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Field Triage and Patient Maldistribution in a Mass-Casualty Incident

Published online by Cambridge University Press:  28 June 2012

Richard M. Zoraster ,
Cathy Chidester  and
William Koenig
Richard M. Zoraster*
Affiliation:
Los Angeles County Emergency Medical Services
Cathy Chidester
Affiliation:
Los Angeles County Emergency Medical Services
William Koenig
Affiliation:
Los Angeles County Emergency Medical Services
*
Richard M. Zoraster, Los Angeles County Emergency Medical Services 5555 Ferguson Drive, Suite 220 Commerce, California 90022-5152USA E-mail: [email protected]
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Abstract

Introduction:

Management of mass-casualty incidents should optimize outcomes by appropriate prehospital care, and patient triage to the most capably facilities. The number of patients, the nature of injuries, transportation needs, distances, and hospital capabilities and availabilities are all factors to be considered. Patient maldistributions such as overwhelming individual facilities, or transport to facilities incapable of providing appropriate care should be avoided. This report is a critical view of the application of the START triage nomenclature in the prehospital arena following a train crash in Los Angeles County on 26 January 2005.

Methods:

A scheduled debriefing was held with the major fire and emergency medical services responders, Medical Alert Center staff, and hospitals to assess and review the response to the incident. Site visits were made to all of the hospitals involved. Follow-up questions were directed to emergency department staff that were on duty during the day of the incident.

Results:

The five Level-I Trauma Centers responded to the poll with the capacity to receive a total of 12 “Immediate” patients, 2.4 patients per center, the eight Level-II Trauma Centers responded with capacity to receive 17 “Immediate” patients, two patients per center, while the 25 closest community hospitals offered to accept 75 “Immediate” patients, three patients per hospital. These community hospitals were typically about one-half of the size of the trauma centers (average 287 beds versus 548, average 8.7 operating rooms versus 16.6). Twenty-six patients were transported to a community hospital >15 miles from the scene, while eight closer community hospitals did not receive any patients.

Conclusions:

The debriefing summary of this incident concluded that there were no consistently used criteria to decide ultimate destination for “Immediates”, and that they were distributed about equally between community hospitals and trauma centers.

Keywords

emergency medical servicesmass-casualty incidentpatient maldistributionSTART triagetrauma centertriage
Type
Special Report
Information
Prehospital and Disaster Medicine , Volume 22 , Issue 3 , June 2007 , pp. 224 - 229
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2007

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References

1.Domres, B, Koch, M, Manger, A, Becker, H: Ethics and triage. Prehosp Disast Med 2001;16(1):53–58.CrossRefGoogle ScholarPubMed
2.Bissell, R, Becker, B, Burkle, F: Health care personnel in disaster response. Emerg Med Clin N Amer 1996;14(22):267–288.CrossRefGoogle ScholarPubMed
3.Kennedy, K, Aghababian, R, Gans, L, Lewis, C: Triage: Techniques and applications in decision-making. Ann Emerg Med 1996;28:136–144.CrossRefGoogle Scholar
4.Auf der Heide, E: “Disaster planning, Part II” Emerg Med Clini Amer 1966;14(2):453–480.CrossRefGoogle Scholar
5.Jacobs, L, Goody, M, Sinclair, A: The role of a trauma center in disaster management. J Trauma 1983;23(8):697–701.CrossRefGoogle ScholarPubMed
6.Waeckerle, J: Disaster planning and response. N Engl J Med 1991;324(12): 815–821.Google ScholarPubMed
7.Nathens, A, Brunet, F, Maier, R: Development of trauma systems and effect on outcomes after injury. Lancet 2004;363:1794–1801.CrossRefGoogle ScholarPubMed
8.Trunkey, D: History and development of trauma care in the United States. Clin Orthop Relat Res 2000;374:36–46CrossRefGoogle Scholar
9.Hoff, W, Schwab, C: Trauma system development in North America. Clin Orthop Relat Res 2004;442:17–22.CrossRefGoogle Scholar
10.MacKenzie, EJ, Rivara, FP, Jurkovich, GJ, Nathens, AB, Frey, KP, Egleston, BL, Salkever, DS, Scharfstein, DO: A national evaluation of the effect of trauma center care on mortality. N Engl J Med 2006;354:366–378.CrossRefGoogle ScholarPubMed
11.Asaeda, G: The day that the START Triage System came to a STOP: Observations from the World Trade Center Disaster. Acad Emerg Med 2002;9(3):255–256.CrossRefGoogle ScholarPubMed
12.Vayer, J, Ten Eyck, R, Cown, M: New concepts in triage. Ann Emerg Med 1986;15:927–930.CrossRefGoogle ScholarPubMed
13.Arnold, J, Tsai, M, Halpern, P, Smithline, H, Stok, E, Ersoy, G: Mass-casualty, terrorist bombings: Epidemiological outcomes, resource utilization, and time course of emergency needs. Prehosp Disast Med 2003;18(3):220–234.CrossRefGoogle ScholarPubMed
14.Halpern, P, Tsai, M, Arnold, J, Stok, E, Ersoy, G: Mass-casualty, and terrorist bombings: Implications for emergency department and hospital emergency response. Prehosp Disast Med 2003;18(3):235–241.CrossRefGoogle ScholarPubMed
15.Gans, L, Kennedy, T: Management of unique clinical entities in disaster medicine. Emerg Med Clin N Amer 1996;14(2):301–326.CrossRefGoogle ScholarPubMed
16.Rodoplu, U, Arnold, JL, Tokvay, R, Ersoy, G, Cetiner, S, Yucel, T: Mass-casualty terrorist bombings in Istanbul, Turkey, November 2003: Report of the events and the prehospital emergency response. Prehosp Disast Med 2004;19(2):133–145.CrossRefGoogle ScholarPubMed
17.Stein, M, Hirsberg, A: Medical Consequences of terrorism. Surg Clin North Am 1999;79:1537–1552.CrossRefGoogle ScholarPubMed
18.Hogan, D, Waeckerle, J, Dire, D, Lillibridge, S: Emergency department impact of the Oklahoma City terrorist bombing. Ann Emerg Med 1999;34:160–167.CrossRefGoogle ScholarPubMed
19.Hoey, B, Schwab, C: Level I center triage and mass casualties. Clin Orthop Relat Res 2004;422:23–29.CrossRefGoogle Scholar
20.Benson, M, Koenig, K, Schultz, C: Disaster triage: START–Then SAVE—A new method of dynamic triage for victims of a catastrophic earthquake. Prehosp Disast Med 1996;11:117–124.CrossRefGoogle ScholarPubMed
21.Janousek, JT, Jackson, D, Lorenzo, R, Coppola, M: Mass casualty triage knowledge of military medical personnel. Mil Med 1999;164:332–335.CrossRefGoogle ScholarPubMed
22.Garner, A, Lee, A, Harrison, K. Schultz, C: Comparative analysis of multiplecasualty incident triage algorithms. Ann Emerg Med 2001;38:541–549.CrossRefGoogle ScholarPubMed
23. Firescope Field Operations Guide 2003.Google Scholar
24. START Triage. Available at: http://www.miemss.org/Start.pdf. Accessed 17 October 2005.Google Scholar
25.Sacco, W, Mavin, M, Fledler, K, Waddell, R, Long, W, Buckman, R: Precise formulation and evidence-based application of resource-constrained triage.Acad Emerg Med 2005;12:759–770.Google ScholarPubMed
26.Repine, T, Lisagor, P, Cohen, D: The dynamics and ethics of triage: Rationing care in hard times.Mil Med 2005;170,6;505–509.CrossRefGoogle ScholarPubMed
27.Cone, C, MacMillan, M: Mass-casualty triage system: A hint of science. Acad Emerg Med 2005;12(8):739–741.Google ScholarPubMed
28.Heightman, A, Mohlenbrok, S, Eckstein, M: Disaster on the rails. JEMS 2005;46–67.Google Scholar
29.Committee of Trauma, American College of Surgeons: Statement on disaster and mass casualty management. J Am Coll Surg 2003;197(5).Google Scholar
30.Keck School of Medicine, Division of Trauma Critical Care Available at: http://www.usc.edu/schools/medicine/departments/surgery/divisions/trauma/index.html. Accessed 13 February 2006.Google Scholar
31.Keck School of Medicine, Department of Neurological Surgery.Available at: http://www.usc.edu/schools/medicine/departments/neurological_surgery/in dex.html. Accessed 13 February 2006.Google Scholar
32.Coupland, R, Parker, P, Gray, R:Triage of war wounded: The experience of the International Committee of the Red Cross. Injury 1992;23(8)507–510.CrossRefGoogle ScholarPubMed
33.Frykberg, E: Medical management of disasters and mass casualties from terrorist bombing: How can we cope? J Trauma 2002;53(2):201–212.CrossRefGoogle ScholarPubMed
34.Hirshberg, A, Holcomb, J, Mattox, K: Hospital trauma care in multiple-casualty incidents: A critical view. Ann Emerg Med 2001;37(6):647–652.CrossRefGoogle ScholarPubMed