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	You are here: Home > Triage Guidelines		Planning Guidance for Response to a Nuclear Detonation, 1/2009 (Homeland Security Council) Key Response Planning Factors for the Aftermath of Nuclear Terrorism, 8/2009 (Lawrence Livermore National Laboratory) Population Monitoring in Radiation Emergencies: A Guide for State and Local Public Health Planners, 8/2007 (HHS/CDC)    New Users: Where Do I Start? What's New on REMM Patient Management Algorithms Print Algorithms & Tables Isotopes of Interest Countermeasures Decontamination Procedures Dose Estimator for Exposure Manage ARS Subsyndromes Multi-organ Dysfunction Syndrome Hematopoietic Subsyndrome Cutaneous Radiation Syndrome Time/Dose Effects in ARS Time Phases of ARS Strategic National Stockpile Animations, Illustrations, Photos Dictionary Emergency Contacts Download REMM (6/2009) Download Mobile REMM (6/2009)    AFRRI AHRQ CDC CRCPD DHS DOE EPA FDA HHS   HPS IAEA ICRP NCRP NRC OSHA REAC/TS RITN WHO
	Triage Guidelines Overview "START" Algorithm (Simple Triage and Rapid Treatment) for Mass Casualty Events Other Primary Mass Casualty Triage Systems Radiation Algorithms Expected Changes in Triage Categories After Whole-body Irradiation Sample of Triage Tag Usable in Radiation Incident (PDF - 127 KB) Overview REMM provides algorithms for radiation treatment. These reflect radiation issues not trauma specific issue. Contamination Exposure Exposure + Contamination Sample of Triage Tag Usable in Radiation Incident (PDF - 127 KB) Additional References: 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] Planning Guidance for Response to a Nuclear Detonation, First edition, 1/16/2009 (PDF - 1.69 MB), (Homeland Security Council Interagency Policy Coordination Subcommittee for Preparedness and Response to Radiological and Nuclear Threats) top of page "START" Algorithms for Mass Casualty Events "START" Algorithm (Adults) JumpSTART Algorithm (Children) top of page Other Primary Mass Casualty Triage Systems (selected list) Sort, Assess, Life Saving Interventions, Treatment and/or Transport (SALT)1, 2 Secondary Assessment of Victim Endpoint (SAVE)3 Move, Assess, Sort, Send (MASS)4, 5 Sacco Triage Method (STM)6, 7 Other useful tools/systems for predicting morbidity/mortality in critical care Glasgow coma score8 Multi-organ dysfunction score (MODS)9 Sequential organ failure score (SOFA)10 Acute physiology and chronic health evaluation (APACHE II)11 Triage systems sort patients into categories Triage Systems START 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: 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] 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] 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] Coule P, Dallas C, James J, et al., eds. Basic Disaster Life Support (BDLS) Provider Manual, Chicago: American Medical Association; 2003. 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] 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] Cone DC, MacMillan DS. Mass-casualty triage systems: A hint of Science. Acad Emerg Med 2005, 12(8): 739-741 [PubMed Citation] Glasgow Coma Scale (HHS/CDC Accessed December 16, 2008) 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] 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] 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 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] 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] top of page   Radiation Algorithms REMM provides algorithms for radiation triage Contamination Exposure Exposure + Contamination Other radiation triage algorithms and systems: HHS Hrdina CM, Coleman CN, Bogucki S, Bader JL, Hayhurst RE, Forsha JD, Marcozzi D, Yeskey K, Knebel AR. The "RTR" medical response system for nuclear and radiological mass-casualty incidents: a functional TRiage-TReatment-TRansport medical response model. Prehosp Disaster Med. 2009 May-Jun;24(3):167-78. [PubMed Citation] Coleman CN, Hrdina C, Bader JL, Norwood A, Hayhurst R, Forsha J, Yeskey K, Knebel A. Medical Response to a Radiologic/Nuclear Event: Integrated Plan From the Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services. Ann Emerg Med. 2009 Feb;53(2):213-22. [PubMed Citation] Other US Government Armed Forces Radiobiology Research Institute (AFRRI) - Biodosimetry Assessment Tool (BAT) Medical management of radiological casualties handbook (PDF - 977 KB) (AFRRI) Treatment of Combined Injuries in a Radiation Incident (REAC/TS) International Medical Management of Radiation Accidents: Manual on the Acute Radiation Syndrome. (METREPOL) (PDF - 970 KB) (originally published by Oxford: British Institute of Radiology; 2001) Compendium to the main METREPOL document (PDF - 580 KB) European approach for the medical management of mass radiation exposure (PDF - 252 KB) (European group for Blood Marrow Transplantation, Ulm University - Germany, Radioprotection and Nuclear Safety Institute - France) Triage, Monitoring and Treatment - Handbook for management of the public in the event of malevolent use of radiation (Registration required for download) (TMT Handbook Partners) Kuniak M, Azizova T, Day R, Wald N, Suyama J, Zhang A, Sumina MV, Pesternikova VS, Vasilenko E, Soaita A, Slaughter DM. The Radiation Injury Severity Classification (RISC) system: an early injury assessment tool for the frontline health-care provider. Br J Radiol. 2008 Mar;81(963):232-43. [PubMed Citation] Azizova TV, Osovets SV, Day RD, et al. Predictability of acute radiation injury severity. Health Phys. 2008 Mar;94(3):255-63. [PubMed Citation] Other Thoma GE, Wald N. The diagnosis and management of accidental radiation injury. J Occup Med 1959;1:421-47. top of page Expected Changes in Triage Categories After Whole-body Irradiation D 1. Based on dose of radiation (in units of gray) (What is gray (Gy)?) 2. Priorities in triage of patients with and without combined injury 3. Definition of triage categories: minimal, delayed, immediate, expectant Source: Planning Guidance for Response to a Nuclear Detonation, First edition, page 74, 1/16/2009 (PDF - 1.69 MB), (Homeland Security Council Interagency Policy Coordination Subcommittee for Preparedness and Response to Radiological and Nuclear Threats) top of page

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