Review articleMass casualty management of a large-scale bioterrorist event: an epidemiological approach that shapes triage decisions☆
Section snippets
Conventional triage management
Disaster medicine deals with large populations. Triage is the first of three principles of mass casualty care, followed by standard procedures and evacuation [2]. Modern disaster medicine uses the utilitarian approach to triage, in which the greatest good is provided for the greatest number of victims in the shortest time to maximize success with the limited resources available [1], [2], [3], [13], [14]. An example of the utilitarian approach can be seen in International Humanitarian Law, which
Discovery phase
The discovery of a BT incident will most likely occur in an emergency department, doctor's office, or clinic [5], [12], [18], [19], [20], [21]. During the discovery phase, assumptions about the nature of the event will initially guide triage and management. One can assume that the “desired” terrorist bioagent will be an airborne virus or bacterium that is highly stable as an aerosol, highly contagious, has an incubation period of one week or less, a low recovery rate, and a course of at least
Triage authority
Early in the Persian Gulf War, triage officers recognized that they might confront multiple weaponry options, including biological, chemical, mixed biological-chemical, or some combination with explosives [62]. During the 1996 Olympics in Atlanta, the CDC enlisted assistance from multiple agencies and laboratories to ensure a robust capacity to identify and manage the consequences of a variety of potential weaponry, including single known, unknown, and mixed pathogens, and multiple chemical and
Triage lessons learned from large-scale disasters
It is rare for the United States to suffer a large-scale disaster requiring triage for a prolonged period of time. Most disasters result in limited numbers of casualties that are easily managed with high physician-to-victim ratios. If resources are a problem, it is usually one of time-limited distribution and not a lack of actual resources. Personnel, equipment, and evacuation are rarely compromised. Documentation of the planning or events during the Cold War, the Persian Gulf War, and complex
Summary
The threat of a BT event has catalyzed serious reflection on the troublesome issues that come with event management and triage. Such reflection has had the effect of multiplying the efforts to find solutions to what could become a catastrophic public health disaster. Management options are becoming more robust, as are reliable detection devices and rapid access to stockpiled antibiotics and vaccines. There is much to be done, however, especially in the organizing, warehousing, and
Acknowledgements
The author gratefully acknowledges the review of this document by Peter Merkle, PhD, of the Defense Threat Reduction Agency, Fort Belvoir, Virginia; John N. Bombardt, PhD, of the Institute for Defense Analysis, Alexandria, Virginia; and Denis Mollison, PhD, of Heriot-Watt University, Edinburgh, Scotland.
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The opinions and assertions contained herein are the private views of the author and are not to be construed as official or reflecting the views of the Department of Defense.