Prehospital and Disaster Medicine

Case Study

Triage in Mass-Casualty Events: The Haitian Experience

Ofer Merina1a2a3, Ian N. Miskina1a3a4, Guy Lina5, Itay Wisera1 and Yitshak Kreissa1

a1 Israel Defense Forces Medical Corps Field Hospital, Jerusalem, Israel

a2 Trauma Unit and Department of Cardiothoracic Surgery, Shaare Zedek Medical Center, Jerusalem, Israel

a3 Hebrew University Faculty of Medicine, Jerusalem, Israel

a4 Clalit Health Services, Jerusalem District, Israel

a5 General Surgery, Rambam Medical Center, Haifa, Israel

Abstract

Introduction: Mass-casualty triage is implemented when available resources are insufficient to meet the needs of all patients in a disaster situation. The basic principle is to do the maximum good for the most casualties with the least amount of resources. There are limited data to support the applicability of this principle in massive disasters such as the January 2010 earthquake in Haiti, in which the number of patients seeking medical attention overwhelmed the local resources.

Objective: To analyze the application of a triage system developed for use in a mass-casualty setting with limited resources. The system was designed to admit only those patients who had medical conditions requiring urgent treatment that were within the capabilities of the hospital and had a good chance of survival after discharge. Priority was given to those whose treatment could be administered within a short hospital stay.

Method: A retrospective, observational review of computerized registration forms of Haitian earthquake victims who sought medical care at a 72-bed field hospital within four to 14 days after the event. An analysis of the efficacy of the triage protocol that was used followed, using length of hospital stay to measure consumption of resources.

Results: A total of 1,111 patients were triaged for treatment in the field hospital within 14 days of the earthquake. The median length of stay for all patients for whom data was available was 16 hours (mean = 29.7 hours). The majority of patients (n = 620, 65%) were discharged within 24 hours. Two hundred five patients underwent surgery and were discharged within a median of 39 hours (mean = 52.6 hours); of these, 124 (62%) were discharged within 48 hours. The total mortality of the treated patients was 1.5% (n = 17).

Conclusions: Currently accepted triage principles for the most part are appropriate for efficiently providing medical care in a disaster area with extremely limited resources, but require extensive adaptation to local conditions.

(Received January 31 2011)

(Accepted February 17 2011)

(Revised March 07 2011)

(Online publication January 27 2011)

Correspondence:

c1 Correspondence: Ofer Merin, MD Department of Cardiothoracic Surgery Shaare Zedek Medical Center POB 3235, Tel Aviv 91031, Israel E-mail: merin@szmc.org.il

Footnotes

Merin O, Miskin IN, Lin G, Wiser I, Kreiss Y: Triage in mass-casualty events: the Haitian experience. Prehosp Disaster Med 2011;26(5):386–390.