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How will disaster victims react to first responder commands—A survey of simulated disaster victims

Sophie Monnier-Serov, MD, MPH, Abhinav Gupta, MD, Virginia Mangolds, PhD, FNP-C, ENP-C, John P. Broach, MD, MPH, MBA, FACEP, Laurel O’Connor, MD, Andrew Milsten MD, MS FACEP


Objective: To determine whether victim behavior and interaction with triage personnel would conform to expected actions as dictated by the Simple Triage and Rapid Treatment (START) triage methodology, which emphasizes that victims will accept their assigned triage category.

Methods: In total, 105 volunteers were recruited to complete a 32-question survey after portraying victims in a triage-focused mass casualty incident (MCI) simulation. Questions included sociodemographic characteristics, willingness to follow commands of first responders, and willingness to help first responders. The authors examined whether the outcomes differed by demographics, healthcare experience, or disaster exposure of participants.

Results: The survey response rate was 90 percent (95/105). The mean age of participants was 31 years (58 percent women). Half of respondents indicated that they would ask responders to change their triage color if they disagreed with it and 75 percent would ask first responders to change their friend or family members’ triage colors. Twenty-one percent of victims reported that they would alter their own triage tag to receive treatment faster and 38 percent would alter a friend or family member’s triage color. The youngest (<20 years) and oldest (>40 years) respondents were most likely to act maladaptively.

Conclusion: Triage algorithms rely upon victims following the instructions of rescuers. This study suggests that maladaptive behavior by some victims should be anticipated.


mass casualty incident, victim behavior, triage, emergency preparedness, first responder

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