Gleaning data from disaster: A hospital-based data mining method to study all-hazard triage after a chemical disaster
DOI:
https://doi.org/10.5055/ajdm.2013.0116Keywords:
triage, chemical disaster, mass casualty, methods for disaster researchAbstract
Objective: To describe the methods of evaluating currently available triage models for their efficacy in appropriately triaging the surge of patients after an all-hazards disaster.
Design: A method was developed for evaluating currently available triage models using extracted data from medical records of the victims from the Graniteville chlorine disaster.
Setting: On January 6, 2005, a freight train carrying three tanker cars of liquid chlorine was inadvertently switched onto an industrial spur in central Graniteville, SC. The train then crashed into a parked locomotive and derailed. This caused one of the chlorine tankers to rupture and immediately release ~60 tons of chlorine. Chlorine gas infiltrated the town with a population of 7,000.
Participants: This research focuses on the victims who received emergency care in South Carolina.
Results: With our data mapping and decision tree logic, the authors were successful in using the available extracted clinical data to estimate triage categories for use in our study.
Conclusions: The methodology outlined in this article shows the potential use of well-designed secondary analysis methods to improve mass casualty research.The steps are reliable and repeatable and can easily be extended or applied to other disaster datasets.
References
Culley JM, Effken JA: Development and validation of a mass casualty conceptual model. J Nurse Scholarship. 2009; 42(1): 66-75.
McGarvey D, Shroy B: Modeling chemical terrorism risk through probabilistic risk assessment. Paper presented at the 2011 Chemical and Biological Defense Science Technology Conference, Las Vegas, NV. Available at http://cbdstconf2011.sainc.com/parallelSessionView2.aspx?ConferenceSessionId=29. Accessed July 16, 2012.
Ash S, Stoto M, Mendes M, et al.: A review of instruments assessing public health preparedness. Pub Health Rep. 2005; 120(5): 532- 542.
Cone DC,Koenig KL: Mass casualty triage in the chemical, biological, radiological, or nuclear environment. Eur J Emerg Med. 2005; 12(6): 287-302.
Kahn C, Schultz C, Miller K, et al.: Does START triage work? An outcomes level assessment of use at a mass casualty event. Acad Emerg Med. 2009; 53(3): 424-430.
Cone DC, MacMillan DS, Parwani V, et al.: Pilot test of a proposed chemical/biological/radiation/nuclear-capable mass casualty triage system. Prehosp Emerg Care. 2008; 12(2): 236-240.
Wenck MA, Van Sickle D, Drociuk D, et al.: Rapid assessment of exposure to chlorine released from a train derailment and resulting health impact. Public Health Reports. 2007; 122(6): 784-792.
Van Sickle D,Wenck MA, Belflower A, et al.: Acute health effects after exposure to chlorine gas released after a train derailment. Am J Emerg Med. 2009; 27: 1-7.
Frykberg ER: Medical management of disaster and mass casualties from terrorist bombings: How can we cope? J Traum. 2002; 53(2): 201-212.
Jenkins J, McCarthy M, Sauer L, et al.: Mass-casualty triage: Time for an evidence-based approach. Prehosp Disaster Med. 2008; 23(1): 3-8.
Armstrong J, Frykberg E, Burnis D: Toward a national standard in primary mass casualty triage. Disaster Med Public Health Prep. 2008; 2(1): S8-S10.
Fernandes C, Tanabe P, Gilboy N, et al.: Five-level triage: A report from the ACEP/ENA five-level triage task force. J Emerg Nurs. 2005; 31(1): 39-50.
Joint Commission on Accreditation of Healthcare Organizations (JCAHO): Standing Together: An Emergency Planning Guide for America’s Communities. Oakbrook Terrace, IL, 2005.
Task Force on Quality Control of Disaster Management: Health Disaster Management: Guidelines for Evaluation and Research in the Utstein Style: Executive Summary. Available at www.laerdalfoundation.org/dok/Health_Disaste_%20Management.pdf. Accessed July 16, 2012.
Birnbaum M: Disaster medicine: Status, roles, responsibilities, and needs. J Prehosp Disaster Med. 2002; 17(3): 117-118.
Chan T, Killeen J, Griswold W, et al.: Information technology and emergency medical care during disasters. Acad Emerg Med. 2004; 11 (11): 1229-1236.
Benson M,Koenig KL, Schultz CH: Disaster triage: START, then SAV—A new method of dynamic triage for victims of a catastrophic earthquake. Prehosp Disaster Med. 1996; 11(2): 117-124.
Ihlenfeld JT: A primer on triage and mass casualty events. Dimens Crit Care Nurs. 2003; 22(5): 204-207.
Knopp R, Yanagi A, Kallsen G, et al.: Mechanisms of injury and anatomic injury as criteria for prehospital trauma triage. Ann Emerg Med. 1988; 17(9): 895-902.
Landau TP, Ledley RS, Champion HR, et al.: Decision theory model of the emergency medical triage process. Comput Biol Med. 1982; 12(1): 27-42.
Schultz DH, Koenig KL, Noji EK: A medical disaster response to reduce immediate mortality after an earthquake. New Engl J Med. 1996; 334(7): 438-444.
Kilner T: Triage decisions of prehospital emergency health care providers, using a multiple casualty scenario paper exercise. Emerg Med J. 2002; 19: 348-353.
Burstein JL, Henry MC, Alicandro JM, et al.: Evidence for and impact of selective reporting of trauma triage mechanisms criteria. Acad Med. 1996; 3(110): 1011-1015.
Parker M: Critical care and disaster management. Crit Care Med. 2006; 34(3 Suppl): S52-S55.
MacKenzie MH, Alcorta EJ, Kelen GD: Compliance with prehospital triage protocols for major trauma patients. J Trauma. 1999; 46(1): 168-175.
Hoey GA, Schwab CW: Level I center triage and mass casualties. Clin Orthop Relat Res. 2004; 422: 23-29.
Domres B, Koch M, Mange A, et al.: Ethics and triage. Prehosp Disaster Med. 2001; 16(1): 53-58.
Sharma R: Development of pre-hospital trauma-care-system— An overview. Injury. 2005; 36(5): 579-587.
Gebbi K, Merill J: Public health worker competencies for emergency response. J Public Health Man. 2002; 8(3): 73-81.
Rüter A: Disaster Medicine- Performance Indicators, Information Support and Documentation. Linköping, Sweden: Liu-Tryck, 2006.
Birnbaum M: Disaster research: Why how and when? Prehosp Disaster Med. 2000; 15(3): s88.
Auf der Heide E: The importance of evidence-based disaster planning. Ann Emerg Med. 2006; 47(1): 34-49.
Tierney K: Disaster response: Research findings and their implications for resilience measures. CARRI Research Report 6. University of Colorado at Boulder.Available at http://www.resilientus.org/wp-content/uploads/2013/06/Tierney-20092.pdf. Accessed August 8, 2013.
Mulholland S, Gabbe B, Cameron P, et al.: Is paramedic judgment useful in prehospital trauma triage? Injury. 2005; 36(11): 1298-1305.
Albright S: Simple Triage and Rapid Treatment: START. Available at www.sc-ems.com/starttriage/StartTriage.pdf. Accessed July 16, 2012.
Gilboy N, Tanabe P, Travers D, et al.: Emergency Severity Index, Version 4: Implementation Handbook. AHRQ Publication No. 05-0046-2. Rockville, MD: Agency for Health Care Research and Quality, 2011.
Eitel D, Travers D, Rosenau A, et al.: The emergency severity index triage algorithm version 2 is reliable and valid. Acad Emerg Med. 2003; 10(10): 1070-1080.
Tanabe R, Travers D, Gilboy N, et al.: Refining emergency severity index triage criteria. Acad Emerg Med. 2005; 12(6): 497-501.
Wuerz RC, Travers D, Gilboy N, et al.: Implementation and refinement of the emergency severity index. Acad Emerg Med. 2001; 8(2): 170-176.
Gimbel T, Yarnold P, Adams J: The emergency severity index (version 3) 5-level triage system scores predict D resource consumption. J Emerg Nurse. 2004; 30(1): 22-29.
Baumann M, Strout T: Evaluation of the emergency severity index (version 3) triage algorithm in pediatric patients. Acad Emerg Med. 2005; 12(3): 219-224.
SALT mass casualty triage: Concept endorsed by the American College of Emergency Physicians, American College of Surgeons Committee on Trauma,American Trauma Society, National Association of EMS Physicians, National Disaster Life Support Education Consortium, and State and Territorial Injury Prevention Directors Association. Disaster Med Public Health Prep. 2008; 2(4): 245-246.
Lee CH: Disaster and mass casualty triage. Virtual Mentor. 2010; 12(6): 466-470.
Ginsberg JP, Holbrook JR, Chanda D, et al.: Posttraumatic stress and tendency to panic in the aftermath of the chlorine gas disaster in Graniteville, South Carolina. Soc Psychiatry Psychiatr Epidemiol. 2012; 47(9): 1441-1448.
Ball LJ, Dworak J: Disaster in Graniteville. S C Nurse. 2005; 12(2): 1.
Aacharya RP, Gastmans C, Denier Y: Emergency department triage: An ethical analysis. BMC Emerg Med. 2011: 11: 16.
Lerner EB, Cone DC,Weinstein ES, et al.: Mass casualty triage: An evaluation of the science and refinement of a national guideline. Disaster Med Public Health Prep. 2011; 5(2): 129-137.
Published
How to Cite
Issue
Section
License
Copyright 2007-2023, Weston Medical Publishing, LLC
All Rights Reserved
