Prehospital Triage for Mass Casualties
A mass casualty incident (MCI) is a disaster or major incident characterized by a quantity, severity, and diversity of injuries in patients that can rapidly overwhelm the ability of local medical resources to deliver comprehensive and definitive medical care. Multiple resources, such as EMS, police, hospitals, and equipment, will likely be depleted/exhausted during an MCI.
It is important that a rapid and effective triage system be performed to evaluate the number and severity of patients. During an MCI, resources are limited. The goal is to perform the greatest good for the largest number of people. Overall, patients should be rapidly organized into categories by using a triage system.
There are numerous triage systems currently available that include START (simple triage and rapid treatment), SALT (sort, assess, lifesaving interventions, treatment/triage), SAVE (secondary assessment of victim endpoint), and STM (sacco triage method). No matter which system is used, the goal is to perform minimal care to determine which patients have the greatest survival chance. This can be difficult as training always encourages giving comprehensive care and saving lives, but in an MCI, there will be severely ill patients who are determined to have a poor survival chance and there should be no attempt to save their life. All triage systems organize patients using a universal color coding system.
Tag Color in the Triage System:
Black: Expectant - Unlikely to survive given injuries
Red: Immediate - Requires immediate medical attention for survival
Yellow: Delayed - Has serious injuries, but not immediately life threatening
Green: Minor - Minor injuries that patient could survive for days
There should always be consideration of scene safety before entering/engaging in any MCI. Large areas will need to be identified and marked for patients to be placed based on the color of the tag. Always notify the local hospital as early as possible so that preparation and resources can be allocated to help care for the multiple patients.
The severity level of a patient can change. The triage system is fluid. It is important that patients are monitored once organized into a certain color tag zone. It is possible for any patient to become more ill or decompensate. If this happens, a patient’s color tag may need to be upgraded to a more severe color. Frequent reevaluation of patients is imperative in any triage system.
You arrive to a mall shooting and police report that the scene has been cleared and is safe. You enter to find multiple victims. There is a 56-year-old male who is walking toward you with a hand that is bleeding. There is a 34-year-old female who is not breathing and when you reposition her airway, she still does not breathe. There is a 12-year-old boy who is breathing and the respiratory rate is 12 breaths per minute. There is a 19-year-old female who is lying on the ground breathing with a respiratory rate of 20 breaths per minute with a radial pulse and is able to blink her eyes. How would you triage these patients using START and JumpSTART?
56-year-old male - Green
34-year-old female - Black
12-year-old boy - Red
19-year-old female - Yellow
