Gleaning data from disaster: A hospital-based data mining method to study all-hazard triage after a chemical disaster

Abstract

Objective The objective of this paper is to describe the methods of evaluating currently available triage models for their efficacy in appropriately triaging the surge of patients after an all-hazards disaster. Design We developed a method for evaluating currently available triage models using extracted data from medical records of the victims from the Graniteville chlorine disaster. Setting On January 6, 2005, a freight train carrying three tanker cars of liquid chlorine was inadvertently switched onto an industrial spur in central Graniteville, South Carolina. The train then crashed into a parked locomotive and derailed. This caused one of the chlorine tankers to rupture and immediately release ~60 tons of chlorine. Chlorine gas infiltrated the town with a population of 7,000. Participants This research focuses on the victims who received emergency care in South Carolina. Results With our data mapping and decision tree logic, we were successful in employing the available extracted clinical data to estimate triage categories for use in triage effectiveness research. Conclusions The methodology outlined in this paper can be used to assess the performance of triage models after a disaster. The steps are reliable and repeatable and can easily be extended or applied to other disaster datasets.

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

“…Because this study focused on triage efficacy, the initial clinical presentation data were exclusively used to assess triage effecacy and the later clinical data collected during the remainder of the hospitalization or treatment within the ED were simply used contextually or to determine the actual severity of injury. 5 This methodology was described by Culley et al . 5 …”

“…16 However, due to the surge of patients to the ED at the time of the chlorine incident, that medical resource was not completed for all patients. 5 …”

“…1 To mitigate the ‘surge’ of casualties into a healthcare facility after a mass casualty event, hospitals and emergency responders use triage to assess patients and prioritize care with the goal of saving as many lives as possible. However, the proposed national guideline for existing mass casualty triage does not take fully into account all hazards events 4 that include chemical incidents requiring decontamination and toxidrome (a group of symptoms or a specific syndrome associated with exposure to a specific poison or agent 5,6 ) assessment.…”

“…The train derailed and heavily damaged chlorine tankers ruptured, immediately releasing approximately 60 tons of chlorine. 5,21 Within minutes, the dense chlorine gas infiltrated the surrounding town with a population of over 7,000. Nine people died, 71 were hospitalized, 840 were treated as outpatients, and 220 experienced immediate health problems including skin, eye, nose and throat injuries.…”

Validation of a novel irritant gas syndrome triage algorithm

“…6,7 Currently, there is no triage system that is appropriate to manage an IGSA MCI such as the Graniteville, SC, chlorine release in 2005 or the Minot, ND, anhydrous ammonia release in 2002. 3,8-10 Therefore, the development of triage informatics tools to manage IGSA MCIs is essential.…”