A Validation Study of 5 Triage Systems Using Data From the 2005 Graniteville, South Carolina, Chlorine Spill

Validating Signs and Symptoms From An Actual Mass Casualty Incident to Characterize An Irritant Gas Syndrome Agent (IGSA) Exposure: A First Step in The Development of a Novel IGSA Triage Algorithm

“…Data analysis for the Graniteville study showed an overestimate of the victims classified as Level l and Level 2 using the ESI triage system and an underestimate of red (immediate) victims by the START/JumpSTART (pediatric START) system. 1 Patients exposed to chemicals can experience dramatic and latent changes in S/S, (specifically low oxygen saturation), requiring ongoing monitoring and evaluation, which current triage systems do not consider. 1 Triage algorithms specific to IGSA exposures are needed to accurately determine the priority of care.…”

“…Rapid medical assessment and accurate identification of a chemical exposure by first responders and emergency nurses are crucial in reducing death and disability. 1–4 A study of the January, 2005 Graniteville, SC chlorine disaster that killed nine and sent hundreds to the local community hospital found that usual triage systems do not recognize signs/symptoms (S/S) specific to irritant gas syndrome agents (IGSA), or latent signs of respiratory distress associated with chemical exposures. 1–4 IGSA gasses/liquids (also known as choking, lung or pulmonary agents) include such chemicals as chlorine, anhydrous ammonia and sulfur dioxide, may cause severe irritation and swelling of the respiratory tract (lining of the nose, throat, and lungs).…”

“…1–4 A study of the January, 2005 Graniteville, SC chlorine disaster that killed nine and sent hundreds to the local community hospital found that usual triage systems do not recognize signs/symptoms (S/S) specific to irritant gas syndrome agents (IGSA), or latent signs of respiratory distress associated with chemical exposures. 1–4 IGSA gasses/liquids (also known as choking, lung or pulmonary agents) include such chemicals as chlorine, anhydrous ammonia and sulfur dioxide, may cause severe irritation and swelling of the respiratory tract (lining of the nose, throat, and lungs). 5,6 None of the triage systems analyzed in our previous study 1 demonstrated efficacy in establishing priorities for treatment of chlorine victims.…”

“…1–4 IGSA gasses/liquids (also known as choking, lung or pulmonary agents) include such chemicals as chlorine, anhydrous ammonia and sulfur dioxide, may cause severe irritation and swelling of the respiratory tract (lining of the nose, throat, and lungs). 5,6 None of the triage systems analyzed in our previous study 1 demonstrated efficacy in establishing priorities for treatment of chlorine victims. Furthermore, no informatics tools currently exist to assist first responders and emergency nurses in processing victims efficiently, to continuously monitor for latent S/S, or to provide triage recommendations for IGSA exposures.…”

“…Furthermore, no informatics tools currently exist to assist first responders and emergency nurses in processing victims efficiently, to continuously monitor for latent S/S, or to provide triage recommendations for IGSA exposures. 1–4 To mitigate the “surge” of casualties into emergency departments after a chemical mass casualty incident (MCI), informatics solutions are needed for emergency nurses to quickly and accurately identify, process, and triage patients. This study describes the validation of the S/S of an IGSA syndrome using patient data from an actual incident.…”