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
  • Erik Svendsen, PhD, MS




mass casualty incidents, chemical mass casualty incidents, evidence-based medicine, mass casualty triage systems, validation


Introduction: Mass casualty incidents (MCIs) include natural (eg, earthquake) or human (eg, terrorism or technical) events. They produce an imbalance between medical needs and resources necessitating the use of triage strategies. Triage of casualties must be performed accurately and efficiently if providers are to do the greatest good for the greatest number. There is limited research on the validation of triage system efficacy in determining the priority of care for victims of MCI, particularly those involving chemicals.

Objective: To review the literature on the validation of current triage systems to assign onsite treatment status codes to victims of mass casualties, particularly those involving chemicals, using actual patient outcomes.

Methods: The focus of this article is a systematic review of the literature to describe the influences of MCIs, particularly those involving chemicals, on current triage systems related to the onsite assignment of treatment status codes to a victim and the validation of the assigned code using actual patient outcomes.

Results: There is extensive literature published on triage systems used for MCI but only four articles used actual outcome data to validate mass casualty triage outcomes including three for chemical events. Currently, the amount and type of data collected are not consistent or standardized and definitions are not universal.

Conclusions: Current literature does not provide needed evidence on the validity of triage systems for MCI in particular those involving chemicals. Well-designed studies are needed to validate the reliability, sensitivity, and specificity of triage systems used for MCI including those involving chemicals.

Author Biographies

Joan M. Culley, PhD, MPH, RN, CWOCN

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.



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How to Cite

Culley, PhD, MPH, RN, CWOCN, J. M., and E. Svendsen, PhD, MS. “A Review of the Literature on the Validity of Mass Casualty Triage Systems With a Focus on Chemical Exposures”. American Journal of Disaster Medicine, vol. 9, no. 2, Apr. 2014, pp. 137-50, doi:10.5055/ajdm.2014.0150.