Pediatric Multicasualty Incident Triage. Lou E. Romig MD, FAAP, FACEP Miami Children’s Hospital Miami-Dade Fire Rescue FL-5 DMAT. Topics. Triage Categories. What is Triage?. Triage Tools. What is Triage?. “Triage” means “to sort”
Lou E. Romig MD, FAAP, FACEP
Miami Children’s Hospital
Miami-Dade Fire Rescue
What is Triage?
Priority is to get as many soldiers back into action as possible.
Priority is to maximize survival of the greatest number of victims.
Those with the least serious wounds may be the first treatment priority
Those with the most serious but realistically salvageable injuries are treated first
In both models, victims with clearly lethal injuries or those who are unlikely to survive even with extensive resource application are treated as the lowest priority.
This is one of the few places where a "utilitarian rule" governs medicine: the greater good of the greater number rather than the particular good of the patient at hand. This rule is justified only because of the clear necessity of general public welfare in a crisis.
A. Jonsen and K. Edwards, “Resource Allocation” in Ethics in Medicine, Univ. of Washington School of Medicine, http://eduserv.hscer.washington.edu/bioethics/topics/resall.html
Do the best for each individual.
Do the greatest good for the greatest number. Maximize survival.
Life-threatening but treatable injuries requiring rapid medical attention
Potentially serious injuries, but are stable enough to wait a short while for medical treatment
Minor injuries that can wait for longer periods of time for treatment
Dead or still with life signs but injuries are incompatible with survival in austere conditions
Mass Casualty Triage: An Evaluation of the Data and Development of a Proposed National Guideline
E. Brooke Lerner, PhD, Richard B. Schwartz, MD, Phillip L. Coule, MD, et al
DISASTER MEDICINE AND PUBLIC HEALTH PREPAREDNESS - 2(Supplement_1): 25-34 2008
Scene Characterization Triage Priority Order
Multiple casualty; resource levels stressed 4 5 6 3 2 7 1 8+ 2
Estimate about an hour or less to clear the scene.
Large multiple casualty or small mass casualty 5 6 7 8 4 9 3 2 1 9+
requiring staged resources Estimate 1½ to 2½
hours to clear the scene
Mass casualty; resources overwhelmed Estimate 3 or more hours to clear the scene 6 7 8 5 9 10 4 3 2 1 11+
No MCI primary triage tool has been validated by outcome data from MCIs.
Mass-casualty triage: Time for an evidence-based approach. Jenkins JL, McCarthy ML, Sauer LM, Green GB, Stuart S, Thomas TL,
Prehospital Disast Med 2008;23(1):3–8.
It’s likely that no existing MCI triage tool is suitable for use for all types of incidents.
> 2 sec
< 2 sec.
Failure to follow
JumpSTART recommended for prehospital use throughout Israel
Prehospital Response and Field Triage in Pediatric Mass Casualty Incidents: The Israeli Experience
Yehezkel Waisman, MD, Lisa Amir, MD, MPH, Meirav Mor, MD, et al Clin Ped Emerg Med 7:52-58, 2006
The ages of “tweens and teens” can be hard to determine so the current recommendation is:
If a victim appears to be a child, use JumpSTART.
If a victim appears to be a young adult, use START.
Patients who are able to walk are assumed to have stable, well-compensated physiology, regardless of the nature of their injuries or illness.
DO NOT CONTINUE TO VENTILATE THE PATIENT. RESUME TRIAGE DUTIES.