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      Triage, monitoring, and treatment of mass casualty events involving chemical, biological, radiological, or nuclear agents

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          Abstract

          In a mass casualty situation due to chemical, biological, radiological, or nuclear (CBRN) event, triage is absolutely required for categorizing the casualties in accordance with medical care priorities. Dealing with a CBRN event always starts at the local level. Even before the detection and analysis of agents can be undertaken, zoning, triage, decontamination, and treatment should be initiated promptly. While applying the triage system, the available medical resources and maximal utilization of medical assets should be taken into consideration by experienced triage officers who are most familiar with the natural course of the injury presented and have detailed information on medical assets. There are several triage systems that can be applied to CBRN casualties. With no one standardized system globally or nationally available, it is important for deploying a triage and decontamination system which is easy to follow and flexible to the available medical resources, casualty number, and severity of injury.

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          Mass-casualty triage: time for an evidence-based approach.

          Jennifer Lee Jenkins, Melissa L McCarthy, Lauren M Sauer … (2015)
          Mass-casualty triage has developed from a wartime necessity to a civilian tool to ensure that constrained medical resources are directed at achieving the greatest good for the most number of people. Several primary and secondary triage tools have been developed, including Simple Treatment and Rapid Transport (START), JumpSTART, Care Flight Triage, Triage Sieve, Sacco Triage Method, Secondary Assessment of Victim Endpoint (SAVE), and Pediatric Triage Tape. Evidence to support the use of one triage algorithm over another is limited, and the development of effective triage protocols is an important research priority. The most widely recognized mass-casualty triage algorithms in use today are not evidence-based, and no studies directly address these issues in the mass-casualty setting. Furthermore, no studies have evaluated existing mass-casualty triage algorithms regarding ease of use, reliability, and validity when biological, chemical, or radiological agents are introduced. Currently, the lack of a standardized mass-casualty triage system that is well validated, reliable, and uniformly accepted, remains an important gap. Future research directed at triage is recognized as a necessity, and the development of a practical, universal, triage algorithm that incorporates requirements for decontamination or special precautions for infectious agents would facilitate a more organized mass-casualty medical response.
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            Triage: techniques and applications in decision making.

            K. Kennedy, R Aghababian, L. Gans … (1996)
            Correct decision making may have far-reaching consequences. Triage is an area in which decision-makers must know what they are doing, why they are doing it, and which actions to take to achieve a satisfactory outcome. Triage has its origins in military history and today is used in a variety of medical settings. In this article we focus on the role of triage in disaster situations, its application in military settings, and its use in disaster medicine. Useful concepts enabling correct decision making by the triage officer include the application of computer technology and a review of methods of patient categorization. The dynamic nature of triage and the role of the triage officer as part of a team approach to disaster patient management are highlighted. We explore techniques for the successful training and education of triage officers and investigate a model of the emergency physician as the triage officer.
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              Hospital preparedness for weapons of mass destruction incidents: an initial assessment.

              Paul M. Furbee, C G Stamper, K N Treat … (2001)
              We performed an assessment of hospital preparedness for weapons of mass destruction (WMD) incidents in Federal Emergency Management Agency (FEMA) Region III. Interviews of hospital personnel were completed in 30 hospitals. Data collected included level of preparedness, mass decontamination capabilities, training of hospital staff, and facility security capabilities. No respondents believed their sites were fully prepared to handle a biologic incident, 73% (22/30) believed they were not prepared to manage a chemical weapons incident, and 73% believed they were unprepared to handle a nuclear event. If a WMD incident were to occur, 73% of respondents stated a single-room decontamination process would be set up. Four (13%) hospitals (all rural) reported no decontamination plans. WMD preparedness had been incorporated into hospital disaster plans by 27% (8/30) of facilities. Eighty-seven percent (26/30) believed their emergency department could manage 10 to 50 casualties at once. Only 1 facility had stockpiled any medications for WMD treatment. All facilities had established networks of communication. No hospital had preprepared media statements specific to WMD. Nearly one fourth (7/30) stated that their hospital staff had some training in WMD event management. All reported need for WMD-specific training but identified obstacles to achieving this. Seventy-seven percent (23/30) of hospitals had a facility security plan in place, and half were able to perform a hospital-wide lock down. Ninety-six percent (29/30) reported no awareness regarding the threat of a secondary device. Hospitals in this sample do not appear to be prepared to handle WMD events, especially in areas such as mass decontamination, mass medical response, awareness among health care professionals, health communications, and facility security. Further research is warranted, including a detailed assessment of WMD preparedness using a statistically valid sample representative of hospital emergency personnel at the national level.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Pharm Bioallied Sci
                Journal ID (publisher-id): JPBS
                Title: Journal of Pharmacy and Bioallied Sciences
                Publisher: Medknow Publications Pvt Ltd (India )
                ISSN (Print): 0976-4879
                ISSN (Electronic): 0975-7406
                Publication date (Print): Jul-Sep 2010
                Volume: 2
                Issue: 3
                Pages: 239-247
                Affiliations
                [1]Ramaiah Medical College and Hospitals, MSR Nagar, MSRIT Post, Bangalore - 560 054, India
                Author notes
                Address for correspondence: Dr. Aruna C. Ramesh, E-mail: arunacr2@ 123456gmail.com
                Article
                Publisher ID: JPBS-2-239
                DOI: 10.4103/0975-7406.68506
                PMC ID: 3148628
                PubMed ID: 21829319
                SO-VID: 88392f59-4f0e-450d-8e66-4a35f58c9341
                Copyright © © Journal of Pharmacy and Bioallied Sciences
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 04 July 2010
                Date revision received : 04 July 2010
                Date accepted : 06 July 2010
                Categories
                Subject: Symposium

                ScienceOpen disciplines: Pharmacology & Pharmaceutical medicine
                Keywords: treatment,or nuclear event,chemical,casualty,radiological,biological
                Data availability:
                ScienceOpen disciplines: Pharmacology & Pharmaceutical medicine
                Keywords: treatment, or nuclear event, chemical, casualty, radiological, biological

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