The Journal of TRAUMA, July 2010; 69:215-225“Operational Comparison of the Simple Triage and Rapid Treatment Method and the Sacco Triage Method in Mass Casualty Exercises”
Parallel 99 patient exercises comparing START and STM showed STM to be faster, more accurate, and better at prioritizing patients. Under START, only 2 of the 13 most serious patients were transported on the first 13 ambulances and the three most serious left by bus nearly an hour later. Under STM, the 12 of the 13 most serious left in the first 6 ambulances.
Disaster Medicine and Public Health Preparedness, March 2010; VOL.4/NO.1:10-12“Science and Evidence-Based Considerations for Fulfilling the SALT Triage Framework”
This manuscript details how STM includes the features suggested by SALT, and how color coded methods cannot satisfy the SALT framework.
Annals of Emergency Medicine June 2010; Volume 55, No. 6:579-580“Does START Triage Work? The Answer is Clear!”
The paper comments on and extends the conclusions of Kahn (et al) in their retrospective analysis of the performance of START in the Glendale California train crash.
Military Medicine. December 2009"Application of a New Resource Constrained Triage Method to Military-Aged Victims"
This research extends the STM to blast overpressure trauma for military aged patients, and compares the outcome performance of STM to START in Iraqi combat simulations, showing life saving increases ranging from 18% to a 18 fold increase.
The Journal of TRAUMA, August 2007;63:316–325"A New Resource-Constrained Triage Method Applied to Victims of Penetrating Injury"
This paper extends the original STM research to penetrating trauma, providing survival probability correlations and deterioration rates for each STM score. Data clearly indicates more rapid decline for patients with penetrating trauma, highlighting START’s impactful failure to triage by type of trauma.
Academic Emergency Medicine Volume 12: 7; August 2005 Issue"Precise Formulation and Evidence Based Application of Resource Constrained Triage"
This paper presents the landmark research of the Sacco Triage Method, the first evidence based outcome driven method. It presents the mathematical underpinnings of the method that maximizes expected survivors in consideration of patient prognoses and the timing and availability of transport and treatment resources. The paper presents the survival correlations and deterioration rates for blunt trauma, and details the scientific limitations of START.
Evidence based geriatric and pediatric triage through extentions of the Sacco Triage Method for blunt and penetrating trauma.
Survival probability correlations are completed by STM score across 5 age groups for blunt and penetrating trauma. The mathematical underpinnings of STM are updated to reflect age-based triage. This research is the first step in correcting the life costing practice of overtriage and undertriage in pediatric and geriatric patients, respectively.
Evidence Based Medevac Dispatch decreases flights and mortality rates.
Data on more than 90,000 trauma patients shows the potential to decrease the number of flights by 60%, with also reducing mortality. By extending the STM physiological analysis, and quantifying the impact of ACS criteria, patients with high survival probability and little expected deterioration, and in consideration of the logistics of the travel and treatment resources, can be screened from medevac consideration . Overall outcomes actually improve by correcting the widely known bias against geriatric patients in using medevacs.
Trade Journal Publications
EMS Magazine Volume 34: 8 August 2005"Triage is Broken"
The inconsistency and inaccuracies of START are exposed in a study documenting the 45 patient tabletop exercise results of 280 EMS providers in Pennsylvania.
EMS Magazine Volume 34: 9 September 2005"A Disaster Doesn't Have to be a Disaster"
Defines the operational steps of STM and its use in a mass casualty incident.
Journal of Emergency Medical Services Volume 30: 7"New Triage Method Considers Available Resources" ~ Jeffrey Lindsey, Ph.D.,
RPM score works in conjunction with the STM to improve on current triage methods.
MERGINET: Medical Emergency, Rescue and Global Information Network"New Triage Method Seeks Consistency, Reduced Mortality" ~ Daniel King, EMT-P
Sacco Triage Method organizes and transports patients in a manner that increases survivability.