title: Casualty collection in mass-casualty incidents: a better method for finding proverbial needles in a haystack.
abstract: BACKGROUND
  Mass-casualty incidents (MCIs) are on the rise. The ability to locate, identify, and triage patients quickly and efficiently results in better patient outcomes. Poor lighting due to time of day, inclement weather, and power outages can make locating patients difficult. Efficient methods of locating patients allow for quicker transport to definitive care.
  
  
  OBJECTIVE
  The objective of this study was to evaluate the methods currently used in mass-casualty collection, and to determine whether the use of the Simple Triage and Rapid Treatment (START) triage tag system can be improved by using easily discernable tags (glow sticks) in conjunction with the standard triage tags.
  
  
  METHODS
  Numerous drills were performed utilizing the START triage method. In Trial A, patients were identified with the triage tags only. In Trial B, patients were identified using triage tags and glow sticks. Four rounds of triage drills were performed in low ambient light for each Trial, and the differences in casualty collection times were compared.
  
  
  RESULTS
  Casualty relocation and collection times were considerably shorter in the trials that utilized both the glow sticks and triage tags. An average of 2.58 minutes (31.75%) were saved during the casualty collections. In addition, fewer patient errors occurred during the trials in which the glow sticks were used. Between the four rounds, an average of four patient errors occurred during the trials that utilized the triage tags. However, there was an average of only one patient error for the drills when participants utilized both the triage tags and the glow sticks.
  
  
  CONCLUSIONS
  The use of the highly visible glow sticks, in conjunction with the START triage tags, allowed for more rapid and accurate casualty collection in suboptimal lighting. The use of the glow sticks made it easier to relocate previously triaged patients and arrange for expeditious transport to definitive care. In addition, the glow sticks reduced the number of patient errors. Most importantly, there was a significant reduction in the number of patients that initially were triaged via the START method, but were overlooked during casualty collection and transport.
authors.affiliation: Genesys Regional Medical Center, Grand Blanc, MI 48439, USA.
authors.forename: Kristina E
authors.initials: KE
authors.lastname: Knotts
authors.forename: Stuart
authors.initials: S
authors.lastname: Etengoff
authors.forename: Kimberly
authors.initials: K
authors.lastname: Barber
authors.forename: Ina J
authors.initials: IJ
authors.lastname: Golden
mesh_terms: D004189:Disaster Planning; D004633:Emergency Medical Tags; D006801:Humans; D008027:Light; D010355:Patient Identification Systems; D016544:Patient Simulation; D013996:Time and Motion Studies; D014218:Triage / Q000379:methods*; D014947:Wounds and Injuries / Q000145:classification*