Continuous integrated triage is an approach to triage

Triage

Triage or ) is the process of determining the priority of patients' treatments based on the severity of their condition. This rations patient treatment efficiently when resources are insufficient for all to be treated immediately. The term comes from the French verb trier, meaning to separate,...

 in mass casualty

Casualty (person)

A casualty is a person who is the victim of an accident, injury, or trauma. The word casualties is most often used by the news media to describe deaths and injuries resulting from wars or disasters...

 situations. It is both efficient and sensitive to psychosocial and disaster

Disaster

A disaster is a natural or man-made hazard that has come to fruition, resulting in an event of substantial extent causing significant physical damage or destruction, loss of life, or drastic change to the environment...

 behavioral health

Behavioral health

In psychology behavioral health, as a general concept, refers to the reciprocal relationship between human behavior, individually or socially, and the well-being of the body, mind, and spirit, whether the latter are considered individually or as an integrated whole...

 issues that effect the number of patients seeking care (surge), the manner in which a hospital or healthcare facility deals with that surge (surge capacity), and the overarching medical needs of the event.



Continuous integrated traige combines three forms of triage with progressive specificity to most rapidly identify those patients in greatest need of care. It balances the needs of the individual patients against the available resources and the needs of other patients. Continuous integrated triage employs:

• Group (Global) Triage (i.e. M.A.S.S. Triage)
• Physiologic (Individual) Triage (i.e. S.T.A.R.T. or Simple Triage and Rapid Treatment
  Simple triage and rapid treatment
  Simple triage and rapid treatment is a method used by first responders to effectively and efficiently evaluate all of the victims during a mass casualty incident . The first-arriving medical personnel will use a triage tool called a triage tag to categorize the victims by the severity of their...
  
  )
• Hospital Triage (i.e. E.S.I. or Emergency Severity Index)

However any Group, Individual and/or Hospital Triage system can be used at the appropriate level of evaluation.

History

Continuous Integrated Triage was developed by the Founding Chairperson, Maurice A. Ramirez, of the American Board of Disaster Medicine

American Board of Disaster Medicine

Disaster medicine as a specialty and mindset was not only a reaction from September 11, 2001, but to the numerous subsequent events that seemed to all too quickly follow: random anthrax attacks, the SARS outbreak, the New York City blackout in the summer of 2003, the December 26, 2004 Indian Ocean...

 by applying the lessons learned at the Louis Armstrong International Airport

Louis Armstrong New Orleans International Airport

Louis Armstrong New Orleans International Airport is a Class B public use international airport in Jefferson Parish, Louisiana, United States. It is owned by the City of New Orleans and is located 10 nautical miles west of its central business district. The airport's address is 900 Airline Drive...

 in New Orleans, Louisiana

New Orleans, Louisiana

New Orleans is a major United States port and the largest city and metropolitan area in the state of Louisiana. The New Orleans metropolitan area has a population of 1,235,650 as of 2009, the 46th largest in the USA. The New Orleans – Metairie – Bogalusa combined statistical area has a population...

 following the 2005 Hurricane Katrina

Hurricane Katrina

Hurricane Katrina of the 2005 Atlantic hurricane season was a powerful Atlantic hurricane. It is the costliest natural disaster, as well as one of the five deadliest hurricanes, in the history of the United States. Among recorded Atlantic hurricanes, it was the sixth strongest overall...

 to Mass Casualty Triage at hospitals and healthcare institutions.

Application and Technique

Using a Group (Global) Triage method (i.e. M.A.S.S. Triage), patients are divided into ambulatory (green) and non-ambulatory (red, yellow & black) triage categories.



Ambulatory patients are directed to self decon

Decontamination

Decontamination is the process of cleansing the human body to remove contamination by hazardous materials including chemicals, radioactive substances, and infectious material...

showers and then progress to the Green Triage holding area for re-triage using a Hospital Based Triage method and treatment.



Patients who are not responsive are immediately re-triaged using a Physiological (Individual) Triage method (i.e. S.T.A.R.T. or JumpS.T.A.R.T.) modified to include behavioral triage considerations prior to decon. Those found in respiratory arrest or pulseless are tagged deceased and not moved due to legal considerations.



Unresponsive patients with critical vital signs undergo assisted decon while receiving only immediately life sustaining interventions then re-triaged again using a Physiological (Individual) Triage method (i.e. S.T.A.R.T. or JumpS.T.A.R.T.) modified to include behavioral triage considerations.



Next, unresponsive patients with stable vital signs undergo assisted decon. After decon these patients too are re-triaged using a Physiological (Individual) Triage method (i.e. S.T.A.R.T. or JumpS.T.A.R.T.) modified to include behavioral triage considerations.



Finally, non-ambulatory responsive patients undergo assisted decon followed by re-triage using a Physiological (Individual) Triage method (i.e. S.T.A.R.T. or JumpS.T.A.R.T.) modified to include behavioral triage considerations.



Following assisted decon, patients found to be Alert, Oriented, Responsive and able to Follow Commands but non-ambulatory are triaged to the Yellow Triage holding area for re-triage using a Hospital Based Triage method and treatment.



Following assisted decon, unresponsive patients are triaged to either the Critical (red) or Expectant (black) treatment areas based on whether or not there are sufficient resources available at that moment in time to treat the patient without denying care to two or more other patients.

Ambulatory with minimal or no assistance (Green triage area)

• NY Heart Class I
• Gold COPD Class I
• NIHSS 0
• GCS 15
• 80% of Patient Surge

Non-ambulatory follows commands (Yellow triage area)

• NY Heart Class II or III
• Gold COPD Class II or III
• NIHSS 1 or 2
• GCS 15
• 16% of Patient Surge

Non-ambulatory and unresponsive/inappropriate (Physiological triage)

• 4% of Patient Surge

Respirations

• None – Dead (Black)
• <12 or >20 (Red) – Not Age Appropriate for Child
• 12 to 20 – Age Appropriate for Child (check pulse)

Pulse

• None – Dead (Black)
• <60 or >100 (Red) – Not Age Appropriate for Child
• 60 to 100 – Age Appropriate for Child (check mentation)

Mentation

• Alert, Oriented, Responsive, Ambulatory
• (Green Medical)
• (Green Med/Behavioral)
• Alert, Oriented, Responsive, Non-Ambulatory
• (Yellow Medical)
• (Yellow Med/Behavioral)
• Unresponsive or comatose (Resource based triage decision)
• Inadequate resources to save patient without denying care to two or more other patients - Expectant (Black)
• Adequate resources to save patient without denying care to two or more other patients - Critical (Red)

Hospital Triage

• E.S.I. (Emergency severity index) or other resource based hospital triage system