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Triage in Complex, Coordinated Terrorist Attacks

Part of: Prehospital and Disaster Medicine Counterterrorism Collection

Published online by Cambridge University Press:  07 August 2019

Matt Pepper Open the ORCID record for Matt Pepper [Opens in a new window] ,
Frank Archer  and
John Moloney
Matt Pepper*
Affiliation:
Monash University Accident Research Centre, Melbourne, Victoria, Australia
Frank Archer
Affiliation:
Monash University Accident Research Centre, Melbourne, Victoria, Australia
John Moloney
Affiliation:
Monash University Community Emergency Health and Paramedics, Melbourne, Victoria, Australia
*
Correspondence: Matt Pepper, MPhil, Monash University Accident Research Centre, 4 Karloo Pde, Newport, Sydney, NSW, Australia 2106, E-mail: Matt@atma.net.au
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Abstract

Introduction:

Terror attacks have increased in frequency, and tactics utilized have evolved. This creates significant challenges for first responders providing life-saving medical care in their immediate aftermath. The use of coordinated and multi-site attack modalities exacerbates these challenges. The use of triage is not well-validated in mass-casualty settings, and in the setting of intentional mass violence, new and innovative approaches are needed.

Methods:

Literature sourced from gray and peer-reviewed sources was used to perform a comparative analysis on the application of triage during the 2011 Oslo/Utoya Island (Norway), 2015 Paris (France), and 2015 San Bernardino (California USA) terrorist attacks. A thematic narrative identifies strengths and weaknesses of current triage systems in the setting of complex, coordinated terrorist attacks (CCTAs).

Discussion:

Triage systems were either not utilized, not available, or adapted and improvised to the tactical setting. The complexity of working with large numbers of patients, sensory deprived environments, high physiological stress, and dynamic threat profiles created significant barriers to the implementation of triage systems designed around flow charts, physiological variables, and the use of tags. Issues were identified around patient movement and “tactical triage.”

Conclusion:

Current triage tools are inadequate for use in insecure environments, such as the response to CCTAs. Further research and validation are required for novel approaches that simplify tactical triage and support its effective application. Simple solutions exist in tactical triage, patient movement, and tag use, and should be considered as part of an overall triage system.

Keywords

Emergency Medical Servicestactical medicineterrorismtriage
Type
Special Report
Information
Prehospital and Disaster Medicine , Volume 34 , Issue 4 , August 2019 , pp. 442 - 448
Copyright
© World Association for Disaster and Emergency Medicine 2019 

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