New NHS Prehospital Major Incident Triage Tool: from MIMMS to MITT

Abstract

Triage is a key principle in the effective management of major incidents and is the process by which patients are prioritised on the basis of their clinical acuity. However, work published over the last decade has demonstrated that existing methods of triage perform poorly when trying to identify patients in need of life-saving interventions. As a result, a review of major incident triage was initiated by NHS England with the remit to determine the optimum way in which to triage patients of all ages in a major incident for the UK. This article describes the output from this review, the changes being undertaken to UK major incident triage and the introduction of the new NHS Major Incident Triage Tool from the Spring of 2023.

The implication of a translational triage tool in mass casualty incidents: part three: a multinational study, using validated patient cards

“…Using the initial concept of utilitarianism, the historical review emphasizes the rule of saving the most, and from a primary triage perspective, this process must proceed rapidly [ 24 ]. Therefore, there is no time or opportunity for discussions about a special color tag or confusion about the number of respiratory or heart rates counted, the measure obtained, or the age and gender of the victims [ 29 ]. This is especially important in an MCI, which presents a chaotic environment [ 29 – 31 ].…”

“…Therefore, there is no time or opportunity for discussions about a special color tag or confusion about the number of respiratory or heart rates counted, the measure obtained, or the age and gender of the victims [ 29 ]. This is especially important in an MCI, which presents a chaotic environment [ 29 – 31 ]. Consequently, a mutual, simple, and easy-to-perform triage algorithm that can initially close the gaps between different and existing prehospital primary triage systems is undoubtedly crucial.…”

Ten second triage: A novel and pragmatic approach to major incident triage

“…The use of a non-physiological initial triage tool has a number of key advantages. 2 The first is time to triage; even with responders experienced in triage, the use of the MITT still takes between 40 and 60 seconds to complete; by comparison, the TST takes approximately 10 seconds. 4 By reducing the time required to perform triage, we are able to deliver key life-saving interventions rapidly to a large number of casualties in the initial phase of a major incident, in order to optimise survivability.…”

“…1 Historically, the triage process has been conducted using an assessment of the casualty's physiology and within the United Kingdom, a recent NHS England review of major incident triage culminated in the development of the new NHS Major Incident Triage Tool (MITT). 2 The introduction of the MITT represents the optimum method of triage based on physiological criteria at a major incident. However, it has become apparent from recent experiences of major incidents that in practice, the use of physiological triage may not be possible, especially in the early stages of an incident, where the casualties are likely to significantly outnumber responders.…”

“…1 Historically, the triage process has been conducted using an assessment of the casualty's physiology and within the United Kingdom, a recent NHS England review of major incident triage culminated in the development of the new NHS Major Incident Triage Tool (MITT). 2…”