Hostname: page-component-6bf8c574d5-b4m5d Total loading time: 0 Render date: 2025-02-20T05:27:04.189Z Has data issue: false hasContentIssue false
  • English
  • Français

Mass Casualty Triage: An Evaluation of the Science and Refinement of a National Guideline

Published online by Cambridge University Press:  08 April 2013

E. Brooke Lerner ,
David C. Cone ,
Eric S. Weinstein ,
Richard B. Schwartz ,
Phillip L. Coule ,
Michael Cronin ,
Ian S. Wedmore ,
Eileen M. Bulger ,
Deborah Ann Mulligan  and
Raymond E. Swienton
...Show all authors
Get access Rights & Permissions [Opens in a new window]

Abstract

Mass casualty triage is the process of prioritizing multiple victims when resources are not sufficient to treat everyone immediately. No national guideline for mass casualty triage exists in the United States. The lack of a national guideline has resulted in variability in triage processes, tags, and nomenclature. This variability has the potential to inject confusion and miscommunication into the disaster incident, particularly when multiple jurisdictions are involved. The Model Uniform Core Criteria for Mass Casualty Triage were developed to be a national guideline for mass casualty triage to ensure interoperability and standardization when responding to a mass casualty incident. The Core Criteria consist of 4 categories: general considerations, global sorting, lifesaving interventions, and individual assessment of triage category. The criteria within each of these categories were developed by a workgroup of experts representing national stakeholder organizations who used the best available science and, when necessary, consensus opinion. This article describes how the Model Uniform Core Criteria for Mass Casualty Triage were developed.

(Disaster Med Public Health Preparedness. 2011;5:129-137)

Keywords

Model Uniform Core Criteria for Mass Casualty TriagetriageguidelinesrespondersSALT Triagemass casualty incidentsalgorithmsUnited Statestask performance and analysisdisaster response
Type
Special Focus
Information
Disaster Medicine and Public Health Preparedness , Volume 5 , Issue 2 , June 2011 , pp. 129 - 137
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.Jenkins, JL, McCarthy, ML, Sauer, LM.Mass-casualty triage: time for an evidence-based approach. Prehosp Disaster Med. 2008;23 (1):3–8.CrossRefGoogle ScholarPubMed
2.Lerner, EB, Schwartz, RB, Coule, PL.Mass casualty triage: an evaluation of the data and development of a proposed national guideline. Disaster Med Public Health Prep. 2008;2(Suppl 1)S25–S34.CrossRefGoogle ScholarPubMed
3.Lerner, EB, Schwartz, RB, Coule, PL, Pirrallo, RG.Use of SALT triage in a simulated mass-casualty incident. Prehosp Emerg Care. 2010;14 (1):21–25.Google Scholar
4.Cone, DC, Serra, J, Burns, K, MacMillan, DS, Kurland, L, Van Gelder, C.Pilot test of the SALT mass casualty triage system. Prehosp Emerg Care. 2009;13 (4):536–540.Google Scholar
5.SALT mass casualty triage: concept endorsed by the American College of Emergency Physicians, American College of Surgeons Committee on Trauma, American Trauma Society, National Association of EMS Physicians, National Disaster Life Support Education Consortium, and State and Territorial Injury Prevention Directors Association. Disaster Med Public Health Prep. 2008;2 (4):245–246.CrossRefGoogle Scholar
6.Wang, T, Hung, C.Appraisal of field triage in mass casualty incidents in Taipei. Ann Disaster Med. 2005;3:69–75.Google Scholar
7.Wallis, LA, Carley, S.Comparison of paediatric major incident primary triage tools. Emerg Med J. 2006;23 (6):475–478.Google Scholar
8.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
9.Baker, D.Civilian exposure to toxic agents: emergency medical response. Prehosp Disaster Med. 2004;19 (2):174–178.CrossRefGoogle ScholarPubMed
10.Hodgetts, TTriage: A position statement. http://ec.europa.eu/echo/civil_protection/civil/prote/pdfdocs/disaster_med_final_2002/d6.pdf. Accessed July 21, 2010.Google Scholar
11.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):40–46.CrossRefGoogle ScholarPubMed
12.Lee, WH, Chiu, TF, Ng, CJ, Chen, JC.Emergency medical preparedness and response to a Singapore airliner crash. Acad Emerg Med. 2002;9 (3):194–198.CrossRefGoogle ScholarPubMed
13.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):117–124.CrossRefGoogle ScholarPubMed
14.Kragh, JF Jr, Walters, TJ, Baer, DG.Survival with emergency tourniquet use to stop bleeding in major limb trauma. Ann Surg. 2009;249 (1):1–7.Google Scholar
15.Kragh, JF Jr, Walters, TJ, Baer, DG.Practical use of emergency tourniquets to stop bleeding in major limb trauma. J Trauma. 2008;64 2(Suppl)S38–S49, discussion S49-S50.Google ScholarPubMed
16.Kragh, JF Jr, Littrel, ML, Jones, JA.Battle casualty survival with emergency tourniquet use to stop limb bleeding. J Emerg Med. 2009 August28[Epub ahead of print].Google ScholarPubMed
17.Okumura, T, Suzuki, K, Fukuda, A.The Tokyo subway sarin attack: disaster management, Part 1: Community emergency response. Acad Emerg Med. 1998;5 (6):613–617.Google Scholar
18.Kahn, CA, Schultz, CH, Miller, KT, Anderson, CL.Does START triage work? An outcomes assessment after a disaster. Ann Emerg Med. 2009;54 (3):424–430, 430, e1.Google Scholar
19.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):7–13.Google Scholar
20.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):129–135.CrossRefGoogle Scholar
21.Garner, A, Lee, A, Harrison, K, Schultz, CH.Comparative analysis of multiple-casualty incident triage algorithms. Ann Emerg Med. 2001;38 (5):541–548.Google Scholar
22.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):104–111.CrossRefGoogle ScholarPubMed
23.Bellamy, RF.The causes of death in conventional land warfare: implications for combat casualty care research. Mil Med. 1984;149 (2):55–62.CrossRefGoogle ScholarPubMed
24.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):310–313.CrossRefGoogle ScholarPubMed
25.Bellamy, RF, Pedersen, DC, DeGuzman, LR.Organ blood flow and the cause of death following massive hemorrhage. Circ Shock. 1984;14 (2):113–127.Google ScholarPubMed
26.Doyle, GS, Taillac, PP.Tourniquets: a review of current use with proposals for expanded prehospital use. Prehosp Emerg Care. 2008;12 (2):241–256.CrossRefGoogle ScholarPubMed
27.Lee, C, Porter, KM, Hodgetts, TJ.Tourniquet use in the civilian prehospital setting. Emerg Med J. 2007;24 (8):584–587.Google Scholar
28.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):155–163.Google Scholar
29.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):191–197.CrossRefGoogle ScholarPubMed
30.Eckstein, M, Suyehara, D.Needle thoracostomy in the prehospital setting. Prehosp Emerg Care. 1998;2 (2):132–135.Google Scholar
31.Okumura, T, Suzuki, K, Fukuda, A.The Tokyo subway sarin attack: disaster management, Part 2: Hospital response. Acad Emerg Med. 1998;5 (6):618–624.CrossRefGoogle ScholarPubMed
32.American College of Surgeons Committee on Trauma. Advanced Trauma Life Support Program for Doctors: ATLS. 8th ed. Chicago, IL: American College of Surgeons.; 2008.Google Scholar
33.Part 2: Adult basic life support. Circulation. 2005;112(22_suppl):III-5-III-16.Google Scholar
34.National Association of Emergency Medical Technitions. PHTLS Prehospital Trauma Life Support (PHTLS: Basic & Advanced Prehospital Trauma Life Support). St Louis, MO: Mosby Elsevier.; 2007.Google Scholar
35. McManus, J, Yershov, AL, Ludwig, D.Radial pulse character relationships to systolic blood pressure and trauma outcomes. Prehosp Emerg Care. 2005;9 (4):423–428.Google Scholar
36.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):821–828, discussion 828-829.Google Scholar
37.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):748–754.Google Scholar
38.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):96–102.Google Scholar
39.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):242–248.CrossRefGoogle ScholarPubMed
40.Bazarian, JJ, Eirich, MA, Salhanick, SD.The relationship between pre-hospital and emergency department Glasgow coma scale scores. Brain Inj. 2003;17 (7):553–560.Google Scholar
41.Schriger, DL, Baraff, LJ.Capillary refill—is it a useful predictor of hypovolemic states? Ann Emerg Med. 1991;20 (6):601–605.CrossRefGoogle ScholarPubMed
42.Hogan, DE, Waeckerle, JF, Dire, DJ, Lillibridge, SR.Emergency department impact of the Oklahoma City terrorist bombing. Ann Emerg Med. 1999;34 (2):160–167.Google Scholar
43.Quintana, DA, Parker, JR, Jordan, FB, Tuggle, DW, Mantor, PC, Tunell, WP.The spectrum of pediatric injuries after a bomb blast. J Pediatr Surg. 1997;32 (2):307–310, discussion 310-311.CrossRefGoogle ScholarPubMed
44.Koehler, JJ, Malafa, SA, Hillesland, J.A multicenter validation of the prehospital index. Ann Emerg Med. 1987;16 (4):380–385.CrossRefGoogle ScholarPubMed
45.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):178–182.Google Scholar
46.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):814–819.Google Scholar
47.Christian, MD, Hawryluck, L, Wax, RS.Development of a triage protocol for critical care during an influenza pandemic. CMAJ. 2006;175 (11):1377–1381.Google Scholar
48.Fong, F, Schrader, DC.Radiation disasters and emergency department preparedness. Emerg Med Clin North Am. 1996;14 (2):349–370.Google Scholar
49.Frykberg, ER.Principles of mass casualty management following terrorist disasters. Ann Surg. 2004;239 (3):319–321.Google Scholar
50.Frykberg, ER.Medical management of disasters and mass casualties from terrorist bombings: how can we cope? J Trauma. 2002;53 (2):201–212.Google Scholar
51.Coule, PL, Horner, JA.National disaster life support programs: a platform for multi-disciplinary disaster response. Dent Clin North Am. 2007;51 (4):819–825, vi. vi.Google Scholar
52.Emergency War Surgery. 3rd US. rev ed. Washington, DC: Borden Institute, Walter Reed Army Medical Center; 2004.Google Scholar
53.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):742–747.Google Scholar
54.Hines, S, Payne, A, Edmondson, J, Heightman, AJ.Bombs under London. The EMS response plan that worked. JEMS. 2005;30:58-60, 62, 64-57.Google Scholar
55.Einav, S, Feigenberg, Z, Weissman, C.Evacuation priorities in mass casualty terror-related events: implications for contingency planning. Ann Surg. 2004;239 (3):304–310.CrossRefGoogle ScholarPubMed
56.Willis, CD, Cameron, PA, Bernard, SA, Fitzgerald, M.Cardiopulmonary resuscitation after traumatic cardiac arrest is not always futile. Injury. 2006;37 (5):448–454.Google Scholar
57.Part 1: introduction. Circulation. 2005;112(22_suppl)III-1–III-4.Google Scholar