Page 67 - JSOM Spring 2023

data collection, partly based on recall. It is virtually impossi- Trauma; et al. Model uniform core criteria for mass casualty tri-
ble to collect data prospectively unless someone is assigned to age. Disaster Med Public Health Prep. 2011;5(2):125–128.
do this in advance or, ultimately, if technology is used on all 15. Randolph R, Morsch G, Chacko S. Disaster medicine: disaster
response and on-scene care. FP Essent. 2019;487:27–33.
casualties. Comparing triage methods, other than in tabletop 16. Jenkins JL, McCarthy ML, Sauer LM, et al. Mass-casualty tri-
exercises or studies, is even more difficult given the frequency age: time for an evidence-based approach. Prehosp Disaster Med.
and wide variability of real-world events. 2008;23(1):3–8.
17. U.S. Department of Health & Human Services: Chemical Haz-
ards Emergency Medical Management. START Adult Triage Al-
Conclusion gorithm. Last updated 1 September 2022. https://chemm.hhs.gov/
Many MCI algorithms exist. They use measurement of pulse, startadult.htm. Accessed 4 April 2022.
mental status, and respirations to sort the severity of casual- 18. Cone DC, MacMillan DS. Mass-casualty triage systems: a hint of
science. Acad Emerg Med. 2005;12(8):739–741.
ties and among them have four or five categories requiring the 19. Crews CM. Disaster Response: Efficacy of Simple Triage and
placement of tags. Most treatment is limited to bleeding con- Rapid Treatment in Mass Casualty Incidents. Long Beach, CA:
trol. Common failure points in MCIs include communications California State University; 2018.
and movement of casualties. Overall, triage systems are infre- 20. Strommen JJ, Waterman SM, Mitchell CA, Grogan BF. 2014 Fort
quently used and have limited efficacy. MCIs are chaotic and Hood, Texas, mass casualty incident: reviews and perspectives.
Curr Rev Musculoskelet Med. 2015;8(3):298–303.
dangerous and can involve dozens to hundreds of casualties in 21. Cone DC, Serra J, Kurland L. Comparison of the SALT and Smart
varied and complex environments. Adoption of simpler, more triage systems using a virtual reality simulator with paramedic
easily reproduced systems may improve first responder use of students. Eur J Emerg Med. 2011;18(6):314–321.
such algorithms. 22. U.S. Department of Health & Human Services: Chemical Hazards
Emergency Medical Management. JumpSTART Pediatric Triage
Algorithm. Last updated 1 September 2022. https://chemm.hhs.
References gov/startpediatric.htm. Accessed 11 April 2022.
1. Kennedy K, Aghababian RV, Gans L, Lewis CP. Triage: techniques 23. Romig LE. Pediatric triage: a system to JumpSTART your triage
and applications in decisionmaking. Ann Emerg Med. 1996;28 of young patients at MCIs. JEMS. 2002;27(7):52–58.
(2):136–144. 24. Malik ZU, Pervez M, Safdar A, Masood T, Tariq M. Triage and
2. Carli P, Télion C. Nouveau concept de triage en médecine de ca- management of mass casualties in a train accident. J Coll Physi-
tastrophe. In: Le congrès médecins, conférence d’actualisation. Paris, cians Surg Pak. 2004;14(2):108–111.
France: Société Française d’Anésthesie et de Réanimation; 2016. 25. National Ambulance Service Medical Directors Group. NARU in-
https://123dok.net/document/zkw88o0e-nouveau-concept-triage put to new triage sieve. 27 Feb 2014. https://naru.org.uk/naru-input
-en-m%C3%A9decine-catastrophe.html Accessed 11 April 2022. -to-new-triage-sieve/. Accessed 11 April 2022.
3. Kotwal RS, Howard JT, Orman JA, et al. The effect of a golden 26. Wallis LA, Carley S. Validation of the Paediatric Triage Tape.
hour policy on the morbidity and mortality of combat casualties. Emerg Med J. 2006;23(1):47–50.
JAMA Surg. 2016;151(1):15–24. 27. Care Flight Collective. Tactical medicine in the civilian setting—
4. Howard JT, Kotwal RS, Santos-Lazada AR, Martin MJ, Stock- part 3. 27 November 2016. https://careflightcollective.com/tag/
inger ZT. Reexamination of a battlefield trauma golden hour pol- triage. Accessed 4 April 2022.
icy. J Trauma Acute Care Surg. 2018;84(1):11–18. 28. Tran MD, Garner AA, Morrison I, Sharley PH, Griggs WM,
5. Harmsen AMK, Giannakopoulos GF, Moerbeek PR, Jansma EP, Xavier C. The Bali bombing: civilian aeromedical evacuation.
Bonjer HJ, Bloemers FW. The influence of prehospital time on Med J Aust. 2003;179(7):353–356.
trauma patients’ outcome: a systematic review. Injury. 2015;46(4): 29. Sacco WJ, Navin DM, Fiedler KE, Waddell RK 2nd, Long WB,
602–609. Buckman RF Jr. Precise formulation and evidence-based appli-
6. Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battlefield cation of resource-constrained triage. Acad Emerg Med. 2005;12
(2001–2011): implications for the future of combat casualty care. (8):759–770.
J Trauma Acute Care Surg. 2012;73(6 Suppl):S431–S437. 30. Lerner EB, Schwartz RB, Coule PL, et al. Mass casualty triage:
7. Holcomb JB, Del Junco DJ, Fox EE, et al; the PROMMTT Study an evaluation of the data and development of a proposed na-
Group. The prospective, observational, multicenter, major trauma tional guideline. Disaster Med Public Health Prep. 2008;2 Suppl
transfusion (PROMMTT) study: comparative effectiveness of a 1:S25–S34.
time-varying treatment with competing risks. JAMA Surg. 2013; 31. Chemical Hazards Emergency Medical Management. SALT Mass
148(2):127–136. Casualty Triage Algorithm. Last updated 1 September 2022.
8. Frykberg ER, Tepas JJ 3rd, Alexander RH. The 1983 Beirut Air- https://chemm.hhs.gov/salttriage.htm. Accessed 11 April 2022.
port terrorist bombing: Injury patterns and implications for disas- 32. Lerner EB, Schwartz RB, Coule PL, et al. Mass casualty triage:
ter management. Am Surg. 1989;55(3):134–141. an evaluation of the data and development of a proposed national
9. Aylwin CJ, König TC, Brennan NW, et al. Reduction in critical guideline. Disaster Med Public Health Prep. 2008;2 Suppl 1:
mortality in urban mass casualty incidents: analysis of triage, S25–S34.
surge, and resource use after the London bombings on July 7, 33. Bennett A. Methodologies utilized and lessons learned in high
2005. Lancet. 2006;368(9554):2219–2225. threat environments and mass casualty environments. J High
10. Gutierrez de Ceballos JP, Turégano-Fuentes T, Perez-Diaz D, Threat Austere Med. 2019;1–7. file:///C:/Users/daves/Downloads/
Sanz-Sanchez M, Martin-Llorente C, Guerrero-Sanze JE. 11 March Methodologies_Utilized_and_Lessons_Learned_in_High.pdf. Ac-
2004: the terrorist bomb explosions in Madrid, Spain—an anal- cessed 11 April 2022.
ysis of the logistics, injuries sustained and clinical management 34. Vayer JS, Ten Eyck RP, Cowan ML. New concepts in triage. Ann
of casualties treated at the closest hospital. Crit Care. 2005;9(1): Emerg Med. 1986;15(8):927–930.
104–111. 35. Vassallo J, Smith J, Bouamra O, Lecky F, Wallis LA. The civilian
11. Postma ILE, Weel H, Heetveld MJ, et al. Mass casualty triage after validation of the Modified Physiological Triage Tool (MPTT): an
an airplane crash near Amsterdam. Injury. 2013;44(8):1061–1067. evidence-based approach to primary major incident triage. Emerg
12. Frykberg ER. Medical management of disasters and mass casual- Med J. 2017;34(12):810–815.
ties from terrorist bombings: how can we cope? J Trauma. 2002; 36. Garner A, Lee A, Harrison K, Schultz CH. Comparative analysis
53(2):201–212. of multiple-casualty incident triage algorithms. Ann Emerg Med.
13. Pepper M, Archer F, Moloney J. Triage in complex, coordinated 2001;38(5):541–548.
terrorist attacks. Prehosp Disaster Med. 2019;34(4):442–448. 37. Cross KP, Cicero MX. Head-to-head comparison of disaster tri-
14. American Academy of Pediatrics; American College of Emer- age methods in pediatric, adult, and geriatric patients. Ann Emerg
gency Physicians; American College of Surgeons–Committee on Med. 2013;61(6):668–676.

Triage Algorithms for Prehospital Response MCI | 65