title: [Triage protocols for mass casualty incidents : An overview 30 years after START].
abstract: BACKGROUND
  Since the publication of the first mass casualty triage protocol approximately 30 years ago, numerous adaptions and alternatives have been introduced and are currently in use throughout the world. This variety may represent a challenge for the cooperation between emergency medical providers and the interoperability of emergency medical services often required during mass casualty incidents. To enhance cooperation and interoperability a standardization of triage protocols is required.
  
  
  OBJECTIVE
  This survey was carried out in order to identify and characterize published triage protocols on national and international levels. Furthermore, evidence for validation of the identified triage algorithms was discussed and recommendations for standardization of triage protocols are given.
  
  
  METHODS
  In a systematic literature search 59 relevant articles were identified and evaluated with respect to the given objectives.
  
  
  RESULTS
  A total of 12 triage concepts were identified and characterized which are categorized according to the basic principle.
  
  
  CONCLUSIONS
  The endpoints of the studies, the chosen observation units and the mode of data collection were discussed with respect to their impact on validation. Furthermore, the impact of the degree and dynamics of system capacity overload, which are pathognomonic for mass casualty incidents, were discussed.
  
  
  CONCLUSIONS
  There is not sufficient evidence to declare one of the triage protocols superior in all aspects to the others and no triage protocol has been implemented on a comprehensive level in Germany. In order to initialize a national or regional convergence process towards an interoperability of emergency medical services, the model uniform core criteria for mass casualty triage approach has been identified as being appropriate.
authors: Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Ludwig-Maximilians-Universität, Schillerstr. 53, 80336, München, Deutschland. sebastian.streckbein@med.uni-muenchen.de.
authors: S
authors: S
authors: Streckbein
authors: Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Ludwig-Maximilians-Universität, Schillerstr. 53, 80336, München, Deutschland.
authors: T
authors: T
authors: Kohlmann
authors: Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Ludwig-Maximilians-Universität, Schillerstr. 53, 80336, München, Deutschland.
authors: J
authors: J
authors: Luxen
authors: Anästhesiologische Klinik, Universitätsklinikum Erlangen, Erlangen, Deutschland.
authors: T
authors: T
authors: Birkholz
authors: Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Ludwig-Maximilians-Universität, Schillerstr. 53, 80336, München, Deutschland.
authors: S
authors: S
authors: Prückner
mesh_terms: D000465:Algorithms; D004189:Disaster Planning / Q000458:organization & administration*; D004632:Emergency Medical Services / Q000458:organization & administration*; D005858:Germany; D006801:Humans; D038622:Internationality; D054527:Mass Casualty Incidents; D017410:Practice Guidelines as Topic; D014218:Triage / Q000458:organization & administration*
keywords: Implementation; Observation unit; Outcome; Triage; Validation
references: J Trauma. 1998 Jan;44(1):41-9
references: 9464748
references: Disaster Med Public Health Prep. 2007 Sep;1(1 Suppl):S14-24
references: 18388607
references: J Trauma. 2003 Sep;55(3):466-70
references: 14501888
references: Ann Emerg Med. 1990 Dec;19(12):1401-6
references: 2240753
references: Injury. 2011 May;42(5):460-8
references: 21130438
references: J Trauma. 2005 Apr;58(4):686-93; discussion 694-5
references: 15824643
references: J Trauma. 2010 Nov;69(5):1074-81; discussion 1081-2
references: 20693920
references: Prehosp Disaster Med. 2008 Jan-Feb;23(1):3-8
references: 18491654
references: Injury. 2013 May;44(5):629-33
references: 22877789
references: Ann Emerg Med. 2009 Sep;54(3):424-30, 430.e1
references: 19195739
references: World J Surg. 1983 Jan;7(1):4-11
references: 6837064
references: J Trauma. 2002 Aug;53(2):201-12
references: 12169923
references: Ann Emerg Med. 2001 Nov;38(5):541-8
references: 11679866
references: Disaster Med Public Health Prep. 2011 Jun;5(2):125-8
references: 21685308
references: Resuscitation. 2010 Jul;81(7):788-9
references: 20483521
references: J Trauma. 2010 Feb;68(2):452-62
references: 20154558
references: J Trauma. 1974 Mar;14(3):187-96
references: 4814394
references: Disaster Med Public Health Prep. 2008 Sep;2 Suppl 1:S25-34
references: 18769263
references: Am J Surg. 2010 Dec;200(6):724-7; discussion 727
references: 21146011
references: Ann Emerg Med. 2013 Jun;61(6):677-689.e101
references: 23522610
references: Prehosp Emerg Care. 2008 Oct-Dec;12(4):467-9
references: 18924010
references: Ann Emerg Med. 2013 Jun;61(6):668-676.e7
references: 23465555
references: J Trauma. 1988 Jan;28(1):69-77
references: 3123707
references: J Trauma. 2006 Oct;61(4):820-3
references: 17033546
references: BMC Emerg Med. 2010 Aug 11;10:17
references: 20701802
references: Ann Surg. 2004 Mar;239(3):322-4
references: 15075648
references: Am J Disaster Med. 2008 Sep-Oct;3(5):265-71
references: 19069030
references: Acad Emerg Med. 2005 Aug;12(8):759-70
references: 16079430
references: Am J Emerg Med. 1992 Jul;10(4):294-7
references: 1616515
references: J Trauma. 2007 Aug;63(2):316-25
references: 17693830
references: Prehosp Emerg Care. 2010 Jan-Mar;14(1):21-5
references: 19947863
references: J Trauma. 1996 Sep;41(3):380-6; discussion 386-8
references: 8810953
references: Emerg Nurse. 2012 Jun 12;20(3):9
references: 27715155
references: Ann Emerg Med. 1990 Dec;19(12):1396-400
references: 2240752
references: Ann Emerg Med. 1994 Nov;24(5):885-9
references: 7978562
references: J Coll Physicians Surg Pak. 2004 Feb;14(2):108-11
references: 15228876
references: Disaster Manag Response. 2007 Jul-Sep;5(3):68-73
references: 17719507
references: Disaster Med Public Health Prep. 2011 Jun;5(2):129-37
references: 21685309
references: Unfallchirurg. 2009 Jan;112(1):23-30, 32
references: 19099281