The development and features of the Spanish prehospital advanced triage method (META) for mass casualty incidents

Abstract

This text describes the process of development of the new Spanish Prehospital Advanced Triage Method (META) and explain its main features and contribution to prehospital triage systems in mass casualty incidents. The triage META is based in the Advanced Trauma Life Support (ATLS) protocols, patient’s anatomical injuries and mechanism of injury. It is a triage method with four stages including early identification of patients with severe trauma that would benefit from a rapid evacuation to a surgical facility and introduces a new patient flow by-passing the advanced medical post to improve evacuation. The stages of triage META are: I) Stabilization triage that classifies patients according to severity to set priorities for initial emergency treatment; II) Identifying patients requiring urgent surgical treatment, this is done at the same time than stage I and creates a new flow of patients with high priority for evacuation; III) Implementation of Advanced Trauma Life Support protocols to patients previously classified according to stablished priority; and IV) Evacuation triage, stablishing evacuation priorities in case of lacks of appropriate transport resources. The triage META is to be applied only by prehospital providers with advanced knowledge and training in advanced trauma life support care and has been designed to be implemented as prehospital procedure in mass casualty incidents (MCI).

Triage Systems in Mass Casualty Incidents and Disasters: A Review Study with A Worldwide Approach

“…In each step, certain actions must be performed according to the algorithm. In the first step, the injured people are placed on the red, yellow, and green classes according to the A, B, C, D and E criteria, and at the next step, the injured individuals are classified based on the evaluation of the surgery and injuries (Figure 8, and 9) [24].…”

Accuracy of National Early Warning Score 2 (NEWS2) in Prehospital Triage on In-Hospital Early Mortality: A Multi-Center Observational Prospective Cohort Study

“…1,2 Patients during MCIs are cared for according to a sequential triage. The first triage aims at determining as quickly and accurately as possible the priority of attention, highlighting systems such as Simple Triage and Rapid Treatment (START), Sacco Triage Method (STM), Prehospital Advanced Triage Method (META), CRAMS score (circulation, respiration, abdomen, motor, speech), [3][4][5][6][7] as well as others. In the second triage, once the Basic Life Support (BLS) and/or Advanced Life Support (ALS) maneuvers have been applied, the objective is to identify which casualties have the least chance of surviving if they are not referred to a center that is suitable to their pathology, and have therefore a higher priority of evacuation.…”

A Multicenter Observational Prospective Cohort Study of Association of the Prehospital National Early Warning Score 2 and Hospital Triage with Early Mortality

“…The Prehospital Emergency Medical Services (PhEMS) have a growing interest in implementing systems in their operational protocols that allow them to quickly and effectively classify critical patients beyond accidents with multiple victims or catastrophes in which they are already using different specific triage systems designed for this purpose [4, 5].…”