Mass Casualty Incident (MCI) Triage

Author

Jacob Kopp

National Center for Disaster PreparednessMailman School of Public Health

Columbia University

Date14 April 2011

Outline

• Introductions• Define triage• Review the three most common triage methods• Triage in a military setting• Key takeaways

Introduction

• Jacob Kopp– 10 years pre-hospital medicine

• Military/Civilian• Pre-hospital/Hospital

– MPH candidate, Columbia University– Research Assistant at the National Center for

Disaster Preparedness

What is MCI Triage

• The systematic assessment and categorization of patients by severity and likelihood of survival with available resources, for the greatest number of patients in the shortest period of time.

What is MCI Triage

• Maximizing survivability – In a MCI the emphasis shifts from the

individual to the population. • Triage situations mandate that individual

autonomy be placed secondary to the collective good.

When to MCI Triage

• Three conditions must be met if triage is to be appropriately employed:

– A scarcity of healthcare resources exists;– A healthcare worker assesses each

patient’s medical needs; and,– The triage officer uses a system usually

based on an algorithm or criteria set, to determine a treatment or assign a treatment priority to each patient.

Civilian Triage Models

• Three main models:– SACCO (STM)– START/JumpSTART– SALT

SACCO

– Bill Sacco PhD– Maximize the expected number of survivors – Analysis of respiratory rate, pulse and motor

response adjusted for age and MOI– Explicit; objective – Outcome driven, measured by lives saved – Can be used on a daily basis– Expensive– Not being used by any organizations

SACCO

SACCO

-3 -3 -2

SACCO

Survival Probability Curve for Blunt Trauma

0

0.2

0.4

0.6

0.8

1

1.2

Physiological Score

Suvr

ival

Pro

babi

lity

slow deterioration

rapiddeterioration

transitional deterioration .09 .15 .23 .35

.98.97.94.90.75

.63.49

.84

RPM: 1 2 3 4 5 6 7 8 9 10 11 12

START

• Simple Triage And Rapid Treatment• Do the greatest good for the greatest number • Used by most pre-hospital professionals• Easy• Not specific; subjective • Can’t be measured • Can’t be reproduced; no formulation of problem

JumpSTART

• The world's first objective tool developed specifically for the triage of children in the multi-casualty/disaster setting.

• Objectives:– Optimize the primary triage of injured children in

the MCI setting– Enhance the effectiveness of resource allocation

for all MCI victims – Reduce the emotional burden on triage personnel

who may have to make rapid life-or-death decisions about injured children in chaotic circumstances

• *Not for daily EMS or hospital triage

Civilian Triage Models

S.A.L.T.

• Sort• Assess• Lifesaving Intervention• Treatment/Transport

• The new National Standard for performing triage.• Developed by a Multidisciplinary committee with a

CDC grant

S.A.L.T.

Military Triage

• TCCC– Tactical Combat Casualty Care– Three phases

• Care Under Fire • Tactical Field Care• Combat Casualty Evacuation

– Subjective triage • DIME

– Delayed– Immediate – Minimal – Expectant

Key Takeaways

• Expect to be overwhelmed• There are three types of patient:

– Those that will die despite every resource;– Those that will survive only with the proper

intervention; and, – Those that will survive without any medical aid

• The hardest part of triage is deciding where the line between delayed and immediate falls

Thank You