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Mass-Casualty Triage: Time for an Evidence-Based Approach

Published online by Cambridge University Press:  28 June 2012

Jennifer Lee Jenkins ,
Melissa L. McCarthy ,
Lauren M. Sauer ,
Gary B. Green ,
Stephanie Stuart ,
Tamara L. Thomas  and
Edbert B. Hsu
Jennifer Lee Jenkins*
Affiliation:
Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Melissa L. McCarthy
Affiliation:
Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Lauren M. Sauer
Affiliation:
Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Gary B. Green
Affiliation:
Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Stephanie Stuart
Affiliation:
The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Tamara L. Thomas
Affiliation:
Department of Emergency Medicine, Loma Linda University School of Medicine, Loma Linda, California, USA
Edbert B. Hsu
Affiliation:
Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
*
Assistant Chief of Service, Department of Emergency Medicine, The Johns Hopkins University 5801 Smith Avenue Davis Building Suite 3220 Baltimore, MD 21209 USA E-mail: [email protected]
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Abstract

Mass-casualty triage has developed from a wartime necessity to a civilian tool to ensure that constrained medical resources are directed at achieving the greatest good for the most number of people. Several primary and secondary triage tools have been developed, including Simple Treatment and Rapid Transport (START), JumpSTART, Care Flight Triage, Triage Sieve, Sacco Triage Method, Secondary Assessment of Victim Endpoint (SAVE), and Pediatric Triage Tape. Evidence to support the use of one triage algorithm over another is limited, and the development of effective triage protocols is an important research priority. The most widely recognized mass-casualty triage algorithms in use today are not evidence-based, and no studies directly address these issues in the mass-casualty setting. Furthermore, no studies have evaluated existing mass-casualty triage algorithms regarding ease of use, reliability, and validity when biological, chemical, or radiological agents are introduced. Currently, the lack of a standardized mass-casualty triage system that is well validated, reliable, and uniformly accepted, remains an important gap. Future research directed at triage is recognized as a necessity, and the development of a practical, universal, triage algorithm that incorporates requirements for decontamination or special precautions for infectious agents would facilitate a more organized mass-casualty medical response.

Keywords

evidence-based approachmass-casualty incidenttriage
Type
Review Article
Information
Prehospital and Disaster Medicine , Volume 23 , Issue 1 , February 2008 , pp. 3 - 8
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2008

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References

1. Pesik, N, Keim, ME, Iserson, KV: Terrorism and the ethics of emergency med-ical care. Ann Emerg Med 2001;37(6):642–646.CrossRefGoogle Scholar
2. Richardson, RG: Larrey: Surgeon to Napoleon's Imperial Guard. London: John Murray, 1974.Google Scholar
3. Flexner, JT: Doctors on Horseback. New York: Fordham University Press, 1937.Google Scholar
4. Welch, CE: War wounds of the abdomen. N Engl J Med 1947;237(5):156–162.CrossRefGoogle ScholarPubMed
5. Hughes, JH: Community medicine. Triage—A new look at an old French concept. Postgrad Med 1976;60(4):223–227.CrossRefGoogle Scholar
6. Bowen, TW, Bellamy, RF: Emergency War Surgery. NATO Handbook, 2nd revi-sion. Washington, DC: United States Department of Defense, 1988.Google Scholar
7. Simple Treatment and Rapid Transport TRIAGE. Available at http://www.start-triage.com. Accessed 06 February 2007.Google Scholar
8. Hodgetts, TJ, Mackway-Jones, K: Major Incident Medical Management and Support: The Practical Approach. London: BMJ Publishing, 1995.Google Scholar
9. Garner, A, Lee, A, Harrison, K, Schultz, CH: Comparative analysis of multi-ple-casualty incident triage algorithms. Ann Emerg Med 2001;38(5):541–548.CrossRefGoogle ScholarPubMed
10. Sacco, WJ, Navin, M, Fiedler, EA: Precise formulation and evidence-based application of resource-constrained triage. Acad Emerg Med 2005;12(8):759–770.CrossRefGoogle ScholarPubMed
11. Benson, M, Koenig, KL, Schultz, CH: Disaster triage: Simple Treatment and Rapid Transport, then SAVE— A new method of dynamic triage for victims of a catastrophic earthquake. Prehospital Disast Med 1996;11(2):117–124.CrossRefGoogle Scholar
12. Asaeda, G: The day that the Simple Treatment and Rapid Transport triage system came to a STOP: Observations from the World Trade Center disaster. Acad Emerg Med 2002;9(3):255–256.CrossRefGoogle Scholar
13. Nocera, A, Garner, A: An Australian mass casualty incident triage system for the future based upon triage mistakes of the past: The Homebush Triage Standard. Aust NZJ Surg 1999;69(8):603–608.CrossRefGoogle ScholarPubMed
14. Romig, LE: Pediatric triage. A system to JumpSimple Treatment and Rapid Transport your triage of young patients at mass-casualty incident s. JEMS 2002;27(7):52–53.Google Scholar
15. Hodgetts, TJ: Triage: A Position Statement. European Union Core Group on Disaster Medicine, 2001.Google Scholar
16. Malik, ZU, Pervez, M, Safdar, A, Masood, T, Tariq, M: Triage and management of mass casualties in a train accident. J Coll Physicians Surg Pak 2004;14(2):108–111.Google Scholar
17. TJ, Hodgetts, Hall, J, Maconochie, I, Smart, C: Pediatric Triage Tape. Prehospital Immediate Care 1998;2:155–159.Google Scholar
18. Tran, MD, Garner, AA, Morrison, I, Sharley, PH, Griggs, WM, Xavier, C: The Bali bombing: Civilian aeromedical evacuation. Med J Aust 2003;179(7):353–356.CrossRefGoogle ScholarPubMed
19. Jewell, N: Statistics for Epidemiology. Boca Raton: CRC Press, 2004.Google Scholar
20. Wallis, LA, Carley, S: Comparison of paediatric major incident primary triage tools. Emerg Med J 2006;23(6):475–478.CrossRefGoogle ScholarPubMed
21. Wallis, LA, Carley, S: Validation of the Paediatric Triage Tape. Emerg Med J 2006;23(1):47–50.CrossRefGoogle ScholarPubMed
22. Rothman, RE, Hsu, EB, Kahn, CA, Kelen, GD: Research priorities for surge capacity. Acad Emerg Med 2006;13(11):1160–1168.CrossRefGoogle ScholarPubMed