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KEY POINTS

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KEY POINTS

  1. The combination of an increasing patient population and diminished funding for hospital services is creating a need for optimized distribution of medical resources. Efficient management of major incidents involves triage, treatment and transport.

  2. Triaging tools would benefit initial allocation and future allocation of resources over time to support ongoing needs of survivors of critical illness. Over triage might overburden the local health care systems, have a negative impact on patient outcomes, and decrease cost effectiveness.

  3. This is a review of the most common triage protocols used for illness scoring as methods to identify the severity of the injury, and the most often recommended guidelines for field triage of injured patients.

  4. Critical care regionalization is becoming more common and studies have supported that the transport of critically ill patients to a tertiary care center leads to better patient outcomes.

  5. Patients' and providers' safety, as well as the benefits and cost-effectiveness of the mode of transport are key considerations when assessing whether to transport a critically ill patient. Current standards for interfacility transport dictate that the decision on transport mode and team composition is based on individual patient requirements, considering minimization of transport time and anticipated treatment requirements during transport.

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INTRODUCTION

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The word “triage” originates from the French “trier” (to choose from among several) and was originally applied around 1792 by Baron Dominique Jean Larrey, surgeon-in-chief to Napoleon's Imperial Guard, in reference to the process of sorting wounded soldiers. Its aim was to optimize the use of available medical resources to maximize efficacy; patients with the greatest chance of survival and the least resource use are treated first.1 Currently, the combination of an increasing patient population and diminished funding for hospital services is creating a need for optimized distribution of medical resources. Efficient management of major incidents involves triage, treatment, and transport. Useful triage tools would predict which patients have the greatest chance of survival, which patients are likely to die, and which will benefit most from advanced medical care such as mechanical ventilation. These are important issues not only for initial allocation of resources but also for future allocation of resources over time to support the ongoing needs of survivors of critical illness.

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The challenges associated with the triaging process have caused health systems to initiate a number of adaptational strategies, including regionalization of care, specialization of critical care facilities, and better allocation of available personnel and equipment; the triaging process impacts multiple practices such as pre-hospital care, emergency department services, intensive care, surgical intervention, and the process of determining the order of rank for patients to receive advanced therapeutic treatments (including renal replacement therapy and organ transplantation). In the field, emergency medical services (EMS) providers must ensure that patients receive prompt and appropriate emergency care and are transported in a timely manner to a health care facility for further evaluation and treatment. Identifying the severity of the injury ...

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