Mass Casualty Triage: An Evaluation of the Data and Development of a Proposed National Guideline
ABSTRACT Mass casualty triage is a critical skill. Although many systems exist to guide providers in making triage decisions, there is little scientific evidence available to demonstrate that any of the available systems have been validated. Furthermore, in the United States there is little consistency from one jurisdiction to the next in the application of mass casualty triage methodology. There are no nationally agreed upon categories or color designations. This review reports on a consensus committee process used to evaluate and compare commonly used triage systems, and to develop a proposed national mass casualty triage guideline. The proposed guideline, entitled SALT (sort, assess, life-saving interventions, treatment and/or transport) triage, was developed based on the best available science and consensus opinion. It incorporates aspects from all of the existing triage systems to create a single overarching guide for unifying the mass casualty triage process across the United States.
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ABSTRACT: The most widely used standard for mass-casualty triage, START, relies on a fixed-priority ordering among different classes of patients, and does not explicitly consider resource limitations or the changes in survival probabilities with respect to time. We construct a fluid model of patient triage in a mass-casualty incident that incorporates these factors and characterize its optimal policy. We use this characterization to obtain useful insights about the type of simple policies that have a good chance to perform well in practice, and we demonstrate how one could develop such a policy. Using a realistic simulation model and data from emergency medicine literature, we show that the policy we developed based on our fluid formulation outperforms START in all scenarios considered, sometimes substantially.Manufacturing & Service Operations Management 07/2013; 15(3):361-377. DOI:10.1287/msom.1120.0426 · 1.45 Impact Factor
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ABSTRACT: Best possible pre-hospital treatment in the event of a mass casualty incident (MCI) is related to prioritizing rescue tasks and using rescue resources efficiently. Currently, in-formation is almost always documented on paper-based forms and communicated by one-to-one talks, messengers, radio and mobile phone. Pervasive computer-based solu-tions are not established yet. Although the mere technologi-cal challenges are on the way of being solved within the near future, questions of usability remain. Concerning this matter, we propose an entangled User Centered System Design (UCSD) and Feature Driven Development (FDD) process and introduce the principle Care & Prepare. It is based on two fundamental assumptions. First, the whole design process has to care for the rescue personnel's' needs in these challenging situations and second, the rescue per-sonnel has to be prepared for using these specialized com-puter applications in case of an MCI. Therefore, daily rou-tine has to be the training foundation for these extraordinary operations.
Article: For A MASSive Headache