Serenissima Overboard Triage and Rescue: A Proposal for a Rapid Tool for the Assessment of In-Water Victims of Mass-Casualty Nautical Accidents

Nautical trauma is a rare event yet characterized by high rates of mortality and morbidity. The management of the victims is complicated by environmental challenges and often remote locations. Another challenge is the absence of a triage tool specifically designed for nautical environments. The Serenissima Overboard Triage and Rescue protocol is a triage tool aimed at improving the management of nautical incidents. This tool was developed for responders in the Venetian Lagoon (Italy). This method uses a step-by-step process. For optimal efficiency, rapid triage should begin while the victims are still in the water. Patients are sorted into 4 triage categories: black (not breathing after airway opening and 5 rescue breaths or injuries incompatible with life), red (respiratory rate >30 breaths/min, unable to talk, stertorous breathing/wheezing, or altered mental status), yellow (respiratory rate <30 breaths/min and alert, floating but not able to swim), and green (purposeful swimming and able to maintain airway). This tool can improve the rapidity and quality of rescue in mass-casualty nautical accidents but will need further validation.