Mass casualty incident triage
Background
- Used by first responders to quickly classify victims during a mass casualty incident (MCI) based on the severity of their injury
- Unlike standard medical triage, MCI triage is more utilitarian (i.e. the greatest good for the greatest number of people)
- Multiple triage systems exist, however evidence regarding their effectiveness is lacking[1]
- In an effort to update and standardize MCI triage, the Model Uniform Core Criteria (MUCC) were created as a national guideline for MCI triage[2]
- These criteria have been endorsed by all major national shareholders, including NAEMSP, ACEP, ACS, NAEMT, NASEMSO, AMA, CDC, and others.
- Currently, the SALT triage system is the only one that meets the Model Uniform Core Criteria
Classifications[3]
- Walking wounded/minor (green)
- Delayed (yellow)
- Immediate (red)
- Deceased/expectant (black)
Sort, Assess, Lifesaving intervention, Treatment/Transport (SALT)
Simple Triage and Rapid Treatment (START)
Always make sure you are safe. Then speak loudly and ask people to stand up and walk towards you. People who are:
- Able to walk relocate to a certain area (minor)
- Non-ambulatory patients are then assessed
- No respirations → re-position airway
- No respirations (deceased/expectant)
- Respirations (immediate)
- Yes respirations
- >30/min (immediate)
- <30 → check perfusion
- Radial pulse absent OR capillary refill >2 seconds (immediate)
- Radial pulse present OR capillary refill <2 seconds → check mental status
- Unable to follow simple commands (immediate)
- Follows simple commands (delayed)
- No respirations → re-position airway
JumpSTART (Pediatric Patients)
- Able to walk relocate to a certain area (minor)
- Non-ambulatory patients are then assessed
- No respirations → re-position airway
- Respirations (immediate)
- No respirations → check pulse
- No pulse (deceased/expectant)
- Yes pulse → 5 rescue breaths
- Still no respirations (deceased/expectant)
- Respirations (immediate)
- Yes respirations
- <15 or >45/min (immediate)
- 15-45/min → check perfusion
- Pulse absent or CRT >2 seconds
- Control bleeding (immediate)
- Pulse present or CRT <2 seconds → check mental status
- Inappropriate (immediate)
- Appropriate (delayed)
- Pulse absent or CRT >2 seconds
- No respirations → re-position airway
Secondary Assessment of Victim Endpoint (SAVE)
- Applies after patients have been triaged with START/jumpStart
- Designed for appropriation of limited resources for most gain in immediate on-scene care situations
- Three categories:
- Those who will die regardless of care
- Those who will survive whether or not they receive care
- Those who will benefit from limited immediate field interventions
See also
Video
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References
- ↑ Culley JM, Svendsen E. A review of the literature on the validity of mass casualty triage systems with a focus on chemical exposures. American journal of disaster medicine. 2014;9(2):137-150. doi:10.5055/ajdm.2014.0150.
- ↑ Model uniform core criteria for mass casualty triage. Disaster Med Public Health Prep. 2011;5(2):125-8.
- ↑ Lerner EB, Schwartz RB, Coule PL, et al. "Mass Casualty Triage: An Evaluation of the Data and Development of a Proposed National Guideline." Disaster Medicine and Public Health Preparedness 2(Suppl. 1) 2008, pp S25-S34.