Mass casualty incident triage

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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)

START triage algorithm

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)

JumpSTART (Pediatric Patients)

JumpSTART triage algorithm
  • 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)

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

References

  1. 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.
  2. Model uniform core criteria for mass casualty triage. Disaster Med Public Health Prep. 2011;5(2):125-8.
  3. 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.