Mostly Dead: Can Science Help With Disaster Triage?

Abstract

In this issue of Annals, Schultz et al 2 Kahn C.A. Schultz C.H. Miller K.T. et al. Does START triage work? An outcomes assessment after a disaster. Ann Emerg Med. 2009; 54: 424-430 Abstract Full Text Full Text PDF PubMed Scopus (149) Google Scholar report on the actual use and outcomes, after a train crash, of simple triage and rapid treatment (START) triage, a commonly used system of mass-casualty acuity-based patient sorting. They conclude that START triage substantially overtriages patients, and thus, although it may be useful in ensuring that the critically ill receive immediate care, it may be less helpful in preventing “flooding” of the medical system by an overwhelming number of casualties. This study is one of the few to examine actual use of a triage method after a real disaster, and as such its conclusions must be given great weight. To interpret this result, it may be helpful to review the purpose of disaster triage. Does START Triage Work? An Outcomes Assessment After a DisasterAnnals of Emergency MedicineVol. 54Issue 3PreviewThe mass casualty triage system known as simple triage and rapid treatment (START) has been widely used in the United States since the 1980s. However, no outcomes assessment has been conducted after a disaster to determine whether assigned triage levels match patients' actual clinical status. Researchers hypothesize that START achieves at least 90% sensitivity and specificity for each triage level and ensures that the most critical patients are transported first to area hospitals. Full-Text PDF