An update on developing a national guideline for mass casualty triage was provided at the annual meeting of the National Association of EMS Physicians (NAEMSP) in Bonita Springs, Fla., including announcement of a free online training resource. The drive for a national standard was launched in a special section of the April-June 2004 edition of Prehospital Emergency Care. The available literature was reviewed and dispatch methodology assessed.
The 2004 assessment concluded that field triage procedures are intended to allow prehospital personnel to determine whether any given patient requires the resources of a trauma center. Existing triage procedures didn’t adequately address mass casualty incidents (MCIs) or CBRN (chemical, biological, radiological, and nuclear) issues.
NAEMSP led a workgroup as part of the Centers for Disease Control and Prevention (CDC) sponsored Terrorism Injuries: Information Dissemination and Exchange (TIIDE) project to develop a national guideline for mass casualty triage. The result was a 2008 proposed guideline, entitled SALT (sort, assess, life-saving interventions, treatment and/or transport) triage.
SALT was developed based on the best available science and consensus opinion. It incorporates aspects from all of the existing triage systems to create a single overarching guide for unifying the mass casualty triage process across the U.S. Attention was focused on international communities that experience frequent MCIs and have well-developed EMS response practices.
Implementation of SALT hasn’t been rapid. Lerner, Coule and Schwartz described the journey since the 2008 paper was published. Part of the CDC TIIDE work included a list of essential elements for a mass casualty triage system.
The result of this effort is the 2011 Model Uniform Core Criteria (MUCC) that is the proposed national standard for all mass casualty triage systems. NAEMSP obtained support and buy-in from most of the medical and EMS organizations. In the presentation, the absence of MUCC support from fire department organizations was noted. The issues in replacing thousands of Simple Triage and Rapid Treatment triage tags was also discussed.
In January, the National Disaster Life Support Foundation offered free training on SALT triage. This online training program consists of a 22-minute video, links to articles on SALT mass casualty triage and a downloadable presentation for teaching SALT.
The program offers a five-question quiz that will result in a certificate after successful completion.