Hostname: page-component-848d4c4894-75dct Total loading time: 0 Render date: 2024-05-31T03:43:38.909Z Has data issue: false hasContentIssue false
  • English
  • Français

-PLUS Prehospital Mass-Casualty Triage: A Strategy for Addressing Unusual Injury Mechanisms

Published online by Cambridge University Press:  28 June 2012

Daniel J. Neal ,
Joseph A. Barbera  and
John R. Harrald
Daniel J. Neal*
Affiliation:
George Washington University, Washington, DC USA
Joseph A. Barbera
Affiliation:
George Washington University, Washington, DC USA
John R. Harrald
Affiliation:
George Washington University, Washington, DC USA
*
426 Fox Ridge Drive, SW Leesburg, Virginia, 20175-2500, E-mail: danielneal@verizon.net
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Simple Triage and Rapid Treatment (START) and more recently developed prehospital casualty triage algorithms are widely used, in part because they are easy to teach and learn, and can be performed rapidly. Every rapid triage protocol has inherent, significant limitations: (1) no mechanism of injury (MOI) considerations; (2) limited assessment points; and (3) no refinement in truly mass-casualty situations where transport of “minor” or “moderate” patients may be delayed.

Hypothesis:

When rapid initial triage protocols are utilized, a significant triage deficiency (“under-triage”) may occur when “minor” or “moderate” casualties actually are more severely injured than initially triaged. Some MOI produce casualties with subtle or latent (i.e., hidden or delayed) signs and symptoms not considered in the commonly used prehospital triage algorithms. This research did not focus on START or other initial triage screening methods. Instead, it focuses on developing follow-on triage guidance to more specifically prioritize “delayed transport” casualties based upon signs and symptoms related to their MOI.

Methods:

Using expert opinion and accepted clinical criteria, triage algorithms were developed to re-evaluate patients triaged to “minor” and “moderate” cohorts. A detailed literature search produced a draft list of relevant signs and symptoms for each selected MOI. The lists then were evaluated by a multi-disciplinary panel of experts via an anonymous, mail-based Delphi method. The input shaped triage algorithms for each selected MOI, which then were subjected to a second stage Delphi process.

Results:

Consensus was achieved using the Delphi method. The algorithms extend patient assessment beyond the rapid initial triage protocols and incorporate triage criteria specific to each selected injury mechanism or condition: (1) penetrating injuries; (2) unconventional MOI (burns, blast, chemical, radiation); (3) smoke and other inhalation exposure; and (4) injuries with concomitant pregnancy. The full list of triage protocols is designated by the acronym “-PLUS”.

Conclusions:

“-PLUS” Prehospital Casualty Triage may supplement the strengths of already existing, widely accepted mass-casualty triage strategies. It does not displace START or other rapid initial triage protocols, but in mass-casualty situations with extensive delays in transport, it provides a method to identify under-triage of seriously injured casualties. “-PLUS” also presents a framework for capturing the triage considerations used by experienced medical providers, and so may provide a valuable teaching tool for training future triage professionals. Further research and field assessment is required.

Keywords

emergency medical servicesmass-casualty incident-PLUSSimple Triage and Rapid Treatment (START)triage
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 25 , Issue 3 , June 2010 , pp. 227 - 236
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Domres, B, Koch, M, Manger, A, Becker, HD: Ethics and triage. Prehosp Disaster Med 2001;16:53–58.Google Scholar
2.Auf der Heide, E: Disaster Response: Principles of Preparation and Coordination. St. Louis: Mosby, 1989.Google Scholar
3.DeLorenzo, RA, Porter, RS: Tactical Emergency Care: Military and Operational Out-Of-Hospital Medicine. Upper Saddle River: Brady Prentice Hall, 1999.Google Scholar
4.Simple Triage and Rapid Treatment. Critical illness and Trauma Foundation. Available at http://www.citmt.org/start/thanks.htm. Accessed 11 February 2008.Google Scholar
5.Owens, K: EMS triage: Sorting through the maze. Fire Engineering 2008;161:155–160.Google Scholar
6.START triage plan for disaster scenarios. ED Manag 1996;8:103–104.Google Scholar
7.Streger, MR: Prehospital triage. Emer Med Svcs 1998;27:21–27.Google ScholarPubMed
8.Hogan, DE, Lairet, Triage Jr : In: Hogan, DE, Burnstein, JL, (eds): Disaster Medicine. Philadelphia: Lippincott, Williams, and Wilkins, 2002, p 12.Google Scholar
9.Advanced Disaster Life Support. Available at http://www.ndlsf.org/common/content.asp?PAGE=348. Accessed 22 April 2009.Google Scholar
10.Lerner, EB, Schwartz, RB, Coule, PL: Mass casualty triage: An evaluation of the data and development of a proposed national guideline. Disaster Med Public Health Prep 2008;2:S25–S34.CrossRefGoogle ScholarPubMed
11.Armstrong, JH, Frykberg, ER, Burris, DG: Toward a national standard primary mass casualty triage. Disaster Med Public Health Prep 2008;2(suppl. 1):S8–S10.Google Scholar
12.Bledsoe, BE, Porter, RS, Cherry, RA: Penetrating Trauma. In Paramedic Care: Principles And Practices Trauma Emergencies: Trauma Emergencies. Upper Saddle River: Prentice-Hall, 2001, pp 62–63.Google Scholar
13.Creel, JH: Mechanisms of Injuries Due to Motion. In: Campbell, J, ed. Basic Trauma Life Support for Paramedics and Advanced EMS Providers. Upper Saddle River: Prentice-Hall, 1998, pp 21–24.Google Scholar
14.Moore, EE, Feliciano, DV, Mattox, KL: Trauma. New York: McGraw-Hill Professional; 2003.Google Scholar
15.Barbera, JA, Macintyre, AG: Jane's Mass Casualty Handbook: Hospital. Surrey: Jane's Information Group, 2003.Google Scholar
16.DeAtley, C, Allan, S, Hauda, W, DeHaven, P, Stangby, A: Jane's Mass Casualty Handbook: Pre-hospital Emergency Preparedness and Response. Surrey: Jane's Information Group; 2003.Google Scholar
17.Almogy, G, Belzberg, H, Mintz, Y, Zamir, G, Rivkind, AI: Suicide bombing attacks: Update and modifications to the protocol. Ann Surg 2004;293:295–303.CrossRefGoogle Scholar
18.The Jump START Pediatric MCI Triage Tool and Principles of Multicasualty Triage, Team Life Support. Available at http://www.jump-starttriage.com/JumpSTART_and_MCI_Triage.html. Accessed 24 August 2009.Google Scholar
19.Advanced Trauma Life Support: Program Overview. Available at http://www.facs.org/trauma/atls/program.html. Accessed 18 June 2009.Google Scholar
20.Mulholland, SA, Gabbe, BJ, Cameron, P: Is paramedic judgment useful In prehospital trauma triage? Injury 2005;36:1298–1305.CrossRefGoogle ScholarPubMed
21.Shirani, KZ, Puitt, BA, Mason, AD: The influence of inhalational injury and pneumonia on burn mortality. Ann Surg 1987;205:82–97.Google Scholar
22.Centers for Disease Control and Prevention: Blast Injuries: Essential Facts. Available at http://www.bt.cdc.gov/masscasualties/blastessentials.asp. Accessed 26 August 2009.Google Scholar
23.Bledsoe, BE, Porter, RS, Cherry, RA: Chapter 47 Assessment-Based Management. In: Essentials of Paramedic Care. Upper Saddle River: Prentice-Hall, 2007, pp 1780–1781.Google Scholar
24.Wang, HE, Katz, S: Cognitive control and prehospital endotracheal intubation. Prehosp Emer Care 2007;11(2):234–235.Google Scholar
25.Gebhart, ME, Pence, R: START triage: Does it work? Disaster Manage Response 2007;5(3): 68–73.Google Scholar
26.Wallis, LA, Carley, S: Comparison of paediatric major incident primary triage tools. Emerg Med J 2005;23(6):475–478.Google Scholar
27.Jenkins, JL, McCarthy, ML, Sauer, LM, Green, GB, Stuart, S, Thomas, TL, Hsu, EB: Mass-casualty triage: Time for an evidence-based approach. Prehosp Disaster Med 2008;23(1):3–8.CrossRefGoogle ScholarPubMed