A review of the literature on the validity of mass casualty triage systems with a focus on chemical exposures Joan M. Culley, PhD, MPH, RN, CWOCN and Assistant Professor, College of Nursing, University of South Carolina Columbia, Columbia, South Carolina Erik Svendsen, PhD, MS Associate Professor, Department of Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana INTRODUCTION Our world is full of disasters that frequently result in mass casualties. On average, a disaster occurs in the world each day. 1 Disasters can be natural or technological, 1 unintended or deliberate incidents that bring together a multidisciplinary work force under extreme conditions to determine the priority of care for victims. Disasters produce an imbalance between medical needs and available resources due to the large number of casualties. The large number of casualties necessitates triage strategies to mitigate the imbalance. Thus, the primary goal of triage is to identify patients who have the greatest chance for survival with healthcare intervention and to optimally use limited resources. Triage of casualties must be performed accurately and efficiently if providers are to do the greatest good for the greatest number during times of mass casualty incidents (MCI). Mass casualty research is not suitable for randomized, controlled, experimental studies due to the nature of the incidents. Therefore, current research designs and evaluation strategies usually are anecdotal and much of the data reported has little external validity because no common factors seem able to be identified for generalization to other incidents. Essentially, no two MCI are exactly alike. 2,3 Sundnes and Birnbaum 4 discussed the impediments that influence the conduct of such research and evaluation, namely, lack of uniformly accepted standardized definitions, incomplete and inaccurate documentation, and lack of an accepted set of indicators for specific aspects of MCI. 4–6 To reduce death and disability, it is essential that MCI victims receive life-sustaining care within a few minutes of injury. 7,8 When casualties overwhelm available resources the ability of healthcare providers to do the greatest good for the greatest number is predicated on the validity, reliability, and effectiveness of the triage data collected. Incorrectly performed triage can underestimate the need of critically injured patients for immediate care, resulting in preventable deaths or deformities (under-triage) or can overestimate the extent of minor Corresponding Author Contact Information: Joan M. Culley, PhD, MPH, RN, CWOCN, Assistant Professor, University of South Carolina, College of Nursing 1601 Greene Street, Wms. Brice Nsg. #308A, Columbia, SC 29208. Office: 803.777.1257, jculley@sc.edu, Web Page: http://www.sc.edu/nursing/faculty-staff/culleyj.php. NIH Public Access Author Manuscript Am J Disaster Med. Author manuscript; available in PMC 2014 October 07. Published in final edited form as: Am J Disaster Med. 2014 ; 9(2): 137–150. doi:10.5055/ajdm.2014.0150. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript