There is a consensus that there lacks a standard for primary triage during mass casualty incidents. This is further compounded by a dearth of high quality research on the topic. Some studies suggest the superiority of SALT triage versus other triage systems, however, findings have not widely transitioned to clinical practice. We believe that despite specialized training including that in emergency medicine or emergency medical services (EMS), there will be significant variability amongst triage determination and use of triage methods. This study intends to analyze various provider skill levels and their accuracy of triage determination.

In a disaster exercise, a group of providers trained to use START triage were expected to triage, treat and determine transport order of the patients from a scenario of a simulated intentional radiological dispersal device (RDD) detonation with multiple casualties. Another group of providers trained to use SALT triage were expected to triage, treat, and determine transport order of patients from a scenario of a building collapse after a hurricane to assess SALT triage with the participating officers. Additional cohorts of EMS clinicians will be given the same case scenarios and asked to triage, treat when necessary, and determine transport order of the patients.

The initial data from the RDD exercise includes 102 patient case scenarios with 27 minimal (green), 40 delayed (yellow), and 35 immediate (red) patients. The providers involved in the exercise are trained at minimum to NREMT EMT level. Results showed an under-triage rate of 7.8%, an over-triage rate of 20.6% and overall accuracy of 71.6% when using START triage.

The undertriage rate with START is 7.8% is higher than the generally acceptable rate of less than 5%. Our research is ongoing and we anticipate completion in 2023. We hope that our research provides future direction to improve triage in disaster scenarios.