Triage Categories and Cytokine (G-CSF) Use after A Nuclear Detonation

  • When to use this tool
    • After a nuclear explosion when the number of potential victims could be so large that
    • Senior managers would communicate to their triage teams when it is appropriate to use this tool instead of normal triage procedures.
  • Goals of this tool
    • Recommend triage categories (Immediate, Delayed, Minor, Expectant) for managing very large numbers of victims with injury, burns and/or radiation exposure based on
      • Patient factors
      • Availability of resources (staff, supplies, space) at the medical center where it is used
    • Recommend priorities for using white cell (myeloid) cytokines when availability of this drug is limited by the number of patients who might need it.
    • Provide the greatest good to the greatest number of patients using fair and ethical principles
  • Who is the tool for?
    • Senior, supervisory triage managers
    • Triage teams operating under the supervision of senior managers
  • Where would this tool be used?
    • Wherever patients undergo medical triage
  • How was the tool developed?
    • HHS convened an expert working group from outside and inside of government that evaluated options for optimizing triage of huge numbers of patients after a nuclear detonation.
    • Using computer modeling, experts assessed the outcome of various methods of prioritizing patients under various circumstances.
    • The triage system presented here was shown to provide the greatest good to the greatest number of patients using fair and ethical principles.
    • See details in the publications.
  • CAVEATS:
    • Emergency responders must understand that this tool does NOT use the customary definitions of standard triage categories:
      • Immediate, Delayed, Minor, Expectant
    • With significant stress on resources, the usual triage strategy of managing the sickest first may be modified in order to provide the greatest good to the greatest number.
    • Categories defining resource availability:
      • IOM Letter Report uses 3 categories: Normal, Good, and Fair/Poor
      • The Nuclear Detonation Scarce Resources Working Group Triage Tool uses 4 categories: Normal, Good, Fair, and Poor
    • Categories defining standards of care:
      • Both the IOM Letter Report and the Nuclear Detonation Scarce Resources Working Group Triage Tool use 3 categories: conventional, contingency, crisis.
    • See details in the publications.