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The Principles of Triage in Emergencies and Disasters: A Systematic Review

Published online by Cambridge University Press:  06 March 2020

Jafar Bazyar Open the ORCID record for Jafar Bazyar [Opens in a new window] ,
Mehrdad Farrokhi ,
Amir Salari  and
Hamid Reza Khankeh
Jafar Bazyar
Affiliation:
Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
Mehrdad Farrokhi
Affiliation:
Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
Amir Salari
Affiliation:
Department of Health in Emergencies and Disasters, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Hamid Reza Khankeh*
Affiliation:
Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
*
Correspondence: Hamid Reza Khankeh, Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran E-mail: [email protected]
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Abstract

Introduction:

The use of triage systems is one of the most important measures in response to mass-casualty incidents (MCIs) caused by emergencies and disasters. In these systems, certain principles and criteria must be considered that can be achieved with a lack of resources. Accordingly, the present study was conducted as a systematic review to explore the principles of triage systems in emergencies and disasters world-wide.

Methods:

The present study was conducted as a systematic review of the principles of triage in emergencies and disasters. All papers published from 2000 through 2019 were extracted from the Web of Science, PubMed, Scopus, Cochrane Library, and Google Scholar databases. The search for the articles was conducted by two trained researchers independently.

Results:

The classification and prioritization of the injured people, the speed, and the accuracy of the performance were considered as the main principles of triage. In certain circumstances, including chemical, biological, radiation, and nuclear (CBRN) incidents, certain principles must be considered in addition to the principles of the triage based on traumatic events. Usually in triage systems, the classification of the injured people is done using color labeling. The short duration of the triage and its accuracy are important for the survival of the injured individuals. The optimal use of available resources to protect the lives of more casualties is one of the important principles of triage systems and does not conflict with equity in health.

Conclusion:

The design of the principles of triage in triage systems is based on scientific studies and theories in which attempts have been made to correctly classify the injured people with the maximum correctness and in the least amount of time to maintain the survival of the injured people and to achieve the most desirable level of health. It is suggested that all countries adopt a suitable and context-bond model of triage in accordance with all these principles, or to propose a new model for the triage of injured patients, particularly for hospitals in emergencies and disasters.

Keywords

disastersemergenciesmass-casualty incidentstriage
Type
Systematic Review
Information
Prehospital and Disaster Medicine , Volume 35 , Issue 3 , June 2020 , pp. 305 - 313
Copyright
© World Association for Disaster and Emergency Medicine 2020

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References

Safarpour, H, Khorasani-Zavareh, D. The fourth epidemiological transition: the need for worldwide focus on reducing morbidity and mortality rates of disasters and emergencies. Shiraz E-Med J. 2019;20(8):e86746.CrossRefGoogle Scholar
Jenkins, JL, McCarthy, ML, Sauer, LM, et al.Mass-casualty triage: time for an evidence-based approach. Prehosp Disaster Med. 2008;23(1):3–8.CrossRefGoogle ScholarPubMed
Iserson, KV, Moskop, JC. Triage in medicine, part I: concept, history, and types. Ann Emerg Med. 2007;49(3):275–281.CrossRefGoogle ScholarPubMed
Moskop, JC, Iserson, KV. Triage in medicine, part II: underlying values and principles. Ann Emerg Med. 2007;49(3):282–7.CrossRefGoogle ScholarPubMed
Frykberg, ER. Triage: principles and practice. Scand J Surg. 2005;94(4):272–278.CrossRefGoogle ScholarPubMed
Gagnon, E, Aboutanos, M, Malhotra, A, Dompkowski, D, Duane, T, Ivatury, R. In the wake of Hurricane Isabel: a prospective study of post-event trauma and injury control strategies. Am Surg. 2005;71(3):194–197.Google Scholar
Hodge, JG Jr, Anderson, ED. Principles and practice of legal triage during public health emergencies. NYU Ann Surv Am L. 2008;64:249.Google Scholar
Vassallo, J, Beavis, J, Smith, JE, Wallis, LA. Major incident triage: derivation and comparative analysis of the Modified Physiological Triage Tool (MPTT). Injury. 2017;48(5):992–999.CrossRefGoogle Scholar
Robertson-Steel, I. Evolution of triage systems. Emerg Med J. 2006;23(2):154–155.CrossRefGoogle ScholarPubMed
Koenig, KL, Schultz, CH. Koenig and Schultz’s Disaster Medicine: Comprehensive Principles and Practices. Cambridge, UK: Cambridge University Press; 2010.Google Scholar
Bazyar, J, Farrokhi, M, Khankeh, H. Triage systems in mass casualty incidents and disasters: a review study with a worldwide approach. Open Access Maced J Med Sci. 2019;7(3):482.CrossRefGoogle ScholarPubMed
Arbon, P, Zeitz, K, Ranse, J, Wren, H, Elliott, R, Driscoll, K. The reality of multiple casualty triage: putting triage theory into practice at the scene of multiple casualty vehicular accidents. Emerg Med J. 2008;25(4):230–234.CrossRefGoogle Scholar
Sztajnkrycer, MD, Madsen, BE, Báez, AA. Unstable ethical plateaus and disaster triage. Emerg Med Clin. 2006;24(3):749–768.CrossRefGoogle ScholarPubMed
Berge, LR. Health care emergency management: principles and practice. JAMA. 2011;305(2):203–204.CrossRefGoogle Scholar
Bazyar, J, Pourvakhshoori, N, Khankeh, H, Farrokhi, M, Delshad, V, Rajabi, E. A comprehensive evaluation of the association between ambient air pollution and adverse health outcomes of major organ systems: a systematic review with a worldwide approach. Environ Sci Pollut Res. 2019;26(13):12648–12661.CrossRefGoogle ScholarPubMed
Daliri, S, Safarpour, H, Bazyar, J, Sayehmiri, K, Karimi, A, Anvary, R. The relationship between some neonatal and maternal factors during pregnancy with the prevalence of congenital malformations in Iran: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2019;32(21):3666–3674.CrossRefGoogle ScholarPubMed
Daliri, S, Sayehmiri, K, Asadollahi, K, Rezaei, N, Saroukhani, D, Karimi, A. Prevalence of congenital anomalies in Iran: a systematic review and meta-analysis. Iran J Neonatol. 2018;9(2):1–10.Google Scholar
Bhalla, MC, Frey, J, Rider, C, Nord, M, Hegerhorst, M. Simple Triage Algorithm and Rapid Treatment and Sort, Assess, Lifesaving, Interventions, Treatment, and Transportation mass casualty triage methods for sensitivity, specificity, and predictive values. Am J Emerg Med. 2015;33(11):1687–1691.CrossRefGoogle ScholarPubMed
Kahn, C, Schultz, C, Miller, K. Does START triage work? An outcomes assessment after a disaster. Ann Emerg Med. 2009;54(3):424–430.CrossRefGoogle ScholarPubMed
Cone, D, Serra, J, Kurland, L. Comparison of the SALT and SMART triage systems using a virtual reality simulator with paramedic students. Eur J Emerg Med. 2011;18(6):314–321.CrossRefGoogle ScholarPubMed
Garner, A, Lee, A, Harrison, K, Schultz, C. Comparative analysis of multiple-casualty incident triage algorithms. Ann Emerg Med. 2001;38(5):541–548.CrossRefGoogle ScholarPubMed
Wolf, P, Bigalke, M, Graf, BM, Birkholz, T, Dittmar, MS. Evaluation of a novel algorithm for primary mass casualty triage by paramedics in a physician manned EMS system: a dummy based trial. Scand J Trauma Resusc Emerg Med. 2014;22(50):1–10.CrossRefGoogle Scholar
Vassalloab, J, Beavisc, J, Smithd, JE, Wallisa, LA. Major incident triage: derivation and comparative analysis of the Modified Physiological Triage Tool (MPTT). Injury. 2017;48(5):992–999.CrossRefGoogle Scholar
Kariman, H, Joorabian, J, Shahrami, A, Alimohammadi, H, Noori, Z, Safari, S. Accuracy of emergency severity index of triage in Imam Hossein hospital - Tehran, Iran 2011. J Gorgan Uni Med Sci. 2013;15(1):115–120.Google Scholar
Buschhorn, HM, Strout, TD, Sholl, JM, Baumann, MR, Junction, G. Emergency Medical Services triage using the Emergency Severity Index: is it reliable and valid? J Emerg Nurs. 2013;39(5):55–63.CrossRefGoogle ScholarPubMed
Culley, JM, Svendsen, E. A review of the literature on the validity of mass casualty triage systems with a focus on chemical exposures. Am J Disaster Med. 2014;9(2):137.CrossRefGoogle ScholarPubMed
Wuerz, RC, Milne, LW, Eitel, DR, Travers, D, Gilboy, N. Reliability and validity of a new five‐level triage instrument. Acad Emerg Med. 2000;7(3):236–242.CrossRefGoogle ScholarPubMed
Cannon, M, Roitman, R, Ranse, J, Morphet, J. Development of a mass-gathering triage tool: an Australian perspective. Prehosp Disaster Med. 2017;32(1):101–105.CrossRefGoogle Scholar
Aacharya, R, Gastmans, C, Denier, Y. Emergency department triage: an ethical analysis. BMC Emerg Med. 2011;11(1):1–12.CrossRefGoogle ScholarPubMed
Nordberg, M, Lethvall, S, Castrén, M. The validity of the triage system ADAPT. Scand J Trauma Resusc Emerg Med. 2010;18(S1):P36.CrossRefGoogle Scholar
O’Meara, M, Porter, K, Greaves, I. Triage. Trauma. 2007;9(2):111–118.CrossRefGoogle Scholar
Domres, B, Koch, M, Manger, A, Becker, HD. Ethics and triage. Prehosp Disaster Med. 2001;16(1):53–58.CrossRefGoogle ScholarPubMed
Wilson, KA, Law, EA. Ethics of conservation triage. Frontiers in Ecology and Evolution. 2016;4:112.CrossRefGoogle Scholar
González, PA, Delgado, RC, Alvarez, TC, et al.The development and features of the Spanish prehospital advanced triage method (META) for mass casualty incidents. Scand J Trauma Resusc Emerg Med. 2016;24(1):63.CrossRefGoogle Scholar
Lerner, E, Schwartz, R, Coule, P, Weinstein, E, Cone, D, Hunt, R. Mass casualty triage: an evaluation of the data and development of a proposed national guideline. Disaster Med Public Health. 2008;2(1):25–34.CrossRefGoogle ScholarPubMed
Abadi, ZA-D, Seyedin, SH, Reza-Hosseini, SM, Atighechian, G, Pour-Sheikhian, M, Delkhosh, M. Triage in disasters. Cardiovasc Nurs J. 2013;2(2):58–68.Google Scholar
Dyer, C, Regev, M, Burnett, J, Festa, N, Cloyd, B. SWiFT: a rapid triage tool for vulnerable older adults in disaster situations. Disaster Med Public Health Prep. 2008;2(1):45–50.CrossRefGoogle ScholarPubMed
Sacco, W, Navin, D, Fiedler, K, Waddell, R, Long, W, Buckman, R. Precise formulation and evidence‐based application of resource‐constrained triage. Acad Emerg Med. 2005;12(8):759–770.CrossRefGoogle ScholarPubMed
Tian, L, Fang, Z, Xiao, H, Li, L, Li, Y. Value of triage early warning score for trauma patients in an emergency department. J Central South University Med Sci. 2015 40(5):549–557.Google Scholar
Cone, DC, Koenig, KL. Mass casualty triage in the chemical, biological, radiological, or nuclear environment. Eur J Emerg Med. 2005;12(6):287–302.CrossRefGoogle ScholarPubMed
Cone, DC, MacMillan, DS, Parwani, V, Van Gelder, C. Pilot test of a proposed chemical/biological/radiation/nuclear-capable mass casualty triage system. Prehosp Emerg Care. 2008;12(2):236–240.CrossRefGoogle ScholarPubMed
Coule, P, Horner, J. National disaster life support programs: a platform for multi-disciplinary disaster response. Dental Clinics of North America. 2007 51(4):819–825.CrossRefGoogle ScholarPubMed
Horne, S, Vassallo, J, Read, J, Ball, S. UK triage–an improved tool for an evolving threat. Injury. 2013;44(1):23–28.CrossRefGoogle ScholarPubMed
Wolf, P, Bigalke, M, Graf, BM, Birkholz, T, Dittmar, MS. Evaluation of a novel algorithm for primary mass casualty triage by paramedics in a physician manned EMS system: a dummy based trial. Scand J Trauma Resusc Emerg Med. 2014;22(1):50.CrossRefGoogle Scholar
Durani, Y, Brecher, D, Walmsley, D, Attia, MW, Loiselle, JM. The Emergency Severity Index version 4: reliability in pediatric patients. Pediatric Emerg Care. 2009;25(11):751–753.CrossRefGoogle ScholarPubMed
Hagerman, SM, Satterfield, T. Agreed but not preferred: expert views on taboo options for biodiversity conservation, given climate change. Ecolog Applications. 2014;24(3):548–559.CrossRefGoogle Scholar
Bottrill, MC, Joseph, LN, Carwardine, J, et al.Finite conservation funds mean triage is unavoidable. Trends in Ecology & Evolution. 2009;24(4):183–184.CrossRefGoogle Scholar
TRACIE. Mass Casualty Trauma Triage-Paradigms and Pitfalls 2019. Available from: https://www.jems.com/wp-content/uploads/content/dam/jems/PDFs/aspr-tracie-mass-casualty-triage-final-508.pdf.Google Scholar
Abbasi Dolat Abadi, Z, Hosseini, SMR, Atighechian, G, Pour-Sheikhian, M, Delkhosh, M. Triage in disaster. Iran J Cardiovascular Nurs. 2013;2(2):58–68.Google Scholar
Kelen, G, Kraus, C, McCarthy, M, et al.In-patient disposition classification for the creation of hospital surge capacity: a multiphase study. Lancet. 2006;368(9551):1984–1990.CrossRefGoogle ScholarPubMed
Challen, K, Walter, D. Major incident triage: comparative validation using data from 7th July bombings. Injury. 2013;44(5):629–633.CrossRefGoogle ScholarPubMed
Sidell, F, William, P, Dashiel, T. Janes Chem, Biohand Book. Alexandria, Virginia USA: Janet Information Geop; 1998.Google Scholar
Shelton, R. The emergency severity index 5-level triage system. Dimensions of Critical Care Nursing. 2009;28(1):9–12.CrossRefGoogle ScholarPubMed
Beach, M (ed). Disaster Preparedness and Management 2010. Philadelphia, Pennsylvania USA: F.A. Davis Company; 2016.Google Scholar
Antonacci, AC, Lam, S, Lavarias, V, Homel, P, Eavey, RD. Benchmarking surgical incident reports using a database and a triage system to reduce adverse outcomes. Arch Surg. 2008;143(12):1192–1197.CrossRefGoogle Scholar
Jachowski, DS, Kesler, DC. Allowing extinction: should we let species go? Proc Natl Acad Sci USA. 2009;105(4):2919–2922.Google Scholar
Colyvan, M, Steele, K. Environmental Ethics and Decision Theory: Fellow Travelers or Bitter Enemies? Philosophy of Ecology. Amsterdam, Netherlands: Elsevier; 2011:285–299.Google Scholar
O’Mathúna, D, Gordijn, B, Clarke, M. Disaster Bioethics: Normative Issues when Nothing is Normal. Berlin, Germany: Springer Science & Business Media; 2013.Google Scholar