Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-13T00:49:43.573Z Has data issue: false hasContentIssue false

Model Uniform Core Criteria for Mass Casualty Triage

Published online by Cambridge University Press:  08 April 2013

Abstract

There is a need for model uniform core criteria for mass casualty triage because disasters frequently cross jurisdictional lines and involve responders from multiple agencies who may be using different triage tools. These criteria (Tables 1-4) reflect the available science, but it is acknowledged that there are significant research gaps. When no science was available, decisions were formed by expert consensus derived from the available triage systems. The intent is to ensure that providers at a mass-casualty incident use triage methodologies that incorporate these core principles in an effort to promote interoperability and standardization. At a minimum, each triage system must incorporate the criteria that are listed below. Mass casualty triage systems in use can be modified using these criteria to ensure interoperability. The criteria include general considerations, global sorting, lifesaving interventions, and assignment of triage categories. The criteria apply only to providers who are organizing multiple victims in a discrete geographic location or locations, regardless of the size of the incident. They are classified by whether they were derived through available direct scientific evidence, indirect scientific evidence, expert consensus, and/or are used in multiple existing triage systems. These criteria address only primary triage and do not consider secondary triage. For the purposes of this document the term triage refers to mass-casualty triage and provider refers to any person who assigns primary triage categories to victims of a mass-casualty incident.

(Disaster Med Public Health Preparedness. 2011;5:125–128)

Type
Special Focus
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Wallis, LA, Carley, S.Comparison of paediatric major incident primary triage tools. Emerg Med J. 2006;23 (6):475478.Google Scholar
2.Wang, T, Hung, C.Appraisal of Field Triage in Mass Casualty Incidents in Taipei. Ann Disaster Med. 2005;3 (2):6975.Google Scholar
3.Baker, D.Civilian exposure to toxic agents: emergency medical response. Prehosp Disaster Med. 2004;19 (2):174178.CrossRefGoogle ScholarPubMed
4.Cone, DC, Koenig, KL.Mass casualty triage in the chemical, biological, radiological, or nuclear environment. Eur J Emerg Med. 2005;12 (6):287302.Google Scholar
5.Hodgetts, TJTriage: a position statement.; 2001.Google Scholar
6.Kilner, T, Hall, FJ.Triage decisions of United Kingdom police firearms officers using a multiple-casualty scenario paper exercise. Prehosp Disaster Med. 2005;20 (1):4046.Google Scholar
7.Lee, WH, Chiu, TF, Ng, CJ, Chen, JC.Emergency medical preparedness and response to a Singapore airliner crash. Acad Emerg Med. 2002;9 (3):194198.Google Scholar
8.Benson, M, Koenig, KL, Schultz, CH.Disaster triage: START, then SAVE—a new method of dynamic triage for victims of a catastrophic earthquake. Prehosp Disaster Med. 1996;11 (2):117124.Google Scholar
9.Kahn, CA, Schultz, CH, Miller, KT, Anderson, CL.Does START triage work? An outcomes assessment after a disaster. Ann Emerg Med. 2009;54 (3):424430, e1.Google Scholar
10.Kragh, JF Jr, Littrel, ML, Jones, JA.Battle Casualty Survival with Emergency Tourniquet Use to Stop Limb Bleeding. J Emerg Med. 2009 Aug2819717268.Google Scholar
11.Kragh, JF Jr, Walters, TJ, Baer, DG.Practical use of emergency tourniquets to stop bleeding in major limb trauma. J Trauma. Feb 2008;64(2 Suppl):S38-49; discussion S49-50.Google Scholar
12.Kragh, JF Jr, Walters, TJ, Baer, DG.Survival with emergency tourniquet use to stop bleeding in major limb trauma. Ann Surg. 2009;249 (1):17.CrossRefGoogle ScholarPubMed
13.Okumura, T, Suzuki, K, Fukuda, A.The Tokyo subway sarin attack: disaster management, Part 1: Community emergency response. Acad Emerg Med. 1998;5 (6):613617.Google Scholar
14.Garner, A, Lee, A, Harrison, K, Schultz, CH.Comparative analysis of multiple-casualty incident triage algorithms. Ann Emerg Med. 2001;38 (5):541548.Google Scholar
15.Holcomb, JB, Niles, SE, Miller, CC, Hinds, D, Duke, JH, Moore, FA.Prehospital physiologic data and lifesaving interventions in trauma patients. Mil Med. 2005;170 (1):713.Google Scholar
16.Meredith, W, Rutledge, R, Hansen, AR.Field triage of trauma patients based upon the ability to follow commands: a study in 29,573 injured patients. J Trauma. 1995;38 (1):129135.Google Scholar
17.de Ceballos, JP, Turégano-Fuentes, F, Perez-Diaz, D, Sanz-Sanchez, M, Martin-Llorente, C, Guerrero-Sanz, JE.11 March 2004: The terrorist bomb explosions in Madrid, Spain—an analysis of the logistics, injuries sustained and clinical management of casualties treated at the closest hospital. Crit Care. 2005;9 (1):104111.Google Scholar
18.Bellamy, RF.The causes of death in conventional land warfare: implications for combat casualty care research. Mil Med. 1984;149 (2):5562.Google Scholar
19.Brodie, S, Hodgetts, TJ, Ollerton, J, McLeod, J, Lambert, P, Mahoney, P.Tourniquet use in combat trauma: UK military experience. J R Army Med Corps. 2007;153 (4):310313.Google Scholar
20.Bellamy, RF, Pedersen, DC, DeGuzman, LR.Organ blood flow and the cause of death following massive hemorrhage. Circ Shock. 1984;14 (2):113127.Google Scholar
21.Doyle, GS, Taillac, PP.Tourniquets: a review of current use with proposals for expanded prehospital use. Prehosp Emerg Care. 2008;12 (2):241256.Google Scholar
22.Lee, C, Porter, KM, Hodgetts, TJ.Tourniquet use in the civilian prehospital setting. Emerg Med J. 2007;24 (8):584587.Google Scholar
23.Barton, ED, Epperson, M, Hoyt, DB, Fortlage, D, Rosen, P.Prehospital needle aspiration and tube thoracostomy in trauma victims: a six-year experience with aeromedical crews. J Emerg Med. 1995;13 (2):155163.Google Scholar
24.Davis, DP, Pettit, K, Rom, CD.The safety and efficacy of prehospital needle and tube thoracostomy by aeromedical personnel. Prehosp Emerg Care. 2005;9 (2):191197.Google Scholar
25.Eckstein, M, Suyehara, D.Needle thoracostomy in the prehospital setting. Prehosp Emerg Care. 1998;2 (2):132135.Google Scholar
26.Okumura, T, Suzuki, K, Fukuda, A.The Tokyo subway sarin attack: disaster management, Part 2: Hospital response. Acad Emerg Med. 1998;5 (6):618624.Google Scholar
27.Waisman, Y, Aharonson-Daniel, L, Mor, M, Amir, L, Peleg, K.The impact of terrorism on children: a two-year experience. Prehosp Disaster Med. 2003;18 (3):242248.Google Scholar
28.Bazarian, JJ, Eirich, MA, Salhanick, SD.The relationship between pre-hospital and emergency department Glasgow coma scale scores. Brain Inj. 2003;17 (7):553560.CrossRefGoogle ScholarPubMed
29. McManus, J, Yershov, AL, Ludwig, D.Radial pulse character relationships to systolic blood pressure and trauma outcomes. Prehosp Emerg Care. 2005;9 (4):423428.Google Scholar
30.Holcomb, JB, Salinas, J, McManus, JM, Miller, CC, Cooke, WH, Convertino, VA.Manual vital signs reliably predict need for life-saving interventions in trauma patients. J Trauma. 2005;59 (4):821828, discussion 828-829.Google Scholar
31.Sztajnkrycer, MD, Baez, AA, Luke, A.FAST ultrasound as an adjunct to triage using the START mass casualty triage system: a preliminary descriptive system. Prehosp Emerg Care. 2006;10 (1):96102.Google Scholar
32.Burkle, FM Jr, Newland, C, Orebaugh, S, Blood, CG.Emergency medicine in the Persian Gulf War—Part 2. Triage methodology and lessons learned. Ann Emerg Med. 1994;23 (4):748754.Google Scholar
33.Schriger, DL, Baraff, LJ.Capillary refill—is it a useful predictor of hypovolemic states? Ann Emerg Med. 1991;20 (6):601605.Google Scholar
34.Hogan, DE, Waeckerle, JF, Dire, DJ, Lillibridge, SR.Emergency department impact of the Oklahoma City terrorist bombing. Ann Emerg Med. 1999;34 (2):160167.Google Scholar
35.Quintana, DA, Parker, JR, Jordan, FB, Tuggle, DW, Mantor, PC, Tunell, WP.The spectrum of pediatric injuries after a bomb blast. J Pediatr Surg. Feb 1997;32(2):307-310; discussion 310-301.Google Scholar
36.Koehler, JJ, Malafa, SA, Hillesland, J.A multicenter validation of the prehospital index. Ann Emerg Med. 1987;16 (4):380385.Google Scholar
37.Koehler, JJ, Baer, LJ, Malafa, SA, Meindertsma, MS, Navitskas, NR, Huizenga, JE.Prehospital Index: a scoring system for field triage of trauma victims. Ann Emerg Med. 1986;15 (2):178182.Google Scholar
38.Holmes, JF, Palchak, MJ, MacFarlane, T, Kuppermann, N.Performance of the pediatric glasgow coma scale in children with blunt head trauma. Acad Emerg Med. 2005;12 (9):814819.Google Scholar
39.Christian, MD, Hawryluck, L, Wax, RS.Development of a triage protocol for critical care during an influenza pandemic. CMAJ. 2006;175 (11):13771381.Google Scholar
40.Fong, F, Schrader, DC.Radiation disasters and emergency department preparedness. Emerg Med Clin North Am. 1996;14 (2):349370.Google Scholar
41.Frykberg, ER.Principles of mass casualty management following terrorist disasters. Ann Surg. 2004;239 (3):319321.Google Scholar
42.Frykberg, ER.Medical management of disasters and mass casualties from terrorist bombings: how can we cope? J Trauma. 2002;53 (2):201212.Google Scholar
43.Coule, PL, Horner, JA.National disaster life support programs: a platform for multi-disciplinary disaster response. Dent Clin North Am. 2007;51 (4):819825, vi.Google Scholar
44.Borden Institute. Emergency war surgery.–3rd U.S. revision. Washington, DC: Borden Institute, Walter Reed Army Medical Center.; 2004.Google Scholar
45.Burkle, FM Jr, Orebaugh, S, Barendse, BR.Emergency medicine in the Persian Gulf War—Part 1: Preparations for triage and combat casualty care. Ann Emerg Med. 1994;23 (4):742747.Google Scholar
46.Hines, S, Payne, A, Edmondson, J, Heightman, AJ.Bombs under London. The EMS response plan that worked. JEMS. Aug 2005;30(8):58-60, 62, 64-57.Google Scholar
47.Einav, S, Feigenberg, Z, Weissman, C.Evacuation priorities in mass casualty terror-related events: implications for contingency planning. Ann Surg. 2004;239 (3):304310.Google Scholar