title: Major incident triage: A consensus based definition of the essential life-saving interventions during the definitive care phase of a major incident.
abstract: BACKGROUND
  Triage is a key principle in the effective management of major incidents. The process currently relies on algorithms assigning patients to specific triage categories; there is, however, little guidance as to what these categories represent. Previously, these algorithms were validated against injury severity scores, but it is accepted now that the need for life-saving intervention is a more important outcome. However, the definition of a life-saving intervention is unclear. The aim of this study was to define what constitutes a life-saving intervention, in order to facilitate the definition of an adult priority one patient during the definitive care phase of a major incident.
  
  
  METHODS
  We conducted a modified Delphi study, using a panel of subject matter experts drawn from the United Kingdom and Republic of South Africa with a background in Emergency Care or Major Incident Management. The study was conducted using an online survey tool, over three rounds between July and December 2013. A four point Likert scale was used to seek consensus for 50 possible interventions, with a consensus level set at 70%.
  
  
  RESULTS
  24 participants completed all three rounds of the Delphi, with 32 life-saving interventions reaching consensus.
  
  
  CONCLUSIONS
  This study provides a consensus definition of what constitutes a life-saving intervention in the context of an adult, priority one patient during the definitive care phase of a major incident. The definition will contribute to further research into major incident triage, specifically in terms of validation of an adult major incident triage tool.
authors.affiliation: Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa; Institute of Naval Medicine, Alverstoke, Gosport, UK. Electronic address: vassallo@doctors.org.uk.
authors.forename: James
authors.initials: J
authors.lastname: Vassallo
authors.affiliation: Emergency Department, Derriford Hospital, Plymouth, UK; Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Medical Directorate, Joint Medical Command, Birmingham, UK.
authors.forename: Jason E
authors.initials: JE
authors.lastname: Smith
authors.affiliation: Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Stevan R
authors.initials: SR
authors.lastname: Bruijns
authors.affiliation: Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Wallis
mesh_terms: D000465:Algorithms; D003697:Delphi Technique; D004189:Disaster Planning; D004632:Emergency Medical Services / Q000458:organization & administration*; D017408:Guidelines as Topic; D006801:Humans; D015601:Injury Severity Score; D054527:Mass Casualty Incidents; D019984:Quality Indicators, Health Care; D013019:South Africa; D014218:Triage / Q000458:organization & administration / Q000592:standards; D006113:United Kingdom; D014947:Wounds and Injuries / Q000628:therapy*
keywords: Delphi study; Life saving interventions; Major incident management; Major incidents; Triage