Continuous integrated triage is an approach to triage in mass casualty situations which is both efficient and sensitive to psychosocial and disaster behavioral health issues that effect the number of patients seeking care (surge), the manner in which a hospital or healthcare facility deals with that surge (surge capacity) and the overarching medical needs of the event.
Continuous integrated traige combines three forms of triage with progressive specificity to most rapidly identify those patients in greatest need of care while balancing the needs of the individual patients against the available resources and the needs of other patients. Continuous integrated triage employs:
Group (Global) Triage (i.e. M.A.S.S. Triage)
Physiologic (Individual) Triage (i.e. S.T.A.R.T. or Simple Triage and Rapid Treatment)
Hospital Triage (i.e. E.S.I. or Emergency Severity Index)
However any Group, Individual and/or Hospital Triage system can be used at the appropriate level of evaluation.
Continuous Integrated Triage was developed by the Founding Chairperson of the American Board of Disaster Medicine by applying the lessons learned at the Louis Armstrong International Airport in New Orleans, LA following hurricane Katrina to Mass Casualty Traige at hospitals and healthcare institutions.
Application and Technique
Using a Group (Global) Triage method (i.e. M.A.S.S. traige), patients are divided into ambulatory (green) and non-ambulatory (red, yellow & black) triage categories.
Ambulatory patients are directed to self decon showers and then progress to the Green Triage holding area for re-triage using a Hospital Based Triage method and treatment.
Patients who are not responsive are immediately re-triaged using a Physiological (Individual) Triage method (i.e. S.T.A.R.T. or JumpS.T.A.R.T.) modified to include behavioral triage considerations prior to decon. Those found in respiratory arrest or pulseless are tagged deceased and not moved due to legal considerations.
Unresponsive patients with critical vital signs undergo assisted decon while receiving only immediately life sustaining interventions then re-triaged again using a Physiological (Individual) Triage method (i.e. S.T.A.R.T. or JumpS.T.A.R.T.) modified to include behavioral triage considerations.
Next, unresponsive patients with stable vital signs undergo assisted decon. After decon these patients too are re-triaged using a Physiological (Individual) Triage method (i.e. S.T.A.R.T. or JumpS.T.A.R.T.) modified to include behavioral triage considerations.
Finally, non-ambulatory responsive patients undergo assisted decon followed by re-triage using a Physiological (Individual) Triage method (i.e. S.T.A.R.T. or JumpS.T.A.R.T.) modified to include behavioral triage considerations.
Following assisted decon, patients found to be Alert, Oriented, Responsive and able to Follow Commands but non-ambulatory are triaged to the Yellow Triage holding area for re-triage using a Hospital Based Triage method and treatment.
Following assisted decon, unresponsive patients are triaged to either the Critical (red) or Expectant (black) treatment areas based on whether or not there are sufficient resources available at that moment in time to treat the patient without denying care to two or more other patients.
Overview of continuous integrated triage
Group (global) triage (mass triage)
Ambulatory with minimal or no assistance (Green triage area)