Mass casualty triage concept
Triage is the process of sorting patients into categories based on their level or severity of illness.
In the modern healthcare system centered around the hospital, this allows the sickest patient to gain the immediate attention of the health care provider.
Triage in mass casualty incidents has a slightly different purpose, and that is to guide the allocation of limited resources, in a setting where there simply are not enough doctors, nurses, medical supplies and time to treat or transport most patients.
Mass casualty triage emerged as a concept during times of war, when triage on the battlefield was necessary to identify which soldiers needed to be transported out and which soldiers could stay and return to the fight. In the setting of mass casualty incidents in the civilian world (earthquakes, car bus or plane crashes, floods) triage if the victims at the scene, often by a handful of medical care providers, ensures that constrained medical resources are directed at achieving the greatest good for the most number of people. Because of this, the patients that are helped first are the ones deemed most likely to survive with emergent aid, not the most critically ill.
START and SALT
START triage is the most used triage algorithm to date today. SALT triage system is the system recommended by ACEP.
There are limited studies comparing the effectiveness of different mass triage strategies. There have been other triage strategies described and proposed, some of which include: triage sieve, Care Flight Triage, Sacco Treatment method. No matter the differences, they all rapidly evaluate in some way the ability to walk, to breathe, to follow commands, and perfusion.
START is a triage algorithm developed by the Newport Beach Fire and Marine Department and Hoag Hospital in Newport Beach, California, using ability to obey commands, respiratory rate and capillary refill to assign a triage category. Essentially it tries to identify three problems that would cause death fast in the victim population – impaired breathing and airway, significant hemorrhage and severe head injury.
Actual algorithms
There are four categories into which patients are triaged: minimal or walking wounded, delayed, immediate and expectant, with each category bearing a color.
Triage is the process of sorting patients into categories based on their level or severity of illness.
In the modern healthcare system centered around the hospital, this allows the sickest patient to gain the immediate attention of the health care provider.
Triage in mass casualty incidents has a slightly different purpose, and that is to guide the allocation of limited resources, in a setting where there simply are not enough doctors, nurses, medical supplies and time to treat or transport most patients.
Mass casualty triage emerged as a concept during times of war, when triage on the battlefield was necessary to identify which soldiers needed to be transported out and which soldiers could stay and return to the fight. In the setting of mass casualty incidents in the civilian world (earthquakes, car bus or plane crashes, floods) triage if the victims at the scene, often by a handful of medical care providers, ensures that constrained medical resources are directed at achieving the greatest good for the most number of people. Because of this, the patients that are helped first are the ones deemed most likely to survive with emergent aid, not the most critically ill.
START and SALT
START triage is the most used triage algorithm to date today. SALT triage system is the system recommended by ACEP.
There are limited studies comparing the effectiveness of different mass triage strategies. There have been other triage strategies described and proposed, some of which include: triage sieve, Care Flight Triage, Sacco Treatment method. No matter the differences, they all rapidly evaluate in some way the ability to walk, to breathe, to follow commands, and perfusion.
START is a triage algorithm developed by the Newport Beach Fire and Marine Department and Hoag Hospital in Newport Beach, California, using ability to obey commands, respiratory rate and capillary refill to assign a triage category. Essentially it tries to identify three problems that would cause death fast in the victim population – impaired breathing and airway, significant hemorrhage and severe head injury.
Actual algorithms
There are four categories into which patients are triaged: minimal or walking wounded, delayed, immediate and expectant, with each category bearing a color.
References:
1. START Triage. Available at: www.start-triage.com/start_triage_faq_.htm. Accessed October 14, 2014.
2. START triage plan for disaster scenarios. ED Manag. 1996; 8(9 suppl 101):103–4.
3. Garner A, Lee A, Harrison K, Schultz CH. Comparative analysis of multiple-casualty incident triage algorithms. Ann Emerg Med. 2001; 38:541–8.
4. Cone and McMillan, Academic Emergency Medicine, August 2005, Vol. 12, No. 8, 739-741.
5. Benson M, Koenig KL et al, Prehosp Disaster Med. 1996 Apr-Jun;11(2):117-24.
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