Model Uniform Core Criteria for Mass Casualty Triage

2011 ◽  
Vol 5 (2) ◽  
pp. 125-128 ◽  
Keyword(s):  
Public Health ◽  
Scientific Evidence ◽  
Geographic Location ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Expert Consensus ◽  
Research Gaps ◽  
Triage System ◽  
Significant Research ◽  
Primary Triage

ABSTRACTThere is a need for model uniform core criteria for mass casualty triage because disasters frequently cross jurisdictional lines and involve responders from multiple agencies who may be using different triage tools. These criteria (Tables 1-4) reflect the available science, but it is acknowledged that there are significant research gaps. When no science was available, decisions were formed by expert consensus derived from the available triage systems. The intent is to ensure that providers at a mass-casualty incident use triage methodologies that incorporate these core principles in an effort to promote interoperability and standardization. At a minimum, each triage system must incorporate the criteria that are listed below. Mass casualty triage systems in use can be modified using these criteria to ensure interoperability. The criteria include general considerations, global sorting, lifesaving interventions, and assignment of triage categories. The criteria apply only to providers who are organizing multiple victims in a discrete geographic location or locations, regardless of the size of the incident. They are classified by whether they were derived through available direct scientific evidence, indirect scientific evidence, expert consensus, and/or are used in multiple existing triage systems. These criteria address only primary triage and do not consider secondary triage. For the purposes of this document the term triage refers to mass-casualty triage and provider refers to any person who assigns primary triage categories to victims of a mass-casualty incident.(Disaster Med Public Health Preparedness. 2011;5:125–128)

Mass Casualty Triage: An Evaluation of the Science and Refinement of a National Guideline

2011 ◽  
Vol 5 (2) ◽  
pp. 129-137 ◽  
Author(s):  
E. Brooke Lerner ◽  
David C. Cone ◽  
Eric S. Weinstein ◽  
Richard B. Schwartz ◽  
Phillip L. Coule ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
The United States ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
National Guideline ◽  
Public Health Preparedness ◽  
The Core ◽  
Individual Assessment ◽  
Triage Category

ABSTRACTMass casualty triage is the process of prioritizing multiple victims when resources are not sufficient to treat everyone immediately. No national guideline for mass casualty triage exists in the United States. The lack of a national guideline has resulted in variability in triage processes, tags, and nomenclature. This variability has the potential to inject confusion and miscommunication into the disaster incident, particularly when multiple jurisdictions are involved. The Model Uniform Core Criteria for Mass Casualty Triage were developed to be a national guideline for mass casualty triage to ensure interoperability and standardization when responding to a mass casualty incident. The Core Criteria consist of 4 categories: general considerations, global sorting, lifesaving interventions, and individual assessment of triage category. The criteria within each of these categories were developed by a workgroup of experts representing national stakeholder organizations who used the best available science and, when necessary, consensus opinion. This article describes how the Model Uniform Core Criteria for Mass Casualty Triage were developed.(Disaster Med Public Health Preparedness. 2011;5:129-137)

scholarly journals Regional Variation in Critical Care Evacuation Needs for Children After a Mass Casualty Incident

2012 ◽  
Vol 6 (2) ◽  
pp. 146-149 ◽  
Author(s):  
Robert K. Kanter
Keyword(s):  
Public Health ◽  
New York ◽  
Critical Care ◽  
Metropolitan Area ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Evacuation Time ◽  
Pediatric Critical Care ◽  
Ground Ambulance ◽  
Ground Ambulances

ABSTRACTObjectives: To determine the ability of five New York statewide regions to accommodate 30 children needing critical care after a hypothetical mass casualty incident (MCI) and the duration to complete an evacuation to facilities in other regions if the surge exceeded local capacity.Methods: A quantitative model evaluated pediatric intensive care unit (PICU) vacancies for MCI patients, based on data on existing resources, historical average occupancy, and evidence on early discharges and transfers in a public health emergency. Evacuation of patients exceeding local capacity to the nearest PICU center with vacancies was modeled in discrete event chronological simulations for three scenarios in each region: pediatric critical care transport teams were considered to originate from other PICU hospitals statewide, using (1) ground ambulances or (2) helicopters, and (3) noncritical care teams were considered to originate from the local MCI region using ground ambulances. Chronology of key events was modeled.Results: Across five regions, the number of children needing evacuation would vary from 0 to 23. The New York City (NYC) metropolitan area could accommodate all patients. The region closest to NYC could evacuate all excess patients to PICU hospitals in NYC within 12 hours using statewide critical care teams traveling by ground ambulance. Helicopters and local noncritical care teams would not shorten the evacuation. For other statewide regions, evacuation of excess patients by statewide critical care teams traveling by ground ambulance would require up to nearly 26 hours. Helicopter transport would reduce evacuation time by 40%-44%, while local noncritical care teams traveling by ground would reduce evacuation time by 16%-34%.Conclusions: The present study provides a quantitative, evidence-based approach to estimate regional pediatric critical care evacuation needs after an MCI. Large metropolitan areas with many PICU beds would be better able to accommodate patients in a local MCI, and would serve as a crucial resource if an MCI occurred in a smaller community. Regions near a metropolitan area could be rapidly served by critical care transport teams traveling by ground ambulance. Regions distant from a metropolitan area might benefit from helicopter transport. Using local noncritical care transport teams would involve shorter delays and less expert care during evacuation.(Disaster Med Public Health Preparedness. 2012;6:146–149)

Regional Health System Response to the Virginia Tech Mass Casualty Incident

2007 ◽  
Vol 1 (S1) ◽  
pp. S9-S13 ◽  
Author(s):  
Lisa Kaplowitz ◽  
Morris Reece ◽  
Jody Henry Hershey ◽  
Carol M. Gilbert ◽  
Italo Subbarao
Keyword(s):  
Public Health ◽  
Mortality Rate ◽  
Health System ◽  
Trauma Center ◽  
Virginia Tech ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
System Response ◽  
Regional Health ◽  
Severity Scores

ABSTRACTBackground: On April 16, 2007 a mass shooting occurred on the campus of Virginia Polytechnic Institute and State University (Virginia Tech). Due to both distance and weather, air transport of the injured directly to a level 1 trauma center was not possible. The injured received all of their care or were initially stabilized at 3 primary hospitals that either had a level 3 trauma center designation or no trauma center designation.Methods: This article is a retrospective analysis of the regional health system (prehospital, hospital, regional hospital emergency operations center, and public health local and state) response. Data records from all of the regional responding emergency medical services, hospitals, and coordinating services were reviewed and analyzed. Records for all 26 patients were reviewed and analyzed using triage designations, injury severity scores (ISS), and critical mortality.Results: Twenty-five of the 26 patients were triaged in the field. Excluding 1 patient (asthma), the average ISS for victims presenting was 8.2. Twelve patients had an ISS of ≥9, and 5 had an ISS score of ≥15. Ten of the 26 patients (38%) required urgent intervention and surgery in the first 24 hours. The overall regional health system mortality of victims received was 3.8% (1 death [excluding 1 dead on arrival {DOA}]/ 26 victims from scene). The regional health system critical mortality rate (excluding 1 victim who was DOA) was 20% (1/5).Discussion: The outcomes of the Virginia Tech mass casualty incident, as evidenced by the low overall regional health system mortality of victims received at 3.8% (1/26) and low critical mortality rate (excluding 1 victim who was DOA) of 20%, coupled with a need to treat a significant amount of moderately injured victims 46% (12/26 with ISS ≥9) gives credence to the successful response. The successful response occurred as a consequence of regional collaborative planning, training, and exercising, which resulted not only in increased expertise and improved communications but also in essential relationships and a sense of trust forged among all of the responders. (Disaster Med Public Health Preparedness. 2007;1(Suppl 1):S9–S13)

Rural Mass Casualty Preparedness and Response: The Institute of Medicine's Forum on Medical and Public Health Preparedness for Catastrophic Events

2012 ◽  
Vol 6 (3) ◽  
pp. 297-302 ◽  
Author(s):  
Kristin P. Viswanathan ◽  
Robert Bass ◽  
Gamunu Wijetunge ◽  
Bruce M. Altevogt
Keyword(s):  
Public Health ◽  
Best Practices ◽  
Research And Development ◽  
Mass Casualty Incident ◽  
Emerging Technology ◽  
Mass Casualty ◽  
Catastrophic Events ◽  
Public Health Preparedness ◽  
Rural Infrastructure ◽  
Daily Capacity

ABSTRACTThe Institute of Medicine's Forum on Medical and Public Health Preparedness for Catastrophic Events hosted a workshop at the request of the Federal Interagency Committee on Emergency Medical Services (FICEMS) that brought together a range of stakeholders to broadly identify and confront gaps in rural infrastructure that challenge mass casualty incident (MCI) response and potential mechanisms to fill them. This report summarizes the presentations and discussions around 6 major issues specific to rural MCI preparedness and response: (1) improving rural response to MCI through improving daily capacity and capability, (2) leveraging current and emerging technology to overcome infrastructure deficits, (3) sustaining and strengthening relationships, (4) developing and sharing best practices across jurisdictions and sectors, (5) establishing metrics research and development, and (6) fostering the need for federal leadership to expand and integrate EMS into a broader rural response framework.(Disaster Med Public Health Preparedness. 2012;6:297–302)

scholarly journals Mass Casualty Triage: An Evaluation of the Data and Development of a Proposed National Guideline

2008 ◽  
Vol 2 (S1) ◽  
pp. S25-S34 ◽  
Author(s):  
E. Brooke Lerner ◽  
Richard B. Schwartz ◽  
Phillip L. Coule ◽  
Eric S. Weinstein ◽  
David C. Cone ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Scientific Evidence ◽  
The United States ◽  
Mass Casualty ◽  
National Guideline ◽  
Public Health Preparedness ◽  
Life Saving ◽  
Review Reports ◽  
Triage Decisions

ABSTRACTMass casualty triage is a critical skill. Although many systems exist to guide providers in making triage decisions, there is little scientific evidence available to demonstrate that any of the available systems have been validated. Furthermore, in the United States there is little consistency from one jurisdiction to the next in the application of mass casualty triage methodology. There are no nationally agreed upon categories or color designations. This review reports on a consensus committee process used to evaluate and compare commonly used triage systems, and to develop a proposed national mass casualty triage guideline. The proposed guideline, entitled SALT (sort, assess, life-saving interventions, treatment and/or transport) triage, was developed based on the best available science and consensus opinion. It incorporates aspects from all of the existing triage systems to create a single overarching guide for unifying the mass casualty triage process across the United States. (Disaster Med Public Health Preparedness. 2008;2(Suppl 1):S25–S34)

Primary Triage, Evacuation Priorities, and Rapid Primary Distribution between Adjacent Hospitals—Lessons Learned from a Suicide Bomber Attack in Downtown Tel-Aviv

2008 ◽  
Vol 23 (4) ◽  
pp. 337-341 ◽  
Author(s):  
Moshe Pinkert ◽  
Ofer Lehavi ◽  
Odeda Benin Goren ◽  
Yaron Raiter ◽  
Ari Shamis ◽  
...  
Keyword(s):  
Trauma Center ◽  
Medical Center ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Severely Injured ◽  
Tel Aviv ◽  
Medical Response ◽  
Level 1 ◽  
Level 1 Trauma Center ◽  
Primary Triage

AbstractIntroduction:Terrorist attacks have occurred in Tel-Aviv that have caused mass-casualties.The objective of this study was to draw lessons from the medical response to an event that occurred on 19 January 2006, near the central bus station, Tel-Aviv, Israel. The lessons pertain to the management of primary triage, evacuation priorities, and rapid primary distribution between adjacent hospitals and the operational mode of the participating hospitals during the event.Methods:Data were collected in formal debriefings both during and after the event. Data were analyzed to learn about medical response components, interactions, and main outcomes. The event is described according to Disastrous Incidents Systematic AnalysiS Through—Components, Interactions and Results (DISAST-CIR) methodology.Results:A total of 38 wounded were evacuated from the scene, including one severely injured, two moderately injured, and 35 mildly injured. The severe casualty was the first to be evacuated 14 minutes after the explosion. All of the casualties were evacuated from the scene within 29 minutes. Patients were distributed between three adjacent hospitals including one non-Level-1 Trauma Center that received mild casualties. Twenty were evacuated to the nearby, Level-1 Sourasky Medical Center, including the only severely injured patient. Nine mildly injured patients were evacuated to the Sheba Medical Center and nine to Wolfson Hospital, a non-Level-1 Trauma Center hospital. All the receiving hospitals were operated according to the mass-casualty incident doctrine.Conclusions:When a mass-casualty incident occurs in the vicinity of more than one hospital, primary triage, evacuation priority decision-making, and rapid distribution of casualties between all of the adjacent hospitals enables efficient and effective containment of the event.

scholarly journals Hospital Disaster Preparedness in Switzerland Over a Decade: A National Survey

2018 ◽  
Vol 13 (03) ◽  
pp. 433-439
Author(s):  
Simone Dell’Era ◽  
Olivier Hugli ◽  
Fabrice Dami
Keyword(s):  
Public Health ◽  
Health Care ◽  
Disaster Preparedness ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Disaster Medicine ◽  
Disaster Plan ◽  
Root Cause ◽  
Swiss Health ◽  
Hospital Disaster Preparedness

ABSTRACTObjectiveThe present study aimed to provide a comprehensive assessment of Swiss hospital disaster preparedness in 2016 compared with the 2006 data.MethodsA questionnaire was addressed in 2016 to all heads responsible for Swiss emergency departments (EDs).ResultsOf the 107 hospitals included, 83 (78%) returned the survey. Overall, 76 (92%) hospitals had a plan in case of a mass casualty incident, and 76 (93%) in case of an accident within the hospital itself. There was a lack in preparedness for specific situations: less than a third of hospitals had a specific plan for nuclear/radiological, biological, chemical, and burns (NRBC+B) patients: nuclear/radiological (14; 18%), biological (25; 31%), chemical (27; 34%), and burns (15; 49%), and 48 (61%) of EDs had a decontamination area. Less than a quarter of hospitals had specific plans for the most vulnerable populations during disasters, such as seniors (12; 15%) and children (19; 24%).ConclusionsThe rate of hospitals with a disaster plan has increased since 2006, reaching a level of 92%. The Swiss health care system remains vulnerable to specific threats like NRBC. The lack of national legislation and funds aimed at fostering hospitals’ preparedness to disasters may be the root cause to explain the vulnerability of Swiss hospitals regarding disaster medicine. (Disaster Med Public Health Preparedness. 2019;13:433-439)

scholarly journals Preparedness cycle to address transitions in diabetes care during the COVID-19 pandemic and future outbreaks

2020 ◽  
Vol 8 (1) ◽  
pp. e001520 ◽  
Author(s):  
Unjali P Gujral ◽  
Leslie Johnson ◽  
Jannie Nielsen ◽  
Priyathama Vellanki ◽  
J Sonya Haw ◽  
...  
Keyword(s):  
Public Health ◽  
Diabetes Care ◽  
Technology Implementation ◽  
Clinical Status ◽  
Implementation Strategies ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Treatment Protocols ◽  
Health Crisis ◽  
Public Health Crisis

The COVID-19 pandemic is considered a mass casualty incident of the most severe nature leading to unearthed uncertainties around management, prevention, and care. As of July 2020, more than twelve million people have tested positive for COVID-19 globally and more than 500 000 people have died. Patients with diabetes are among the most severely affected during this pandemic. Healthcare systems have made emergent changes to adapt to this public health crisis, including changes in diabetes care. Adaptations in diabetes care in the hospital (ie, changes in treatment protocols according to clinical status, diabetes technology implementation) and outpatient setting (telemedicine, mail delivery, patient education, risk stratification, monitoring) have been improvised to address this challenge. We describe how to respond to the current public health crisis focused on diabetes care in the USA. We present strategies to address and evaluate transitions in diabetes care occurring in the immediate short-term (ie, response and mitigation), as well as phases to adapt and enhance diabetes care during the months and years to come while also preparing for future pandemics (ie, recovery, surveillance, and preparedness). Implementing multidimensional frameworks may help identify gaps in care, alleviate initial demands, mitigate potential harms, and improve implementation strategies and outcomes in the future.

Die a Hero or Live Long Enough to Become the Villain: Mass Casualty Preparedness in Hospitals and Protecting Doctors from Liability during Mass Casualty Events

2015 ◽  
Vol 6 (1) ◽  
Author(s):  
Ashley Tseung
Keyword(s):  
Public Health ◽  
United States ◽  
Emergency Preparedness ◽  
Preventive Measures ◽  
The United States ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Public Health Emergency ◽  
Terrorist Attacks ◽  
Mass Casualty Events

AbstractSince 9/11, the United States and the international community have emphasized the need to protect people from terrorist attacks. The Boston Bombing that took place on April 15, 2013, showed that even with all of the preventive measures in place, the United States is not immune from terrorist attacks. If there had been a bioterrorist attack in Boston instead of a homemade bomb, the amount of casualties would likely have been a lot higher. Many hospitals lack effective emergency preparedness plans that address bioterrorist attacks. One area that will help prepare nations during a mass casualty incident or public health emergency involves implementing effective mass casualty preparedness plans for hospitals. This paper analyzes mass casualty preparedness in hospitals and demonstrates the need to have legislation in place to protect doctors who treat patients during mass casualty events.

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