Triage Guidelines


Additional References:
  1. Smith JM, Ansari A, Harper FT. Hospital management of mass radiological casualties: reassessing exposures from contaminated victims of an exploded radiological dispersal device. Health Phys. 2005 Nov;89(5):513-20. [PubMed Citation]
  2. Planning Guidance for Response to a Nuclear Detonation, Second edition, 6/2010 (PDF - 2.62 MB) (National Security Staff, Interagency Policy Coordination Subcommittee for Preparedness & Response to Radiological and Nuclear Threats)
  3. Guidelines for Field Triage of Injured Patients, Recommendations of the National Expert Panel on Field Triage (CDC/MMWR Recommendations and Reports 58(RR01);1-35, January 23, 2009)

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"START" Algorithm for Mass Casualty Incidents

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"JumpSTART" Algorithm for Mass Casualty Incidents

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"SALT" Mass Casualty Triage Algorithm

  • SALT
    • Sort,
    • Assess,
    • Lifesaving Interventions,
    • Treatment/Transport
  • See SALT algorithm1, 2, 3, 4 Management algorithm
    — original algorithm adapted for very large radiation emergency

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Other Primary Mass Casualty Triage Systems (selected list)

  • Secondary Assessment of Victim Endpoint (SAVE)5
  • Move, Assess, Sort, Send (MASS)6, 7
  • Sacco Triage Method (STM)8, 9

Other useful tools/systems for predicting morbidity/mortality in critical care

  • Glasgow coma score10
  • Multi-organ dysfunction score (MODS)11
  • Sequential organ failure score (SOFA)12, 13, 14
  • Acute physiology and chronic health evaluation (APACHE II)15

Triage systems sort patients into categories

Triage Systems

  • JumpSTART
  • SALT
  • SAVE
  • MASS
  • STM
Categories *

  • Immediate, Priority 1, Emergency, Red
  • Urgent, Priority 2, Yellow
  • Delayed, Priority 3, Non-urgent, Green,
    Minor/Minimal, Routine
  • Expectant, Black, Blue
  • Dead
* Note:
  • This is a representative but not complete list of the kinds of categories used in various triage systems.
  • Each bullet lists approximate equivalent categories used by various systems.
  • See each system for the exact meaning of the categories used in that system.
  • Systems typically have 4 or 5 categories, some named by color only.
  • The category "Dead" does not appear in all systems.
  • These systems and categories were created typically for trauma triage or critical care assessments, not specifically incidents involving radiation or trauma plus radiation.

References for Primary Mass Casualty Triage Systems and Tools:

  1. Lerner EB, Schwartz RB, Coule PL, et al., Mass casualty triage: An evaluation of the data and development of a proposed national guideline. Disaster Med and Public Health Preparedness, 2008;2(Suppl 1):S25-S34. [PubMed Citation]
  2. SALT Mass Casualty triage: concept endorsed by the American College of Emergency Physicians, American College of Surgeons Committee on Trauma, American Trauma Society, National Association of EMS Physicians, National Disaster Life Support Education Consortium, and State and Territorial Injury Prevention Directors Association. Disaster Med and Public Health Preparedness, 2008;2(4)245-246. [PubMed Citation]
  3. Model uniform core criteria for mass casualty triage. Disaster Med Public Health Prep. 2011 Jun;5(2):125-8. [PubMed Citation]
  4. Lerner EB, Cone DC, Weinstein ES, Schwartz RB, Coule PL, Cronin M, Wedmore IS, Bulger EM, Mulligan DA, Swienton RE, Sasser SM, Shah UA, Weireter LJ Jr, Sanddal TL, Lairet J, Markenson D, Romig L, Lord G, Salomone J, O'Connor R, Hunt RC. Mass casualty triage: an evaluation of the science and refinement of a national guideline. Disaster Med Public Health Prep. 2011 Jun;5(2):129-37. [PubMed Citation]
  5. Benson M, Koenig KL, Schultz CH, Disaster triage: START, then SAVE-a new method of dynamic triage for victims of a catastrophic earthquake. Prehosp Disaster Med, 1996;11:117-125. [PubMed Citation]
  6. Coule P, Dallas C, James J, et al., eds. Basic Disaster Life Support (BDLS) Provider Manual, Chicago: American Medical Association; 2003.
  7. Coule PL, Horner JA. National Disaster Life Support Programs: A platform for multi-disciplinary disaster response. Dent Clin North Am. 2007 Oct;51(4):819-25, vi. [PubMed Citation]
  8. Sacco WJ, Navin DM, Fiedler KE, et al., Precise formulation and evidence-based application of resource-constrained triage. Acad Emerg Med, 2005;12:759-770. [PubMed Citation]
  9. Cone DC, MacMillan DS. Mass-casualty triage systems: A hint of Science. Acad Emerg Med 2005, 12(8): 739-741 [PubMed Citation]
  10. Glasgow Coma Scale (HHS/CDC Accessed December 16, 2008)
  11. Peres Bota D, Melot C, Lopes Ferreira F et al. The multiorgan dysfunction score (MODS) versus the sequential organ failure score (SOFA) score in outcome prediction. Intensive Care Med 2002; 28:1619-1624. [PubMed Citation]
  12. Minne L, Abu-Hanna A, deJonge E, Evaluation of SOFA-based models for predicting mortality in the ICU: A systematic review. Crit Care, 2008; 12:1-12. [PubMed Citation]
  13. Grissom CK, Brown SM, Kuttler KG, Boltax JP, Jones J, Jephson AR, Orme JF Jr. A modified sequential organ failure assessment score for critical care triage. Disaster Med Public Health Prep. 2010 Dec;4(4):277-84. [PubMed Citation]
  14. Rubinson L, Knebel A, Hick JL. MSOFA: An important step forward, but are we spending too much time on the SOFA? Disaster Med Public Health Prep. 2010 Dec;4(4):270-2. [PubMed Citation]
  15. Ho K, Combining sequential organ failure assessment (SOFA) with acute physiology and chronic health evaluation (APACHE) II score to predict hospital mortality of critically ill patients Anaesth Intensive Care 2007; 35:515-521. [PubMed Citation]

Key reviews and comparison of Mass Casualty Triage Systems

  1. Garner A, Lee A, Harrison K, et al. Comparative analysis of multiple-casualty incident triage algorithms. Ann Emerg Med, 2001;38:541-548. [PubMed Citation]
  2. Jenkins JL, McCarthy ML, Sauer LM, et al. Mass-casualty triage: time for an evidence-based approach. Prehosp Disaster Med, 2008;23:3-8 [PubMed Citation]

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Radiation Algorithms

REMM provides algorithms for radiation triage

Other radiation triage algorithms and systems:

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Expected Changes in Triage Categories After Whole-body Irradiation

Scarce Resources Triage Tool:

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Triage Tag

Example of a commercial CBRNE Triage Tag (Wikipedia)

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Suggestions About Where to Send Patients

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