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

Abstract

BACKGROUND: Injuries caused by emergencies and accidents are increasing in the world. To prioritise patients to provide them with proper services and to optimally use the resources and facilities of the medical centres during accidents, the use of triage systems, which are one of the key principles of accident management, seems essential.
 AIM: This study is an attempt to identify available triage systems and compare the differences and similarities of the standards of these systems during emergencies and disasters through a review study.
 METHODS: This study was conducted through a review of the triage systems used in emergencies and disasters throughout the world. Accordingly, all articles published between 1990 and 2018 in both English and Persian journals were searched based on several keywords including Triage, Disaster, Mass Casualty Incidents, in the Medlib, Scopus, Web of Science, Pubmed, Cochrane Library, Science Direct, Google scholar, Irandoc, Magiran, Iranmedex, and SID databases in isolation and in combination using both and/ or conjunctions.
 RESULTS: Based on the search done in these databases, twenty different systems were identified in the primary adult triage field including START, Homebush triage Standard, Sieve, Care Flight, STM, Military, CESIRA Protocol, MASS, Revers, CBRN Triage, Burn Triage, META Triage, Mass Gathering Triage, SwiFT Triage, MPTT, TEWS Triage, Medical Triage, SALT, mSTART and ASAV. There were two primary triage systems including Jump START and PTT for children, and also two secondary triage systems encompassing SAVE and Sort identified in this respect. ESI and CRAMS were two other cases distinguished for hospital triage systems.
 CONCLUSION: There are divergent triage systems in the world, but there is no general and universal agreement on how patients and injured people should be triaged. Accordingly, these systems may be designed based on such criteria as vital signs, patient's major problems, or the resources and facilities needed to respond to patients’ needs. To date, no triage system has been known as superior, specifically about the patients’ clinical outcomes, improvement of the scene management or allocation of the resources compared to other systems. Thus, it is recommended that different countries such as Iran design their triage model for emergencies and disasters by their native conditions, resources and relief forces.

Prehospital Trauma Care: A Simulation Scenario for Rural-Based Healthcare Providers

“…The main teaching points to be covered in the didactic session are summarized in Table 4. black tags, as their injuries were not amenable to the level of care that may be provided in the field [19] To apply the Developing a systematic approach to communication within a healthcare team is essential to the prevention of medical errors [18]. Closed-loop communication, in which the receiver of information confirms what they hear to the sender who then affirms or corrects the message, is one effective way to mitigate error within complex team-based scenarios [18].…”

Victim evacuation techniques in emergency conditions

“…If there is only one rescuer who has to evacuate a person who cannot walk, is unconscious or conscious, but with injuries that do not allow the use of a mother's grip or a "ram" method, or is too heavy to use, from the danger zone, the rescuer can be dragged along the ground at close range [10]. Take your clothes or place a blanket underneath the evacuated person and pull on a relatively safe surface, flat and horizontal only, so as not to cause additional injury.…”

Triage

“…If no breathing and unconscious, then he is considered dead (white). Figure 1 shows the flowchart for START triage system [18].…”

“…C. JumpSTART: It is the pediatric version of the START system; the main difference is the trial with the child to do airway maneuver and short Flowchart for START triage system [18].…”