Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-28T02:25:46.810Z Has data issue: false hasContentIssue false

Chapter 13 - Advanced Triage Management for Emergency Medical Teams

from Section 4 - Clinical Considerations

Published online by Cambridge University Press:  09 January 2020

By
Frederick M Burkle
Edited by
Elhanan Bar-On ,
Kobi Peleg  and
Yitshak Kreiss
Elhanan Bar-On
Affiliation:
The Israel Center for Disaster Medicine and Humanitarian Response, Sheba Medical Center, Tel Hashomer, Israel
Kobi Peleg
Affiliation:
National Center for Trauma & Emergency Medicine Research, The Gertner Institute for Health Policy and Epidemiology and Tel-Aviv University, Disaster Medicine Department
Yitshak Kreiss
Affiliation:
Sheba Medical Center, Tel Hashomer, Israel
Get access

Summary

This chapter focuses on triage management in both national and international mass casualty incidents. They be a sudden-onset natural disaster, a public health emergency of international concern, or a war or armed conflict resulting in the deployment of field level hospitals that are focused on civilians, the military, or both, and are capable of rapid deployment and expansion or contraction to meet immediate emergency requirements for a specified period of time. The goal of triage is to treat as many victims as possible who have an opportunity for survival. Triage does not exist in isolation, but represents a complex process that balances clinical requirements with resource allocation and system management where the decision operatives are the likelihood of medical success and the conservation of scare resources.

Keywords

Triagetriage managementemergency medical teams (EMTs)sudden-onset disasters (SODs)complex humanitarian emergenciespublic health emergencies of international concernmilitary triage
Type
Chapter
Information
Field Hospitals
A Comprehensive Guide to Preparation and Operation
 , pp. 119 - 132
Publisher: Cambridge University Press
Print publication year: 2020

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

World Health Organization (2007). Mass casualty management systems: strategies and guidelines for building health sector capacity. Health Action in Crises, Injuries and Violence Prevention. http://www.who.int/hac/techguidance/MCM_inside_Jul07.pdfGoogle Scholar
GreenIII, WG, McGinnes, SR (2006). Thoughts on the higher order taxonomy of disaster. Notes on the science of extreme situations, paper no. 7. https://www.researchgate.net/profile/Walter_Green_Iii/publication/241053862_thoughts_on_the_higher_order_taxonomy_of_disasters/links/593af7540f7e9b33170df543/thoughts-on-the-higher-order-taxonomy-of-disasters.pdfGoogle Scholar
Burkle, FM Jr, Greenough, PG. Impact of public health emergencies on modern disaster taxonomy, planning, and response. Disaster Medicine and Public Health Preparedness 2008: 2(3): 192–9.CrossRefGoogle ScholarPubMed
WHO–PAHO Guidelines for the use of foreign field hospitals in the aftermath of sudden-impact disasters (2003). International meeting: Hospitals in Disasters: Handle with Care, San Salvador, El Salvador. http://www.who.int/hac/techguidance/pht/FieldHospitalsFolleto.pdfGoogle Scholar
Norton, I, von Schreeb, J, Aitken, P, Herard, P, Lajolo, C. Classification and minimum standards for foreign medical teams in sudden onset disasters. Geneva: World Health Organization; 2013.Google Scholar
World Health Organization. Humanitarian Health Action. Emergency Medical teams. http://www.who.int/hac/techguidance/preparedness/emergency_medical_teams/enGoogle Scholar
Klein, KR, Burkle, FM Jr, Swienton, R, et al. Qualitative analysis of surveyed emergency responders and the identified factors that affect first stage of primary triage decision-making of mass casualty incidents. PLOS Currents 2016: 19: 8.Google Scholar
Federal Interagency Committee on EMS (2011). National Implementation of the Model Uniform Core Criteria for Mass Casualty Incident Triage. A Concept Paper for FICEMS consideration. https://www.ems.gov/pdf/2011/December/10-MUCC_Options_Paper_Final.pdfGoogle Scholar
Benson, M, Koenig, KL, Schultz, CH. Disaster triage: START, then SAVE – a new method of dynamic triage for victims of a catastrophic earthquake. Prehospital and Disaster Medicine 1996: 11(2): 117–24.CrossRefGoogle Scholar
Burkle, FM. Jr Triage. In Antosia, RE, Cahill, JD (eds.), Handbook of bioterrorism and disaster medicine. New York: Springer Science; 2006: 12.Google Scholar
Emergency war surgery. Fourth United States revision, Falls Church, Virginia. Borden Institute, US Army Medical department Center and School, Office of the Surgeon General; 2013.Google Scholar
Merin, O. The evolution of surgical humanitarian missions. In Roth, R, Frost, EAM, Gevirtz, C, Atcheson, C (eds.), The role of anesthesiology in global health, a comprehensive guide. Springer Science+Business Media; 2015.Google Scholar
Merin, O, Miskin, IN, Lin, G, et al. Triage in mass-casualty events: the Haitian experience. Prehospital and Disaster Medicine 2011: 26(5): 386–90.CrossRefGoogle ScholarPubMed
Merin, O, Ash, N, Levy, G, et al. The Israeli field hospital in Haiti – ethical dilemmas in early disaster response. The New England Journal of Medicine 2010: 362(11): e38.Google Scholar
Klein, KR, Pepe, PE, Burkle, FM, et al. Evolving need for alternative triage management in public health emergencies: a Hurricane Katrina case study. Disaster Medicine and Public Health Preparedness 2008: 2 Suppl 1: S40–4.CrossRefGoogle ScholarPubMed
Klein, KR, Nagel, NE. Mass medical evacuation: Hurricane Katrina and nursing experiences at the New Orleans airport. Disaster Management & Response 2007: 5(2): 56–61.CrossRefGoogle ScholarPubMed
Koenig, KL, Dinerman, N, Kuehl, AE. Disaster nomenclature – a functional impact approach: the PICE system. Academic Emergency Medicine 1996: 3(7): 723–7.CrossRefGoogle ScholarPubMed
Winslow, GR. Triage and justice. Berkeley: University of California Press; 1982: 1–23.Google Scholar
Domres, B, Koch, M, et al. Ethics and triage. Prehospital and Disaster Medicine 2001: 16(1): 53–8.Google Scholar
Raynaud, L, Borne, M, Coste, S, et al. Triage protocol: both undertriage and overtriage need to be evaluated. The Journal of Trauma and Acute Care Surgery 2010: 69(4): 998.CrossRefGoogle ScholarPubMed
World Medical Association (Stockholm, Sweden 1994, revised South Africa 2006). Statement on Medical Ethics in the Event of Disasters. Forty-sixth WMA General Assembly. https://www.wma.net/policies-post/wma-statement-on-medical-ethics-in-the-event-of-disasters/Google Scholar
Sasser, SM, Hunt, RC, Faul, M, et al. Guidelines for field triage of injured patients. MMWR Recommendations and Reports 2012: 61: 1–20.Google ScholarPubMed
Davis, T, Dinh, M, Roncal, S, et al. Prospective evaluation of a two-tiered trauma activation protocol in an Australian major trauma reference hospital. Injury 2010: 41: 470–74.CrossRefGoogle Scholar
Cook, CH, Muscarella, P, Praba, AC, et al. Reducing overtriage without compromising outcomes in trauma patients. The Archives of Surgery 2001: 136:752–6.CrossRefGoogle ScholarPubMed
Mohan, D, Rosengart, MR, Farris, C, et al. Assessing the feasibility of the American College of Surgeons’ benchmarks for the triage of trauma patients. The Archives of Surgery 2011: 146(7): 786–92.Google Scholar
Newgard, CD, Zive, D, Holmes, JF, et al. A multisite assessment of the American College of Surgeons Committee on Trauma field triage decision scheme for identifying seriously injured children and adults. Journal of the American College of Surgeons 2011: 213(6): 709–21.CrossRefGoogle ScholarPubMed
Rapsang, AG, Shyam, DC. Scoring systems of severity in patients with multiple trauma. Cirugía Española 2015: 93(4): 213–21.Google ScholarPubMed
O’Laughlin, DT, Hick, JL. Ethical issues in resource triage. Respiratory Care 2008: 53(2): 190–7.Google ScholarPubMed
Society of Critical Care Medicine Ethics Committee. Consensus statement on the triage of critically ill patients. JAMA 1994: 271: 1200–3.Google Scholar
Rosedale, K, Smith, ZA, Davies, H. The effectiveness of the South African triage score (SATS) in a rural emergency department. South African Medical Journal 2011: 101(8): 37–40.Google Scholar
Mullan, PC, Torrey, SB, Chandra, A. Reduced overtriage and undertriage with a new triage system in an urban accident and emergency department in Botswana: a cohort study. Emergency Medicine Journal 2014: 31(5): 356–60.CrossRefGoogle Scholar
Hick, JL, Hanfling, D, Cantrill, SV. Allocating scarce resources in disasters: emergency department principles. Annals of Emergency Medicine 2012: 59(3): 177–87.CrossRefGoogle ScholarPubMed
Altevogt, BM, Stroud, C, Hanson, SL, et al. (2009) Guidance for establishing crisis standards of care for use in disaster situations, a letter report. Board on Health Sciences Policy. Institute of Medicine. Washington DC: The National Academies Press; https://www.nap.edu/read/12749/chapter/1#iiGoogle Scholar
Geneva convention I. Wounded and sick in the field. https://ihl-databases.icrc.org/applic/ihl/ihl.nsf/7c4d08d9b287a42141256739003e636b/fe20c3d903ce27e3c125641e004a92f3Google Scholar
Pollaris, G, Sabbe, M. Reverse triage: more than just another method. European Journal of Emergency Medicine 2016: 23(4): 240–7.Google Scholar
Burkle, FM. Jr Triage in Burkle, FM Jr, Sanner, PH, Wolcott, BW. Disaster medicine: application for the immediate management and triage of civilian and military disaster victims. Elsevier; 45–80.Google Scholar
Giannou, C, Baldan, M. War surgery: working with limited resources in armed conflict and other situations of violence. Volume 1. Geneva, Switzerland; 2010.Google Scholar
Baker, MS. Creating order from chaos: part II: tactical planning for mass casualty and disaster response at definitive care facilities. Military Medicine 2007: 172(3):237–43.Google ScholarPubMed
Baker, MS. Creating order from chaos: part I: triage, initial care, and tactical considerations in mass casualty and disaster response. Military Medicine 2007: 172(3): 232–6.Google Scholar
Burkle, FM. Jr Operationalizing public health skills to resource poor settings: is this the Achilles heel in the Ebola epidemic campaign? Disaster Medicine and Public Health Preparedness 2015: 9(1): 44–6.Google Scholar
Garner, A. Documentation and tagging of casualties in multiple casualty incidents. Emergency Medicine Journal 2003: 15(5–6): 475–9.Google ScholarPubMed
Nocera, A, Garner, A. An Australian mass casualty incident triage system for the future based upon triage mistakes of the past: the Homebush Triage Standard. ANZ Journal of Surgery 1999: 69(8): 603–8.Google ScholarPubMed
Vayer, JS, Ten Eyck, RP, Cowan, ML. New concepts in triage. Annals of Emergency Medicine 1986: 15(8): 927–30.Google Scholar
Martin, M, Izenberg, S, Cole, F. A decade of experience with a selective policy for direct to operating room trauma resuscitations. The American Journal of Surgery 2012: 204(2): 187–92.CrossRefGoogle ScholarPubMed
Sasser, SM, Hunt, RC, Faul, M. Centers for Disease Control and Prevention (CDC). Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage. MMWR Recommendations and Reports 2011. 2012: 61(RR-1): 1–20.Google Scholar
Burkle, FM. JrTriage and the lost art of decoding vital signs: restoring physiologically based triage skills in complex humanitarian emergencies. Disaster Medicine and Public Health Preparedness 2017: 21: 1–10.Google Scholar
Burkle, FM Jr, Orebaugh, S, Barendse, BR. Emergency medicine in the Persian Gulf War – part 1: preparations for triage and combat casualty care. Annals of Emergency Medicine 1994: 23(4): 742–7.Google ScholarPubMed
Burkle, FM Jr, Newland, C, Orebaugh, S. Emergency medicine in the Persian Gulf War – part 2. triage methodology and lessons learned. Annals of Emergency Medicine 1994: 23(4): 748–54.Google ScholarPubMed
Burkle, FM Jr, Newland, C, Meister, SJ. Emergency medicine in the Persian Gulf War – part 3: battlefield casualties. Annals of Emergency Medicine 1994: 23(4): 755–60.Google ScholarPubMed
Burkle, FM. Jr Advances in the methodology of the triage of disaster related casualties. The Japanese Journal of Acute Medicine 1991: 15(13): 1767–72.Google Scholar
Meara, JG, Greenberg, SL. The Lancet commission on global surgery 2030: evidence and solutions for achieving health, welfare and economic development. Surgery 2015: 157(5): 834–5.Google Scholar
Gerdin, M, Wladis, A, von Schreeb, J. Foreign field hospitals after the 2010 Haiti earthquake: how good were we? Emergency Medicine Journal 2013: 30(1): e8.CrossRefGoogle Scholar
van Berlaer, G, Staes, T, Danschutter, D, et al. Disaster preparedness and response improvement: comparison of the 2010 Haiti earthquake-related diagnoses with baseline medical data. European Journal of Emergency Medicine 2016: (Epub ahead of print).Google Scholar
Herard, P, Boillot, F. Amputation in emergency situations: indications, techniques and Médecins Sans Frontières France’s experience in Haiti. International Orthopaedics 2012: 36(10): 1979–81.CrossRefGoogle Scholar
Center for Disaster Philanthropy. Complex Humanitarian Emergencies. http://disasterphilanthropy.org/issue-insight/complex-humanitarian-emergenciesGoogle Scholar
International Committee of the Red Cross. International review of the Red Cross. Volume 93, Number 884, December 2011. https://www.icrc.org/fre/resources/international-review/review-884/review-884-all.pdfGoogle Scholar
Physicians for Human Rights. Anatomy of a crisis: a map of attacks on health care in Syria: findings as of June 2016. https://s3.amazonaws.com/PHR_syria_map/findings.pdfGoogle Scholar
Centers for Disease Control and Prevention. 2014-2016 Ebola Outbreak in West Africa. Online article. https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.htmlGoogle Scholar
Burkle, FM Jr, Burkle, CN. Triage management, survival, and the law in the age of Ebola. Disaster Medicine and Public Health Preparedness 2015: 9(1): 38–43.Google Scholar
Burkle, FM. Jr Operationalizing public health skills to resource poor settings: is this the Achilles heel in the Ebola epidemic campaign? Disaster Medicine and Public Health Preparedness 2015: 9(1): 44–6.CrossRefGoogle ScholarPubMed
Senga, M, Pringle, K, Ramsay, A, et al. Sierra Leone Kenema district task force and Kenema Government Hospital. Factors underlying Ebola virus infection among health workers, Kenema, Sierra Leone, 2014–2015. Clinical Infectious Diseases 2016: 63(4): 454–9.Google Scholar
Broadhurst, MJ, Kelly, JD, Miller, A, et al. ReEBOV antigen rapid test kit for point-of-care and laboratory-based testing for Ebola virus disease: a field validation study. Lancet 2015: 386(9996): 867–74.CrossRefGoogle ScholarPubMed
Walker, NF, Brown, CS, Youkee, D, et al. Evaluation of a point-of-care blood test for identification of Ebola virus disease at Ebola holding units, Western Area, Sierra Leone, January to February 2015. Eurosurveillance 2015: 20(12).CrossRefGoogle ScholarPubMed
Lin, JY, Anderson-Shaw, L. Rationing of resources: ethical issues in disasters and epidemic situations. Prehospital and Disaster Medicine. 2009: 24(3): 215–21.Google Scholar
Talmor, D, Jones, AE, Rubinson, L, et al. Simple triage scoring system predicting death and the need for critical care resources for use during epidemics. Critical Care Medicine 2007: 35(5): 1251–6.Google Scholar
Burkle, FM. Jr Population-based triage management in response to surge-capacity requirements during a large-scale bioevent disaster. Academic Emergency Medicine 2006: 13(11): 1118–29.Google Scholar
Pandemic Influenza Triage Tools. Pandemic Influenza Triage Algorithm. http://www.cdc.gov/phpr/healthcare/pan-flu-app/desktop/pita.html.Google Scholar
Roser, M (2016). War and peace after 1945. https://ourworldindata.org/war-and-peace-after-1945Google Scholar
Hegre, H, Sambanis, N. Sensitivity analysis of empirical results on civil war onset. Journal of Conflict Resolution. 2006: 50(4): 508–35.CrossRefGoogle Scholar
Gerhardt, RT, Mabry, RL, De Lorenzo, RA, et al. Mass-casualty-incident management. In fundamentals of combat casualty care in Lenhardt, MK, Savitsky, E, Eastridge, B (eds.), Combat casualty care. Lessons Learned from OEF and OIF. Office of the Surgeon General, Department of the Army, USA; 2012: 110.Google Scholar
Emergency War Surgery, 4th US Revision, Chapter 3 (Mass Casualty & Triage) P.3.1–3.10. https://quizlet.com/123921745/emergency-war-surgery-4th-us-revision-chapter-3-mass-casualty-triage-4-aeromedical-evacuation-flash-cardsGoogle Scholar
Katoch, R, Rajagopalan, S. Warfare injuries: history, triage, transport and field hospital setup in the armed forces. Medical Journal Armed Forces India 2010: 66(4): 304–8.CrossRefGoogle ScholarPubMed
Gabriel, RA. No more heroes: madness and psychiatry in war. New York: Hill and Wang; 1987.Google Scholar
Military health system echelons of care. In Nessen, SC, Lounsbury, DE, Hetz, SP (eds.), War surgery in Afghanistan and Iraq: a series of cases, 2003–2007. Washington DC: Department of the Army, Office of the Surgeon General, Borden Institute; 2008: 3–6.Google Scholar
Bellamy, Combat trauma overview. In Zaitchuk, R, Grande, CM (eds.), Anesthesia and perioperative care of the combat casualty. Textbook of military medicine. Washington DC: Department of the Army, Office of the Surgeon General, Borden Institute; 1995: 1–42.Google Scholar
Holcomb, JB, Stansbury, LG, Champion, HR, et al. Understanding combat casualty care statistics. The Journal of Trauma and Acute Care Surgery 2006: 60(2): 397–401.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×