STM & National Triage Initiatives
Recognition that triage is finally viewed as ‘mission critical’ has prompted three notable national initiatives.
STM fulfills the SALT Triage Framework (and color coded methods cannot!)
The Center for Disease Control (CDC) sponsored developing a proposed national guideline for mass casualty triage published in Disaster Medicine and Public Health Preparedness (2008).
STM fulfills the SALT framework. STM provides the scientific specificity and objective methodology needed to enable the SALT conceptual framework. STM is based upon best available science and provides predictive assessments, reproducible and reliable prioritizations, optimal resource allocations and measures to judge accuracy and correctness of triage decisions.
STM uses an easy-to-compute age dependent physiological score – a score suggested to be used every day on every trauma patient -- that accurately differentiates patient acuities and estimates survival probability and deterioration for blunt, penetrating and blast overpressure trauma across all ages. These survival probabilities are more accurate than those from the RTS and ISS, and certainly provide a more accurate patient assessment than color codes. Data shows that existing color coded systems yield broad and overlapping and static categories that cannot differentiate patient acuity effectively, cannot be dynamic in response to the incident type and size (even espouse worst-first triage), do not consider resources in making triage decisions, and result in significant overtriage and subjective prioritization within each category. STM also explicitly and dynamically allocates transport and treatment resources so as to maximize the expected number of survivors.
Details of this are provided in the Editorial Science and Evidence Based Considerations for Fulfilling the SALT Triage Framework (Disaster Medicine and Public Health Preparedness. March 2010.
STM Dominates the AHRQ Recommendations for Mass Casualty Triage
The Agency for Healthcare Research and Quality (AHRQ) assembled an expert panel in 2004 who made recommendations on Altered Standards of Care in Mass Casualty Events. STM dominated these recommendations.
According to the AHRQ,” the goal of an organized and coordinated response to a mass casualty event should be to maximize the number of lives saved.” This is the precise and mathematically formulated goal that is the foundation of STM. It is noteworthy that this is not the goal, nor can it be an attainable goal of non measurable, non evidence based or color coded triage methods. The AHRQ also said changes in the usual standards of health and medical care will be required to achieve the goal of saving the most lives in a mass casualty event and it will be necessary to allocate scarce resources in a different manner to save as many lives as possible. These key findings are the essence of STM. A comparison of all of AHRQs findings to STM is provided as table 6 in The Journal of TRAUMA, August 2007;63:316–325 article, "A New Resource-Constrained Triage Method Applied to Victims of Penetrating Injury."
STM is the only Triage Method Evaluated for NIMS Compliance
STM is also the only triage method to be evaluated for National Incident Management System (NIMS) compatibility and its effectiveness and suitability to the operational environment, and it received a favorable review from various FEMA subject matter experts after a multi day review at the NIMS Support Center. In the testimonials section, please find two letters. The first is a request of FEMA from Director of Public Safety and former Florida State EMS Director asking FEMA to state whether STM is NIMS compatible, and whether START is NIMS compatible. The second letter is FEMA’s response:
“STM was able to demonstrate many of the concepts of NIMS. Its goal to maximize expected survivors is fundamental to preparedness and response and supports the mission of emergency responders and managers…. the scoring of patients was found to be an improvement over color coded systems ... grouping of patients was identified as being an improvement over the current <START> method of conducting triage in a mass casualty ..."
... the capability to generate an objective triage strategy in consideration of the timing and availability of resources is a primary advantage of STM"
START was not formally evaluated during this process. However, START does not consider resources, does not determine an optimal triage strategy, and has no software to evaluate ….”