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Streamlined focused assessment with sonography for mass casualty prehospital triage of blunt torso trauma patients

Published:March 20, 2014DOI:https://doi.org/10.1016/j.ajem.2014.03.014
      Without prompt medical attention and often expedient emergency surgery, earthquake victims having blunt torso trauma will experience increased mortality [
      • Schultz C.H.
      • Koenig K.L.
      • Noji E.K.
      Current concepts—a medical disaster response to reduce immediate mortality after an earthquake.
      ]. Rapid identification of necessary emergent medical vs surgical interventions is critically important. Accurate triage is a necessity, particularly with limited medical resources in the chaos after a mass casualty event. The Simple Triage and Rapid Treatment (START) triage method [
      • Cross K.P.
      • Cicero M.X.
      Head-to-head comparison of disaster triage methods in pediatric, adult, and geriatric patients.
      ] sorts patients into 4 colored tag categories, dependent upon respiratory rate, perfusion (presence of radial pulse and capillary refill time), and mental status (response to commands): red (critically ill patients requiring immediate medical care), yellow (patients in urgent condition, which may receive delayed medical care), green (patients having minor injuries), and black (patients deceased or expectantly soon to be deceased) (Fig. 1). The START method typically requires 3 minutes to complete per patient after an earthquake [
      • Gao Y.
      • Hu H.
      • Jiang J.
      Analysis of consistency for the mass casualty triage START and ISS.
      ]. However, the accuracy of START has been estimated to be 81.6% to 84.2% for blunt torso trauma patients [
      • Hashimoto A.
      • Ueda T.
      • Kuboyama K.
      • Yamada T.
      • Terashima M.
      • Miyawaki A.
      • et al.
      Application of a first impression triage in the Japan Railway West disaster.
      ], leaving significant improvement to be desired.
      Figure thumbnail gr1
      Fig. 1Simple Triage and Rapid Treatment protocol.
      Based on respiratory rate, perfusion (radial pulse presence and capillary refill time), and mental status (ability to obey command), the START procedure sorts patients into 4 triage categories, which include (1) Red tag: Victim requires immediate intervention and transport. Medical attention is required within (60) minutes for survival; (2) Yellow tag: Victim’s transport may be delayed. Serious and potentially life-threatening injuries are included in this strata, but patient status is not expected to deteriorate significantly over several hours; (3) Green tag: Victim had relatively minor injuries and may be able to assist in his/her own care. A proportion will require additional secondary triage; (4) Black tag: Victim is unlikely to survive given severity of injuries, level of available care, or both. Palliative care and pain relief should be provided.
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