Disaster Triage Systems for Large-scale Catastrophic Events

Abstract

Large-scale catastrophic events typically result in a scarcity of essential medical resources and accordingly necessitate the implementation of triage management policies to minimize preventable morbidity and mortality. Accomplishing this goal requires a reconceptualization of triage as a population-based systemic process that integrates care at all points of interaction between patients and the health care system. This system identifies at minimum 4 orders of contact: first order, the community; second order, prehospital; third order, facility; and fourth order, regional level. Adopting this approach will ensure that disaster response activities will occur in a comprehensive fashion that minimizes the patient care burden at each subsequent order of intervention and reduces the overall need to ration care. The seamless integration of all orders of intervention within this systems-based model of disaster-specific triage, coordinated through health emergency operations centers, can ensure that disaster response measures are undertaken in a manner that is effective, just, and equitable.

Portable ultrasound in disaster triage: a focused review

“…The understanding of mass casualty and disaster medical management is critical to the effective management of the same [74,75]. Care priorities in an MCI differ significantly from those in routine civilian incidents [75].…”

The Professionalization of International Disaster Response: It Is Time for Midwives to Get Ready

“…If a disaster zone health care facility, for example, has access to just one small tank of oxygen per day, or there are only a few vials of gentamicin left, or a single set of sterile instruments is available to perform one cesarean, then decisions must be made about who is eligible to justify use of those scarce resources and who is not. The best course of action is to make sure all VHPs are trained in mass casualty triage and to approach decisions about rationing as a team that includes both local and visiting multidisciplinary health professionals, relevant community leaders, and culture brokers …”

“…Crisis standards of care are guidelines to assist health professionals to provide the “best possible medical care when there are not enough resources to give all patients the level of care they would receive under normal circumstances.” The Sphere Project is universally recognized as a global leader on these issues, and the Institute of Medicine has published a comprehensive document addressing crisis standards for the US context. Mass casualty triage systems define crisis standards to assist emergency responders and clinicians in focusing on the utilitarian ethics of extreme resource limitations in overwhelming situations where some victims may not survive due to the inability to deliver the needed but unavailable level of medical care . Additionally, guidelines and protocols are currently being debated and developed regarding how to prepare for and adequately staff health facilities during a deadly epidemic, radiation release, or bioterrorism scenario .…”

Intensive and Critical Care Medicine

“…While some general principles appear to be recognized for the triage of adult patients [86,[88][89][90][91][92][93][94][95][96][97], there is very little published material on the allocation of scarce resources for children in the context of mass casualties or disasters [80,98]. The tenets of the accountability for reasonableness [99][100][101][102] may be useful in working through this process.…”