Utility of Vital Signs in Mass Casualty-Disaster Triage

The triage of patients during a mass casualty – disaster (MCD) event presents the emergency healthcare provider with a complex and difficult issue. The task of evaluating casualties rapidly, using primarily the skills of physical examination, while still accurately identifying casualties likely to have critical injury or illness, may be impossible to achieve in practice. Yet at the same time it is known that accurate triage under MCD conditions improves outcomes not only for the individual critically ill casualty, but also for the entire cohort of casualties presenting for care.1,2 To improve the accuracy of MCD triage, further scientific investigations must be conducted to determine what elements of the physical examination (determining specific anatomic and physiologic factors) correlate best with the probability of critical injury and illness. These investigations should be – when possible – carried out under conditions that closely approximate the MCD environment. In addition, studies must be carried out as to the utility of new technologies that may be applied to the MCD triage process to improve and extend the ability of the triage officer in rapidly determining the condition of the casualty. Some recent studies have reported on data collected under actual MCD conditions, as well as using computer simulation to approximate the conditions of the MCD environment.3,4 These studies are encouraging and hopefully represent an emerging area of research into this area of emergency healthcare. One question frequently posed is that of the utility of vital signs, or specific physiologic parameters reflective of formal vital signs, in the performance of MCD triage. Study of this question has been hampered by multiple factors, including the difficulty in collecting such detailed data under actual MCD conditions.1 This paper provides an analysis of the potential impact of abnormal vital signs on clinical triage categorization in comparison to triage categorization derived from actual dispositions of casualties from two separate MCD events.