Biomedical Engineering Reference
In-Depth Information
The adequacy of the triage system used depends
on the nature of the event and the population
affected. For example, systems such as START
and JumpSTART are trauma-oriented and may
be effective in an explosive event. Traditional
epidemic approaches to triage, considered more
appropriate for biological events, sort infected
patients into three categories: susceptible individ-
uals, infected individuals, and removed individ-
uals (by successful
Appendix G.B Preliminary Review of
Selected Emergency Response Protocols
and Models
A preliminary review of a number of triage proto-
cols and preparedness models was conducted prior
to the expert meeting to assess the extent to which
these documents provided explicit guidance on the
issue of altered standards of care in the context
of a mass casualty event. Brief summaries of the
review of several field triage protocols and the
Modular Emergency Medical System (MEMS) are
presented below.
immunization, recovery, or
death).
These standards have the impact of allocating
resources for patient care. The standards are
relevant to pre-hospital, hospital, and alternate
care sites and to a situation where resources
are constrained and demand is so great that
rationing is required. While most systems offer
detailed clinical measurements of status for triage
purposes, they do not, by definition, provide actual
clinical protocols for the treatment
Field Triage Protocols
One category of altered standards of care focuses
on specific methods for field triage. In a mass
casualty situation of any magnitude, methods of
triage, or sorting victims according to their condi-
tion and resources available, are used to iden-
tify and, if possible, move to immediate treat-
ment those who are most likely to survive or
can benefit the most from treatment. Thus, triage
standards address who receives care and when
care is provided or the urgency with which it is
provided. Triage is performed most often by first
responders.
Triage begins in the field if there is a fixed event
site; however, it also occurs within care settings,
such as hospitals and alternate care sites, where
individual victims may present themselves for care
independent of organized responses. Secondary
triage also may be necessary within a facility, such
as a hospital, as demands on the system grow.
Several well-established standards for triage
are currently in use. 1 5 Triage systems include
START; JumpSTART (a pediatric modification to
START); START, then SAVE; MASS; and others.
Each system seeks to establish a small number of
categories among victims that indicate the urgency
with which they should be treated. Colors are often
used to represent the categories—for example, red
(immediate care); yellow (delayed); green (ambu-
latory and minor injuries); and black (dead and/or
“expectant).
that would
follow.
Modular Emergency Medical System
Another type of standard that is pertinent to this
discussion is one that addresses the organization
of care and provides a context in which triage
and medical care guidelines would be used. The
Modular Emergency Medical System (MEMS)
offers a comprehensive plan of operations and stan-
dards for responding to a mass casualty event of
such size that alternate care delivery sites would
be required.
MEMS emerged in response to Title IV of
The Defense against Weapons of Mass Destruc-
tion Act of 1996 (Public Law 104-201). The law
required that the Secretary of Defense develop
and carry out a program to improve the responses
of Federal, State, and local agencies to emergen-
cies involving biological and chemical weapons.
In response, the U.S. Department of Defense
(DOD) created the Biological Warfare Improved
Response Program. DOD then invited the Depart-
ments of Health and Human Services (DHHS),
Energy (DOE), and Agriculture (USDA), and the
Federal Emergency Management Agency (FEMA),
the Federal Bureau of Investigation (FBI) and
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