Triage in Complex, Coordinated Terrorist Attacks

Abstract

Introduction:Terror attacks have increased in frequency, and tactics utilized have evolved. This creates significant challenges for first responders providing life-saving medical care in their immediate aftermath. The use of coordinated and multi-site attack modalities exacerbates these challenges. The use of triage is not well-validated in mass-casualty settings, and in the setting of intentional mass violence, new and innovative approaches are needed.Methods:Literature sourced from gray and peer-reviewed sources was used to perform a comparative analysis on the application of triage during the 2011 Oslo/Utoya Island (Norway), 2015 Paris (France), and 2015 San Bernardino (California USA) terrorist attacks. A thematic narrative identifies strengths and weaknesses of current triage systems in the setting of complex, coordinated terrorist attacks (CCTAs).Discussion:Triage systems were either not utilized, not available, or adapted and improvised to the tactical setting. The complexity of working with large numbers of patients, sensory deprived environments, high physiological stress, and dynamic threat profiles created significant barriers to the implementation of triage systems designed around flow charts, physiological variables, and the use of tags. Issues were identified around patient movement and “tactical triage.”Conclusion:Current triage tools are inadequate for use in insecure environments, such as the response to CCTAs. Further research and validation are required for novel approaches that simplify tactical triage and support its effective application. Simple solutions exist in tactical triage, patient movement, and tag use, and should be considered as part of an overall triage system.

How to stop the dying, as well as the killing, in a terrorist attack

“…Current triage systems allocate patients into broad groups commonly described as priorities 1, 2, and 3. But reports from marauding terrorist attacks12 have revealed difficulties in recalling and applying these triage systems. The complex problem of defining the triage priorities in the priority 1 group itself remains a significant challenge and is likely to require senior experienced clinicians.…”

Development of the Aerial Remote Triage System using drones in mass casualty scenarios: A survey of international experts

“…However, none of the existing systems are applicable in all situations, since their use is not specified, for example in situations where there may be biological, chemical, radiological or infection risks [ 21 ], poor illumination [ 18 ], rural, or mountainous areas, in short in MCIs or emergencies that are complex or difficult to access [ 22 ]. So, the objective of our study was the development and initial testing of a remote triage procedure using drones.…”

Mobile Triage Applications: A Systematic Review in Literature and Play Store

“…Emergency triage can be identified as the "day-to-day" triage where patients arrive at the emergency department and are classified according to certain levels and, depending on their severity, the waiting time to be treated will be longer or shorter [2]. On the other hand, triage in catastrophes is when the service is faced with a catastrophe (complex emergency) and the situation becomes much more complex with a massive number of victims to be attended with insufficient resources, in this case it is necessary that the triage be fast, simple and standard in order to save the greatest number of victims with the available resources [4,9].…”