcare personnel must have the knowledge and attitude to perform effective Simple Triage and Rapid Treatment. Health workers are recognized for their proficiency in performing Simple Triage and Rapid Treatment. Increased knowledge and attitudes in Simple Triage and Rapid Treatment require more focus from academics. government. and other disaster response stakeholders.

This study shows that the instruments that measure knowledge and attitudes in triaging START among medical and health personnel are valid and reliable. This instrument consists of six components. namely disaster. triage start. principles in conducting Simple Triage and Rapid Treatment. Simple Triage and Rapid Treatment indicator. Simple Triage and Rapid Treatment classification. and Simple Triage and Rapid Treatment implementation procedures. The trige aspect of START shows the importance of the role of medical and health personnel in emergency care during disasters. These findings suggest that understanding and attitudes in the Simple Triage and Rapid Treatment are critical for medical and healthcare personnel. Further development is needed to validate the psychometric properties of the instrument through factor analysis. This instrument can be used to assess the knowledge and attitudes of medical and health personnel regarding the Simple Triage and Rapid Treatment in disaster-prone areas.