Lerner et al reply: We thank Thinksharp, Inc, for submitting the letter to the editor. Triage strategies to improve patient care and save lives have always been the goal of our group, and we are glad that companies like Thinksharp, Inc, share that vision. As we stated in the framework article, we consider our work to be a beginning rather than an end, and our group is continuing to work toward a national guideline for mass casualty triage that will improve interoperability across the United States.
In the development process of the framework article and the corresponding position paper, our members carefully reviewed all available evidence and made what we thought were the best decisions based on that evidence. The expert panel development team considered the following to be important: (1) Initial sorting should identify the casualties in need of lifesaving interventions and provide the lifesaving interventions as soon as possible early in the triage process. (2) Deterioration in the condition of a casualty should be determined through casualty reassessment and not through an estimate of time to deteriorate based on a brief single assessment. (3) The triage guideline must be nonproprietary and inexpensive to widely disseminate.
To continue the development of this work, we have begun to develop the Model Uniform Core Criteria for Mass Casualty Triage. The Model Uniform Core Criteria will be a checklist that industry and communities will be able to use to ensure that whatever triage system they use meets the national guidelines. SALT Triage remains a free, public-domain, nonproprietary system that will be adjusted to conform to the criteria as they develop. We hope that the Model Uniform Core Criteria will be revised at regular intervals as new science becomes available, and we will evaluate any new literature that has become available since our last review. We agree that it is disappointing that a “gold standard” for evaluating triage does not yet exist and hope that as this work progresses, one can be developed. The current lack of a gold standard for the evaluation of triage decisions restricts the research that can be done and the progress that can be made in this area.
Finally, our process addressed only initial triage, and we agree there is a need to expand beyond this to include secondary triage and the provision of care at the scene and the process for moving patients from the scene to the receiving medical facility. We hope that our efforts will someday be expanded to address what comes after patients have initially been sorted.