Casualty Collection in Mass-Casualty Incidents: A Better Method for Finding Proverbial Needles in a Haystack

Abstract

Introduction:Mass-casualty incidents (MCIs) are on the rise. The ability to locate, identify, and triage patients quickly and efficiently results in better patient outcomes. Poor lighting due to time of day, inclement weather, and power outages can make locating patients difficult. Efficient methods of locating patients allow for quicker transport to definitive care.Objective:The objective of this study was to evaluate the methods currently used in mass-casualty collection, and to determine whether the use of the Simple Triage and Rapid Treatment (START) triage tag system can be improved by using easily discernable tags (glow sticks) in conjunction with the standard triage tags.Methods:Numerous drills were performed utilizing the START triage method. In Trial A, patients were identified with the triage tags only. In Trial B, patients were identified using triage tags and glow sticks. Four rounds of triage drills were performed in low ambient light for each Trial, and the differences in casualty collection times were compared.Results:Casualty relocation and collection times were considerably shorter in the trials that utilized both the glow sticks and triage tags. An average of 2.58 minutes (31.75%) were saved during the casualty collections. In addition, fewer patient errors occurred during the trials in which the glow sticks were used. Between the four rounds, an average of four patient errors occurred during the trials that utilized the triage tags. However, there was an average of only one patient error for the drills when participants utilized both the triage tags and the glow sticks.Conclusions:The use of the highly visible glow sticks, in conjunction with the START triage tags, allowed for more rapid and accurate casualty collection in suboptimal lighting. The use of the glow sticks made it easier to relocate previously triaged patients and arrange for expeditious transport to definitive care. In addition, the glow sticks reduced the number of patient errors. Most importantly, there was a significant reduction in the number of patients that initially were triaged via the START method, but were overlooked during casualty collection and transport.

A concept for major incident triage: full-scaled simulation feasibility study

“…Paper tags have well-known limitations such as problematic identification in sub-optimal lightning and the tags are likely to perish in our sub-arctic climate [21,22]. Further, paper tags deviate from familiar routines when stress suggests simple and field-friendly solutions.…”

Disaster preparedness and response: a challenge for hospitals in earthquake-prone countries

“…These were the three key components of emergency preparedness for hospitals. The ability to 'surge' is dependent on pre-planning for the use of the medical facilities' own resources such as staff and supplies and the ability of the facility to quickly link with resources outside of its own structure to increase the communities ability to locate, identify and triage patients (Knotts et al, 2006). In the USA, as in most earthquake-prone countries, the surge capacity of local hospitals to respond to an emergency has greatly diminished in the past 20 years.…”

“…Once patients are triaged it is also critical for the facility to have a plan in place to facilitate moving individuals out of the immediate earthquake region to a less damaged medical facility. While the top priorities of disaster rescue teams are to rescue and provide immediate care for physical trauma, prior planning to allow the establishment of transportation corridors to move evacuees can also be essential to the long-term survival of those injured in an earthquake (Knotts et al, 2006;Gautschi et al, 2008).…”

“…One practical strategy identified by Knotts et al (2006) used to increase the speed of finding and initiating the treatment of earthquake victims in 2006 was the use of the Simple Triage and Rapid Treatment (START). The programme incorporates the use of triage tags in combination with the use of glow sticks to help transport teams relocate victims.…”

Evaluation of a CT triage protocol for mass casualty incidents: results from two large-scale exercises

“…In a real event, all images should be labeled with the identification number of the casualty that could help to avoid this error. There are more sophisticated means of labeling patients such as electronic devices, but even with these, mislabeling errors are reported to occur frequently [23][24][25]. However, a preplanned labeling system is essential for handling multiple casualties.…”