1. Mass Casualty Incident (MCI) Triage Author Jacob Kopp National Center for Disaster Preparedness Mailman School of Public Health Columbia University Date 14 April 2011

2. Outline Introductions Define triage Review the three most common triage methods Triage in a military setting Key takeaways

3. Introduction Jacob Kopp –10 years pre-hospital medicine Military/Civilian Pre-hospital/Hospital –MPH candidate, Columbia University –Research Assistant at the National Center for Disaster Preparedness

4. What is MCI Triage The systematic assessment and categorization of patients by severity and likelihood of survival with available resources, for the greatest number of patients in the shortest period of time.

5. What is MCI Triage Maximizing survivability –In a MCI the emphasis shifts from the individual to the population. Triage situations mandate that individual autonomy be placed secondary to the collective good.

6. When to MCI Triage Three conditions must be met if triage is to be appropriately employed: –A scarcity of healthcare resources exists; –A healthcare worker assesses each patient’s medical needs; and, –The triage officer uses a system usually based on an algorithm or criteria set, to determine a treatment or assign a treatment priority to each patient.

7. Civilian Triage Models Three main models: –SACCO (STM) –START/JumpSTART –SALT

8. SACCO –Bill Sacco PhD –Maximize the expected number of survivors –Analysis of respiratory rate, pulse and motor response adjusted for age and MOI –Explicit; objective –Outcome driven, measured by lives saved –Can be used on a daily basis –Expensive –Not being used by any organizations

9. SACCO

10. -3 -2

11. SACCO slow deterioration rapid deterioration transitional deterioration.09.15.23.35.98.97.94.90.75.63.49.84 RPM: 1 2 3 4 5 6 7 8 9 10 11 12

12. START Simple Triage And Rapid Treatment Do the greatest good for the greatest number Used by most pre-hospital professionals Easy Not specific; subjective Can’t be measured Can’t be reproduced; no formulation of problem

13. JumpSTART The world's first objective tool developed specifically for the triage of children in the multi-casualty/disaster setting. Objectives: –Optimize the primary triage of injured children in the MCI setting –Enhance the effectiveness of resource allocation for all MCI victims –Reduce the emotional burden on triage personnel who may have to make rapid life-or-death decisions about injured children in chaotic circumstances *Not for daily EMS or hospital triage

14. Civilian Triage Models

17. S.A.L.T. Sort Assess Lifesaving Intervention Treatment/Transport The new National Standard for performing triage. Developed by a Multidisciplinary committee with a CDC grant

18. S.A.L.T.

19. Military Triage TCCC –Tactical Combat Casualty Care –Three phases Care Under Fire Tactical Field Care Combat Casualty Evacuation –Subjective triage DIME –Delayed –Immediate –Minimal –Expectant

20. Key Takeaways Expect to be overwhelmed There are three types of patient: –Those that will die despite every resource; –Those that will survive only with the proper intervention; and, –Those that will survive without any medical aid The hardest part of triage is deciding where the line between delayed and immediate falls

21. Thank You