Mass Casualty Triage: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Ling ,  LI Jing , LI Youping , XU Lin

Division of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

LI Jing, Email: lijing68@hotmail.com

Keywords：

Mass casualty incident; Triage; Systematic review; Earthquake

DOI：

10.7507/1672-2531.20080107

Video：

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Objective 　To investigate the mass casualty triage system and its application, to provide evidence and advice for its future standardized use.
Method 　Based on the principles and methods of systematic reviews, we searched MEDLINE (1950 to 2008), The Cochrane library (Issue 2, 2008) and CBM (from establishment to May 2008) to identify papers written in English of Chinese which described mass casualty triage systems or triage systems specific to the aftermath of earthquakes. We extracted information on name, grades, criteria, main characteristics and application of each triage system from the papers involving mass casualty triage systems. We also extracted information on setting, personnel performing the triage, grades, and characteristics from those papers describing any specific triage system for earthquake. We compared the colour of tags, codes and other materials used in different triage systems.
Result 　We included 38 English and 6 Chinese papers. For mass casualty triage systems, we identified 7 primary triage methods with 4 grades.Three of these had relevant application reports. There were 6 secondary triage methods with 3-5 grades, and none had relevant application reports. Four tag methods were identified. Seven papers, 2 of which were published in China, reported specific secondary triage methods for earthquakes.
Conclusion 　Based on the current evidence, there is no universally accepted mass casualty triage system with documented reliability and validity. No triage system has been developed specifically for the wounded in earthquakes. There are large differences between the triage methods for earthquake and other mass casualty incidents. Future research should focus on the development of a reliable and valid mass casualty triage system, aimed at maximizing the capacity for medical rescue.

Citation： WANG Ling,LI Jing,LI Youping,XU Lin. Mass Casualty Triage: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2008, 08(7): 469-476. doi: 10.7507/1672-2531.20080107 Copy

1.	Slater MS, Trunkey DD. Terrorism in America. An evolving threat. Archives of Surgery, 1997, 132(10): 1059-1066.
2.	Iserson KV, Moskop JC. Triage in Medicine, Part I: Concept, History, and Types. Annals of Emergency Medicine, 2007, 49(3): 275-281.
3.	Pesik N, Keim ME, Iserson KV. Terrorism and the ethics of emergency medical care. Annals of Emergency Medicine, 2001, 37(6): 642-646.
4.	Waeckerle JF. Disaster planning and response. New England Journal of Medicine, 1991, 324(12): 815.
5.	Jenkins JL, McCarthy ML, Sauer LM. Mass-casualty triage: time for an evidence-based approach. 2008.
6.	Sacco WJ, Nvain M, Fiedler EA. Precise formulation and evidence-based application of resource-constrained triage. Acad Emerg Med, 2005, 12(8): 759.
7.	Baker MS. Creating Order from Chaos: Part I: Triage, Initial Care, and Tactical Considerations in Mass Casualty and Disaster Response. Military Medicine, 2007, 172(3): 232-236.
8.	列本蒂施, 斯托尔茨, 王衍发. 军事医学若干问题. 北京: 解放军出版, 1984, 438-446.
9.	温世浩, 周亚平, 戴阳. 灾害现场救援大批伤员分类的方法. 灾害学, 2007, 22(1): 138-140.
10.	Killeen JP, Chan TC, Vilke GM. 223 Wireless Computerized Rapid Triage in the Field: How Well Does Technology Perform During Mass Casualty Incidents and Disaster Events? Annals of Emergency Medicine, 2006, 48(4S): 69-69.
11.	Gao T, Massey T, Selavo L. The Advanced Health and Disaster Aid Network: A Light-Weight Wireless Medical System for Triage. Biomedical Circuits and Systems, IEEE Transactions on, 2007, 1(3): 203-216.
12.	Fry EA, Lenert LA. MASCAL: RFID Tracking of Patients, Staff and Equipment to Enhance Hospital Response to Mass Casualty Events. AMIA Annual Symposium Proceedings, 2005, 2005: 261.
13.	Gao T, White D. A Next Generation Electronic Triage to Aid Mass Casualty Emergency Medical Response. Engineering in Medicine and Biology Society, 2006. EMBS’06. 28th Annual International Conference of the IEEE, 2006.
14.	On-Line CEU. Simple Triage and Rapid Transport (START) On-Line CEU for the Peoria Area EMS System and OSF Saint Francis Medical Center’s ED Staff.
15.	Nocera A, Garner A. AN AUSTRALIAN MASS CASUALTY INCIDENT TRIAGE SYSTEM FOR THE FUTURE BASED UPON TRIAGE MISTAKES OF THE PAST: THE HOMEBUSH TRIAGE STANDARD. Aust NZJ Surg, 1999, 69(8): 603-608.
16.	孙志刚, 李宏立. 地震伤员分类的方法和原则. 灾害学, 2001, 16(001): 61-64.
17.	Ramirez M, Peek-Asa C. Epidemiology of Traumatic Injuries from Earthquakes. Epidemiologic Reviews, 2005, 27(1): 47-55.
18.	Baker MS. Creating Order from Chaos: Part II: Tactical Planning for Mass Casualty and Disaster Response at Definitive Care Facilities. Military Medicine, 2007, 172(3): 237-243.
19.	Romig LE. Pediatric triage. A system to JumpSTART your triage of young patients at MCIs.
20.	Hodgetts TJ. Mackway-Jones K., Major Incident Medical Management and Support. The Practical Approach. 1995, BMJ Publishing Group, London.
21.	Hodgetts TJ, Hedges, JR, Irwin L, et al. Paediatric triage tape. Pre-hospital Immediate Care, 1998, 2: 155-159.
22.	Garner A, Lee A, Harrison K, et al. Comparative analysis of multiple-casualty incident triage algorithms. Annals of Emergency Medicine, 2001, 38(5): 541-548.
23.	赵兴吉. 院前急救在灾难救援中的作用. 中华急诊医学杂志, 2007, 11.
24.	Benson M, Koenig KL, Schultz CH. Disaster triage: START, then SAVE--a new method of dynamic triage for victims of a catastrophic earthquake.
25.	Redmond AD, Watson S, Nightingale P. The south Manchester Accident Rescue Team and the earthquake in Iran, June 1990. BMJ, 1991, 302(6791): 1521-1523.
26.	樱庭和典. 阪神大地震的医疗拣选与伦理研究. 医学与哲学, 1997, 18(006): 322-324.
27.	Hsu EB, Matthew M, Lin FY, et al. Emergency medical assistance team response following Taiwan Chi-Chi earthquake. Prehospital & Disaster Medicine, 2002, 17(1): 17-22.
28.	Halpern P, Rosen B, Carasso S, et al. Intensive care in a field hospital in an urban disaster area: Lessons from the August 1999 earthquake in Turkey*. Critical Care Medicine, 2003, 31(5): 1410.
29.	Emami MJ, Tavakoli AR, Alemzadeh H, et al. Strategies in Evaluation and Management of Bam Earthquake Victims. Prehospital Disaster Med, 2005, 20(5): 327-330.
30.	Mulvey JM, Awan SU, Qadri AA, et al. Profile of injuries arising from the 2005 Kashmir Earthquake: The first 72h. Injury, 2007.
31.	李大江, 张卫东, 刘启望. 汶川地震医疗救援中的伤员接诊处置与转出管理. 中国循证医学杂志, 2008, 8(6): 4.
32.	Larrey RR. Surgeon to Napoleon’s Imperial Guard. 1974, London: John Murray.
33.	Welch CE. War wounds of the abdomen. N Engl J Med, 1947, 237: 156-162.
34.	Weinerman, ER, Ratner RS, Robbins A, et al. Yale studies in ambulatory medical care. V. Determinants of use of hospital emergency services. American Journal of Public Health and the Nations Health, 1966, 56(7): 1037.
35.	Torbjorn T. Ethical aspects of triage in mass casualty. Current Opinion in Anaesthesiology, 2007, 20(2): 143.
36.	Kennedy K, Aghababian RV, Gans L, et al. Triage: techniques and applications in decision making. Annals of Emergency Medicine, 1996, 28(2): 136-144.
37.	Ueberle HK, Rose TK. Medical policy in the management of a mass casualty situation with special regard to sorting. Med Law, 1985, 4(3): 275-282.
38.	Wallis L. START is not the best triage stategy. British Medical Journal, 2002, 36(6): 473.
39.	Wesson DE, Scorpio R. Field triage--help or hindrance? Can J Surg, 1992, 35(1): 19-21.
40.	Sacco WJ, Navin M, Fiedler EA. Precise Formulation and Evidence-based Application of Resource-constrained Triage. Academic Emergency Medicine, 2005, 12(8): 759-770.
41.	Wallis LA, Carley S. Comparison of paediatric major incident primary triage tools. British Medical Journal, 2006, 23(6): 475.
42.	Gebhart ME, Pence R. START Triage: Does It Work? Disaster Management & Response, 2007, 5(3): 68-73.
43.	Li WP. 1996~ 2003 年全世界灾害地震统计分析. 華北地震科學, 2005, 23(2): 54-64.
44.	Benson M, Koenig KL, Schultz CH. Disaster triage: START, then SAVE--a new method of dynamic triage for victims of a catastrophic earthquake. Prehospital & Disaster Medicine, 1996, 11(2): 117-124.
45.	Nufer KE, Richards ME. Different medical needs between hurricane and earthquake victims. Ann Emerg Med, 2004, 44.
46.	Mulholland SA, Gabbe BJ, Cameron P. Is paramedic judgement useful in prehospital trauma triage? Injury, 2005, 36(11): 1298-1305.
47.	Simmons E, Hedges JR, Irwin L, et al. Paramedic Injury Severity Perception Can Aid Trauma Triage. Annals of Emergency Medicine, 1995, 26(4): 461-468.

1. Slater MS, Trunkey DD. Terrorism in America. An evolving threat. Archives of Surgery, 1997, 132(10): 1059-1066.
2. Iserson KV, Moskop JC. Triage in Medicine, Part I: Concept, History, and Types. Annals of Emergency Medicine, 2007, 49(3): 275-281.
3. Pesik N, Keim ME, Iserson KV. Terrorism and the ethics of emergency medical care. Annals of Emergency Medicine, 2001, 37(6): 642-646.
4. Waeckerle JF. Disaster planning and response. New England Journal of Medicine, 1991, 324(12): 815.
5. Jenkins JL, McCarthy ML, Sauer LM. Mass-casualty triage: time for an evidence-based approach. 2008.
6. Sacco WJ, Nvain M, Fiedler EA. Precise formulation and evidence-based application of resource-constrained triage. Acad Emerg Med, 2005, 12(8): 759.
7. Baker MS. Creating Order from Chaos: Part I: Triage, Initial Care, and Tactical Considerations in Mass Casualty and Disaster Response. Military Medicine, 2007, 172(3): 232-236.
8. 列本蒂施, 斯托尔茨, 王衍发. 军事医学若干问题. 北京: 解放军出版, 1984, 438-446.
9. 温世浩, 周亚平, 戴阳. 灾害现场救援大批伤员分类的方法. 灾害学, 2007, 22(1): 138-140.
10. Killeen JP, Chan TC, Vilke GM. 223 Wireless Computerized Rapid Triage in the Field: How Well Does Technology Perform During Mass Casualty Incidents and Disaster Events? Annals of Emergency Medicine, 2006, 48(4S): 69-69.
11. Gao T, Massey T, Selavo L. The Advanced Health and Disaster Aid Network: A Light-Weight Wireless Medical System for Triage. Biomedical Circuits and Systems, IEEE Transactions on, 2007, 1(3): 203-216.
12. Fry EA, Lenert LA. MASCAL: RFID Tracking of Patients, Staff and Equipment to Enhance Hospital Response to Mass Casualty Events. AMIA Annual Symposium Proceedings, 2005, 2005: 261.
13. Gao T, White D. A Next Generation Electronic Triage to Aid Mass Casualty Emergency Medical Response. Engineering in Medicine and Biology Society, 2006. EMBS’06. 28th Annual International Conference of the IEEE, 2006.
14. On-Line CEU. Simple Triage and Rapid Transport (START) On-Line CEU for the Peoria Area EMS System and OSF Saint Francis Medical Center’s ED Staff.
15. Nocera A, Garner A. AN AUSTRALIAN MASS CASUALTY INCIDENT TRIAGE SYSTEM FOR THE FUTURE BASED UPON TRIAGE MISTAKES OF THE PAST: THE HOMEBUSH TRIAGE STANDARD. Aust NZJ Surg, 1999, 69(8): 603-608.
16. 孙志刚, 李宏立. 地震伤员分类的方法和原则. 灾害学, 2001, 16(001): 61-64.
17. Ramirez M, Peek-Asa C. Epidemiology of Traumatic Injuries from Earthquakes. Epidemiologic Reviews, 2005, 27(1): 47-55.
18. Baker MS. Creating Order from Chaos: Part II: Tactical Planning for Mass Casualty and Disaster Response at Definitive Care Facilities. Military Medicine, 2007, 172(3): 237-243.
19. Romig LE. Pediatric triage. A system to JumpSTART your triage of young patients at MCIs.
20. Hodgetts TJ. Mackway-Jones K., Major Incident Medical Management and Support. The Practical Approach. 1995, BMJ Publishing Group, London.
21. Hodgetts TJ, Hedges, JR, Irwin L, et al. Paediatric triage tape. Pre-hospital Immediate Care, 1998, 2: 155-159.
22. Garner A, Lee A, Harrison K, et al. Comparative analysis of multiple-casualty incident triage algorithms. Annals of Emergency Medicine, 2001, 38(5): 541-548.
23. 赵兴吉. 院前急救在灾难救援中的作用. 中华急诊医学杂志, 2007, 11.
24. Benson M, Koenig KL, Schultz CH. Disaster triage: START, then SAVE--a new method of dynamic triage for victims of a catastrophic earthquake.
25. Redmond AD, Watson S, Nightingale P. The south Manchester Accident Rescue Team and the earthquake in Iran, June 1990. BMJ, 1991, 302(6791): 1521-1523.
26. 樱庭和典. 阪神大地震的医疗拣选与伦理研究. 医学与哲学, 1997, 18(006): 322-324.
27. Hsu EB, Matthew M, Lin FY, et al. Emergency medical assistance team response following Taiwan Chi-Chi earthquake. Prehospital & Disaster Medicine, 2002, 17(1): 17-22.
28. Halpern P, Rosen B, Carasso S, et al. Intensive care in a field hospital in an urban disaster area: Lessons from the August 1999 earthquake in Turkey*. Critical Care Medicine, 2003, 31(5): 1410.
29. Emami MJ, Tavakoli AR, Alemzadeh H, et al. Strategies in Evaluation and Management of Bam Earthquake Victims. Prehospital Disaster Med, 2005, 20(5): 327-330.
30. Mulvey JM, Awan SU, Qadri AA, et al. Profile of injuries arising from the 2005 Kashmir Earthquake: The first 72h. Injury, 2007.
31. 李大江, 张卫东, 刘启望. 汶川地震医疗救援中的伤员接诊处置与转出管理. 中国循证医学杂志, 2008, 8(6): 4.
32. Larrey RR. Surgeon to Napoleon’s Imperial Guard. 1974, London: John Murray.
33. Welch CE. War wounds of the abdomen. N Engl J Med, 1947, 237: 156-162.
34. Weinerman, ER, Ratner RS, Robbins A, et al. Yale studies in ambulatory medical care. V. Determinants of use of hospital emergency services. American Journal of Public Health and the Nations Health, 1966, 56(7): 1037.
35. Torbjorn T. Ethical aspects of triage in mass casualty. Current Opinion in Anaesthesiology, 2007, 20(2): 143.
36. Kennedy K, Aghababian RV, Gans L, et al. Triage: techniques and applications in decision making. Annals of Emergency Medicine, 1996, 28(2): 136-144.
37. Ueberle HK, Rose TK. Medical policy in the management of a mass casualty situation with special regard to sorting. Med Law, 1985, 4(3): 275-282.
38. Wallis L. START is not the best triage stategy. British Medical Journal, 2002, 36(6): 473.
39. Wesson DE, Scorpio R. Field triage--help or hindrance? Can J Surg, 1992, 35(1): 19-21.
40. Sacco WJ, Navin M, Fiedler EA. Precise Formulation and Evidence-based Application of Resource-constrained Triage. Academic Emergency Medicine, 2005, 12(8): 759-770.
41. Wallis LA, Carley S. Comparison of paediatric major incident primary triage tools. British Medical Journal, 2006, 23(6): 475.
42. Gebhart ME, Pence R. START Triage: Does It Work? Disaster Management & Response, 2007, 5(3): 68-73.
43. Li WP. 1996~ 2003 年全世界灾害地震统计分析. 華北地震科學, 2005, 23(2): 54-64.
44. Benson M, Koenig KL, Schultz CH. Disaster triage: START, then SAVE--a new method of dynamic triage for victims of a catastrophic earthquake. Prehospital & Disaster Medicine, 1996, 11(2): 117-124.
45. Nufer KE, Richards ME. Different medical needs between hurricane and earthquake victims. Ann Emerg Med, 2004, 44.
46. Mulholland SA, Gabbe BJ, Cameron P. Is paramedic judgement useful in prehospital trauma triage? Injury, 2005, 36(11): 1298-1305.
47. Simmons E, Hedges JR, Irwin L, et al. Paramedic Injury Severity Perception Can Aid Trauma Triage. Annals of Emergency Medicine, 1995, 26(4): 461-468.

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