Collaborative Research: In Search of the Greatest Good with Imperfect Triage in the Aftermath of Mass-Casualty Events

University Of North Carolina At Chapel Hill, Chapel Hill NC

Investigators

Abstract

The objective of this collaborative research project is to use mathematical models to investigate if and when triage is useful in the aftermath of mass-casualty incidents. The first stage of the project will develop and analyze mathematical models to identify conditions under which triage is most or least useful given that triage takes time and resources, and is imperfect. The second stage will focus on understanding the effects of triage errors on the expected number of survivors. In particular, the project will examine whether overtriage can be useful as suggested by some in the emergency medicine literature. The research will investigate the effective management of triage errors given that some degree of error is inevitable. Finally, in the third stage, a realistic simulation study will be carried out to test the basic principles and policies obtained in the first two stages. This research project will contribute directly to the society's continuing efforts in improving emergency response systems. Mass-casualty incidents overwhelm the emergency response resources of a community and triage is the means by which these resources are rationed. However, potential benefits of patient triage are unclear mainly for two reasons. First, triage takes time and resources, which can be otherwise used, for example, for stabilizing patients. Second, triage decisions are highly error-prone with a significant overtriage rate. Although these problems have been recognized before, there has been no systematic effort to investigate whether triage meets its intended goals. The current practice largely relies on the belief that triage must have some benefits. The objective of this research is to question this belief and in doing that identify conditions under which triage is useful/harmful, when it makes sense to eliminate triage and move directly to treatment or transportation, and investigate the effects of triage errors.