Triage study challenges notions of emergency medical response to disaster

Terra Daily: In the face of terrorism and catastrophic natural disasters, modern regional trauma systems that improve survival for critically injured patients are more vital than ever. Yet many fundamental assumptions underlying these systems-such as the notion that it is imperative to send the sickest patients to the hospital first-have rarely been subjected to rigorous scientific scrutiny. Now, for the first time, researchers at NewYork-Presbyterian Hospital/Weill Cornell Medical Center have created a computer simulation model of trauma system response to mass casualty incidents involving dozens or hundreds of injured victims.

The study shows that the best response depends more on the capability of regional hospitals to treat critically injured victims than on the ability to accurately identify those victims in the field. "There's been the notion gleaned from prior studies that 'overtriage'-letting some people into emergency care who might not actually need it-usually ends up costing lives, with deaths rising as overtriage rates increase. But our new model demonstrates that overtriage alone is unlikely to be the culprit," says lead researcher Dr. Nathaniel Hupert, assistant professor of public health and medicine at Weill Cornell Medical College and assistant attending physician at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

Instead, levels of overtriage can be beneficial, harmless or detrimental, depending on complex factors included in the researchers' model, he says. Those factors include the capacity of medical facilities to deal with the wounded and the time it takes to process and care for patients.

"No triage system is 100-percent accurate, so the key issue to define from an outcomes perspective is, 'How good is good-enough?'" Dr. Hupert says. "Our study suggests that pre-disaster planning can begin to address this question systematically, using modeling that takes into account local resources and response times, as well as specific types of mass casualty events."

The study is published in a special October supplement on mass casualty incidents of the journal Disaster Medicine and Public Health Preparedness, which focuses on the Virginia Tech shooting….

The bottom line, according to the researchers, is that the "best" triage strategy during a mass casualty event is probably one that takes into account a variety of local and regional factors, which means that use of the model should spur regional collaboration and information sharing. "We hope that this type of modeling study will be used to help disaster response teams plan effective strategies to deal with mass casualty events occurring in their own specific regions," Dr. Hupert says. "We can never predict when or where disaster will strike, but with models like these we can hope to be more prepared."…