To reach a European consensus about terminology, criteria, and cutoffs regarding the reverse triage selection process in Mass Casualty Incidents (MCI) and crowding.

An e-Delphi study with a 2-part design was set up. Part 1a aimed to develop a theoretical framework of a Patient Disposition Classification Model (PDCM). Part 1b facilitated a European expert panel review of the original critical interventions and a consensus regarding their definitions and terminology. In part 2, the final critical interventions needed to be ranked on a 10-point linear numeric scale to what extent withholding or withdrawing them would lead to a Consequential Medical Event (CME). Finally, an upper limit of risk tolerance needed to be assigned to each PDCM category.

A 5-category PDCM and a universal list of 18 critical interventions, applicable for both MCI and daily crowding situations. Furthermore, an upper limit of acceptable CME risk was assigned to each PDCM category and a 10-point linear numeric scale ranking of the 18 critical interventions was achieved.

The Delphi study achieved its objectives with a European consensus on terminology, criteria, and cutoffs regarding the reverse triage selection process in MCI and crowding.

In 2019, the World Health Organization (WHO) published the Health Emergency and Disaster Risk Management (H-EDRM) framework detailing how effective management of disasters, including mass-casualty incidents (MCIs), can be achieved through a whole-of-health system approach where each level of the health care system is involved in all phases of the disaster cycle. In light of this, a primary health care (PHC) approach can contribute to reducing negative health outcomes of disasters, since it encompasses the critical roles that primary care services can play during crises. Hospitals can divert non-severe MCI victims to primary care services by applying reverse triage (RT), thereby preventing hospital overloading and ensuring continuity of care for those who do not require hospital services during the incident.

This study explores the topic by reviewing the literature published on early discharge of MCI victims through RT criteria and existing referral pathways to primary care services.

A scoping literature review was performed and a total of ten studies were analyzed.

The results showed that integrating primary care facilities into disaster management (DM) through the use of RT may be an effective strategy to create surge during MCIs, provided that clear referral protocols exist between hospitals and primary care services to ensure continuity of care. Furthermore, adequate training should be provided to primary care professionals to be prepared and be able to provide quality care to MCI victims.

The results of this current review can serve as groundwork upon which to design further research studies or to help devise strategies and policies for the integration of PHC in MCI management.

The objective of this study was to develop and evaluate an evidence-based information technology (IT) application that guides clinical decision-making during the reverse-triage selection process in mass casualty incidents.

Based upon 28 validated critical interventions (CI) relevant for determining whether a patient qualifies for early discharge, we developed the Reverse Triage Tool of Leuven (RTTL). The RTTL is compatible with the health electronic record (HER) of UZ Leuven, a tertiary hospital in Belgium. During a 3-week period in March 2015, we registered data from 2 groups of patients: a random group (no RTTL usage) and a filtered group (RTTL usage).

When applying the original 28 CIs, we were able to select almost twice as many patients in the filtered group who qualified for early discharge compared with patients in the random group. The predictive validity was highly satisfactory.

The RTTL saves time in 2 ways. First, it reduces the patient population that needs to be evaluated for potential early discharge to one-third. Second, it doubles the probability of selecting an actual dischargeable patient. Each selected patient, however, still must undergo multidisciplinary reassessment in order to qualify for early discharge. Thus, further research is required to optimize the IT application.(Disaster Med Public Health Preparedness. 2018;12:599–605)