Abstract
BackgroundThe triage system used during an actual mass burn casualty (MBC) incident is a major focus of concern. This study introduces a MBC triage system that was used by a burn center during an actual MBC incident following a powder explosion in New Taipei City, Taiwan.MethodsThis study retrospectively analyzed data from patients who were sent to the study hospital during a MBC incident. The patient list was retrieved from a national online management system. A MBC triage system was developed at the study hospital using the following modifiers: consciousness, breathing, and burn size. Medical records were retrieved from electronic records for analysis. Patient outcomes consisted of emergency department (ED) disposition and intervention.ResultsThe patient population was predominantly female (56.3%), with an average age of 24.9 years. Mean burn sizes relative to the TBSA of triage level I, II, and III patients were 57.9%, 40.5%, and 8.7%, respectively. ICU length of stay differed markedly according to triage level (mean days for levels I vs II vs III: 57.9 vs 39.9 vs 2.5 days; p < 0.001). Triage system levels I and II indicate ICU admission with a sensitivity of 93.9% (95%CI 80.4–98.3%) and a specificity of 86.7% (62.1–96.3%).Overall, 3 (6.3%) patients were under-triaged. Two (4.2%) patients were over-triaged. Sixteen (48.5%) and 21 (63.6%) patients of triage levels I and II received endotracheal intubation and central venous catheterization, respectively. Sorting of the study population with simple triage and rapid treatment (START) showed great sensitivity (100.0%) but poor specificity (53.3%). The Taiwan Triage and Acuity Scale (TTAS) presented 87.9% sensitivity and 93.9% specificity.ConclusionsThe current MBC triage algorithm served as a good indicator of ED disposition but might have raised excessive immediate attention and had the potential to exhaust the available resources. These findings add to our knowledge of the MBC triage system and should help future researchers in adjusting the triage criteria to fit actual disasters.
Highlights
The triage system used during an actual mass burn casualty (MBC) incident is a major focus of concern
Examination of the relationship between triage level and patient outcome can improve the triage system to promote future disaster preparedness. Goals of this investigation This study introduces and validates the MBC triage system that was used by a burn center during an actual MBC incident following a powder explosion in New Taipei City, Taiwan
There was a significant difference in emergency department (ED) intervention between the groups
Summary
The triage system used during an actual mass burn casualty (MBC) incident is a major focus of concern. This study introduces a MBC triage system that was used by a burn center during an actual MBC incident following a powder explosion in New Taipei City, Taiwan. There were concerns about the insufficiency of using START triage in mass burn casualty (MBC) incidents [2]. A universal triage system used in a mass burn casualty (MBC) incident during a gas leak or powder explosion has not been validated [9]. The burn matrix might be appropriate for use by a specialist to determine the tier of care 48 h following injury [10]. The development of a MBC triage system based on an actual event should be validated
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