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Triage During Mass Gatherings

Published online by Cambridge University Press:  02 October 2012

Sheila A. Turris  and
Adam Lund
Sheila A. Turris*
Affiliation:
School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
Adam Lund
Affiliation:
Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
*
Correspondence: Sheila A. Turris, RN, PhD School of Nursing, University of British Columbia 6th Floor, 132 West Esplanade North Vancouver, British Columbia V7M 1A2, Canada E-mail sheila.turris@mgm.ubc.ca
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Abstract

Triage is a complex process and is one means for determining which patients most need access to limited resources. Triage has been studied extensively, particularly in relation to triage in overcrowded emergency departments, where individuals presenting for treatment often are competing for the available stretchers. Research also has been done in relation to the use of prehospital and field triage during mass-casualty incidents and disasters.

In contrast, scant research has been done to develop and test an effective triage approach for use in mass-gathering and mass-participation events, although there is a growing body of knowledge regarding the health needs of persons attending large events. Existing triage and acuity scoring systems are suboptimal for this unique population, as these events can involve high patient presentation rates (PPR) and, occasionally, critically ill patients. Mass-gathering events are dangerous; a higher incidence of injury occurs than would be expected from general population statistics.

The need for an effective triage and acuity scoring system for use during mass gatherings is clear, as these events not only create multiple patient encounters, but also have the potential to become mass-casualty incidents. Furthermore, triage during a large-scale disaster or mass-casualty incident requires that multiple, local agencies work together, necessitating a common language for triage and acuity scoring.

In reviewing existing literature with regard to triage systems that might be employed for this population, it is noted that existing systems are biased toward traumatic injuries, usually ignoring mitigating factors such as alcohol and drug use and environmental exposures. Moreover, there is a substantial amount of over-triage that occurs with existing prehospital triage systems, which may lead to misallocation of limited resources. This manuscript presents a review of the available literature and proposes a triage system for use during mass gatherings that also may be used in the setting of mass-casualty incidents or disaster responses.

TurrisSA, LundA. Triage During Mass Gatherings. Prehosp Disaster Med. 2012;27(6):1-5.

Keywords

acuity scalescrowdsdisaster triagemass gatheringsmass participationtriage
Type
Research Report
Information
Prehospital and Disaster Medicine , Volume 27 , Issue 6 , December 2012 , pp. 531 - 535
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2012

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References

1.Arbon, P. Mass-gathering medicine: a review of the evidence and future directions for research. Prehosp Disaster Med. 2007;22(2):131-135.CrossRefGoogle ScholarPubMed
2.Arbon, P. The development of conceptual models for mass-gathering health. Prehosp Disaster Med. 2004;19(3):208-212.CrossRefGoogle ScholarPubMed
3.Arbon, P, Bridgewater, FH, Smith, C. Mass gathering medicine: a predictive model for patient presentation and transport rates. Prehosp Disaster Med. 2001;(3):150-158.CrossRefGoogle ScholarPubMed
4.Hodgetts, TJ, Cooke, MW. The largest mass gathering. BMJ. 1999;318(7189):957-958.CrossRefGoogle ScholarPubMed
5.Milsten, AM, Maguire, BJ, Bissell, RA, Seaman, KG. Mass-gathering medical care: a review of the literature. Prehosp Disaster Med. 2002;17(3):151-162.CrossRefGoogle ScholarPubMed
6.Enock, KE, Jacobs, J. The Olympic and Paralympic Games 2012: literature review of the logistical planning and operational challenges for public health. Public Health. 2008;122(11):1229-1238.CrossRefGoogle ScholarPubMed
7.Jenkins, JL, McCarthy, ML, Sauer, LM, et al. Mass-casualty triage: time for an evidence-based approach. Prehosp Disaster Med. 2008;23(1):3-8.CrossRefGoogle ScholarPubMed
8.Murray, M, Bullard, M, Grafstein, E. CTAS National Working Group, CEDIS National Working Group. Revisions to the Canadian Emergency Department Triage and Acuity Scale implementation guidelines. CJEM. 2004;6(6):421-427.CrossRefGoogle Scholar
9.Wuerz, RC, Travers, D, Gilboy, N, Eitel, DR, Rosenau, A, Yazhari, R. Implementation and refinement of the emergency severity index. Acad Emerg Med. 2001;8(2):170-176.CrossRefGoogle ScholarPubMed
10.Finch, CF, Valuri, G, Ozanne-Smith, J. Injury surveillance during medical coverage of sporting events–development and testing of a standardised data collection form. J Sci Med Sport. 1999;2(1):42-56.CrossRefGoogle ScholarPubMed
11.Feldman, MJ, Lukins, JL, Verbeek, RP, MacDonald, RD, Burgess, RJ, Schwartz, B. Half-a-million strong: the emergency medical services response to a single-day, mass-gathering event. Prehosp Disaster Med. 2004;19(4):287-296.CrossRefGoogle ScholarPubMed
12.Zeitz, KM, Schneider, DP, Jarrett, D, Zeitz, CJ. Mass gathering events: retrospective analysis of patient presentations over seven years. Prehosp Disaster Med. 2002;17(3):147-150.CrossRefGoogle ScholarPubMed
13.Robertson-Steel, I. Evolution of triage systems. Emerg Med J. 2006;23(2):154-155.CrossRefGoogle ScholarPubMed
14.Delaney, JS, Drummond, R. Mass casualties and triage at a sporting event. Br J Sports Med. 2002;36(2):85,88; discussion 88.CrossRefGoogle Scholar
15.Erickson, TB, Koenigsberg, M, Bunney, EB, et al. Prehospital severity scoring at major rock concert events. Prehosp Disaster Med. 1997;12(3):195-199.CrossRefGoogle ScholarPubMed
16.Bond, RJ, Kortbeek, JB, Preshaw, RM. Field trauma triage: combining mechanism of injury with the prehospital index for an improved trauma triage tool. J Trauma. 1997;43(2):283-287.CrossRefGoogle ScholarPubMed
17.Boyle, MJ. Is mechanism of injury alone in the prehospital setting a predictor of major trauma - a review of the literature. J Trauma Manag Outcomes. 2007;1(1):4.CrossRefGoogle ScholarPubMed
18.Sharma, BR. Development of pre-hospital trauma-care system–an overview. Injury. 2005;36(5):579-587.CrossRefGoogle ScholarPubMed
19.Bullard, MJ, Unger, B, Spence, J, Grafstein, E. CTAS National Working Group. Revisions to the Canadian Emergency Department Triage and Acuity Scale (CTAS) adult guidelines. CJEM. 2008;10(2):136-142.CrossRefGoogle Scholar
20.Gravel, J, Manzano, S, Arsenault, M. Validity of the Canadian Paediatric Triage and Acuity Scale in a tertiary care hospital. CJEM. 2009;11(1):23-28.CrossRefGoogle ScholarPubMed
21.Dallaire, C, Poitras, J, Aubin, K, Lavoie, A, Moore, L, Audet, G. Interrater agreement of Canadian Emergency Department Triage and Acuity Scale scores assigned by base hospital and emergency department nurses. CJEM. 2010;12(1):45-49.CrossRefGoogle ScholarPubMed
22.Ma, W, Gafni, A, Goldman, RD. Correlation of the Canadian Paediatric Triage and Acuity Scale to ED resource utilization. Am J Emerg Med. 2008;26(8):893-897.CrossRefGoogle ScholarPubMed
23.Field, S, Lantz, A. Emergency department use by CTAS Levels IV and V patients. CJEM. 2006;8(5):317-322.CrossRefGoogle ScholarPubMed
24.FitzGerald, G, Jelinek, GA, Scott, D, Gerdtz, MF. Emergency department triage revisited. Br Med J. 2010;27(2):86.Google ScholarPubMed
25.Elshove-Bolk, J, Mencl, F, van Rijswijck, BT, Simons, MP, van Vugt, AB. Validation of the Emergency Severity Index (ESI) in self-referred patients in a European emergency department. Emerg Med J. 2007;24(3):170-174.CrossRefGoogle Scholar
26.Jimenez, JG, Murray, MJ, Beveridge, R, et al. Implementation of the Canadian Emergency Department Triage and Acuity Scale (CTAS) in the Principality of Andorra: Can triage parameters serve as emergency department quality indicators? CJEM. 2003;5(5):315-322.Google ScholarPubMed
27.J Murray, M. The Canadian Triage and Acuity Scale: a Canadian perspective on emergency department triage. Emerg Med (Fremantle). 2003;15(1):6-10.CrossRefGoogle Scholar
28.Anderson, CK, Zaric, GS, Dreyer, JF, Carter, MW, McLeod, SL. Physician workload and the Canadian Emergency Department Triage and Acuity Scale: the Predictors of Workload in the Emergency Room (POWER) Study. CJEM. 2009;11(4):321-329.Google ScholarPubMed
29.Rothman, RE, Hsu, EB, Kahn, CA, Kelen, GD. Research priorities for surge capacity. Acad Emerg Med. 2006;13(11):1160-1168.CrossRefGoogle ScholarPubMed
30.Armstrong, JH, Frykberg, ER, Burris, DG. Toward a national standard in primary mass casualty triage. Disaster Med Public Health Prep. 2008;2(Supplement 1):S8.CrossRefGoogle Scholar
31.Salhanick, SD, Sheahan, W, Bazarian, JJ. Use and analysis of field triage criteria for mass gatherings. Prehosp Disaster Med. 2003;18(4):347-352.CrossRefGoogle ScholarPubMed
32.Subbe, CP, Slater, A, Menon, D, Gemmell, L. Validation of physiological scoring systems in the accident and emergency department. Emerg Med J. 2006;23(11):841-845.CrossRefGoogle ScholarPubMed
33.Gottschalk, SB, Wood, D, DeVries, S, Wallis, LA, Bruijns, S. Cape Triage Group. The Cape Triage Score: a new triage system South Africa: Proposal from the Cape Triage Group. Emerg Med J. 2006;23(2):149-153.CrossRefGoogle Scholar
34.Navin, DM, Sacco, WJ, McCord, TB. Does START triage work? The answer is clear!. Ann Emerg Med. 2010;55(6):579-580; author reply 580-581.CrossRefGoogle ScholarPubMed
35.Lund, A, Turris, SA, Gutman, SJ, Louis, A. MGM Online Registry Project. Department of Emergency Medicine, University of British Columbia Web site. Accessed December 31, 2010. http://www.ubcmgm.ca/registry/.Google Scholar