Mass Casualty Triage: An Evaluation of the Data and Development of a Proposed National Guideline

Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Disaster Medicine and Public Health Preparedness (Impact Factor: 0.7). 10/2008; 2 Suppl 1(S1):S25-34. DOI: 10.1097/DMP.0b013e318182194e
Source: PubMed


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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Available from: Nikiah Nudell, Sep 04, 2015
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    • "There is limited evidence for the validity of existing triage tools [3-6]. However, an advisory committee in the United States has proposed the SALT (sort, assess, lifesaving interventions, treatment and/or transport) Triage System as a US national guideline for mass casualty triage [7,8]. A national guideline for mass casualty triage in Norway has recently been developed and published by the Norwegian Directorate of Health. "
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    ABSTRACT: In a mass casualty situation, medical personnel must rapidly assess and prioritize patients for treatment and transport. Triage is an important tool for medical management in disaster situations. Lack of common international and Swedish triage guidelines could lead to confusion. Attending the Advanced Trauma Life Support (ATLS) provider course is becoming compulsory in the northern part of Europe. The aim of the ATLS guidelines is provision of effective management of single critically injured patients, not mass casualties incidents. However, the use of the ABCDE algorithms from ATLS, has been proposed to be valuable, even in a disaster environment. The objective for this study was to determine whether the mnemonic ABCDE as instructed in the ATLS provider course, affects the ability of Swedish physician's to correctly triage patients in a simulated mass casualty incident. The study group included 169 ATLS provider students from 10 courses and course sites in Sweden; 153 students filled in an anonymous test just before the course and just after the course. The tests contained 3 questions based on overall priority. The assignment was to triage 15 hypothetical patients who had been involved in a bus crash. Triage was performed according to the ABCDE algorithm. In the triage, the ATLS students used a colour-coded algorithm with red for priority 1, yellow for priority 2, green for priority 3 and black for dead. The students were instructed to identify and prioritize 3 of the most critically injured patients, who should be the first to leave the scene. The same test was used before and after the course. The triage section of the test was completed by 142 of the 169 participants both before and after the course. The results indicate that there was no significant difference in triage knowledge among Swedish physicians who attended the ATLS provider course. The results also showed that Swedish physicians have little experience of real mass casualty incidents and exercises. The mnemonic ABCDE doesn't significantly affect the ability of triage among Swedish physicians. Actions to increase Swedish physicians' knowledge of triage, within the ATLS context or separately, are warranted.
    Full-text · Article · Dec 2013 · Scandinavian Journal of Trauma Resuscitation and Emergency Medicine
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    • "According to the current practice, these resource allocation decisions are made in a very simple way: the triage class of a patient automatically determines the patient's priority. For example, consider the most widely adopted triage protocol in the U.S., START, which stands for Simple Triage and Rapid Treatment (Lerner 2008). START classifies patients into four different classes. "
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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.
    Full-text · Article · Jul 2013 · Manufacturing & Service Operations Management
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    • "In The Manchester Triage Score [17], the level of consciousness in adult and children is considered separately. A guideline, entitled SALT (sort, assess, life-saving interventions, treatment and/or transport) triage, was developed in 2008; which incorporates aspects from all of the existing triage systems (see Figure 2) to create a single overarching guide for unifying the mass casualty triage process across the United States [35]. START triage utilises the use of colours green, yellow, red and black to categorise the patients (see Figure 3). "
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    ABSTRACT: Emergency departments across the globe follow a triage system in order to cope with overcrowding. The intention behind triage is to improve the emergency care and to prioritize cases in terms of clinical urgency. In emergency department triage, medical care might lead to adverse consequences like delay in providing care, compromise in privacy and confidentiality, poor physician-patient communication, failing to provide the necessary care altogether, or even having to decide whose life to save when not everyone can be saved. These consequences challenge the ethical quality of emergency care. This article provides an ethical analysis of "routine" emergency department triage. The four principles of biomedical ethics - viz. respect for autonomy, beneficence, nonmaleficence and justice provide the starting point and help us to identify the ethical challenges of emergency department triage. However, they do not offer a comprehensive ethical view. To address the ethical issues of emergency department triage from a more comprehensive ethical view, the care ethics perspective offers additional insights. We integrate the results from the analysis using four principles of biomedical ethics into care ethics perspective on triage and propose an integrated clinically and ethically based framework of emergency department triage planning, as seen from a comprehensive ethics perspective that incorporates both the principles-based and care-oriented approach.
    Full-text · Article · Oct 2011 · BMC Emergency Medicine
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