Triage Categories and Cytokine Use after A Nuclear Detonation

When to use this tool
- After a nuclear explosion when the number of potential victims could be so large that
  - Medical facilities would be overwhelmed
  - Medical resources would be constrained or limited, at least initially, according to US Institute of Medicine definitions. See Response Resource Availability and Crisis Standards of Care.
- Senior managers would communicate to their triage teams when it is appropriate to use this tool instead of normal triage procedures.
Goals of this tool
- Recommend triage categories (Immediate, Delayed, Minor, Expectant) for managing very large numbers of victims with injury, burns and/or radiation exposure based on
  - Patient factors
  - Availability of resources (staff, supplies, space) at the medical center where it is used
- Recommend priorities for using white cell (myeloid) cytokines when availability of this drug is limited by the number of patients who might need it.
- Provide the greatest good to the greatest number of patients using fair and ethical principles
Who is the tool for?
- Senior, supervisory triage managers
- Triage teams operating under the supervision of senior managers
Where would this tool be used?
- Wherever patients undergo medical triage
How was the tool developed?
- HHS convened an expert working group from outside and inside of government that evaluated options for optimizing triage of huge numbers of patients after a nuclear detonation.
- Using computer modeling, experts assessed the outcome of various methods of prioritizing patients under various circumstances.
- The triage system presented here was shown to provide the greatest good to the greatest number of patients using fair and ethical principles.
- See details in the publications.
CAVEATS:
- Emergency responders must understand that this tool does NOT use the customary definitions of standard triage categories:
  - Immediate, Delayed, Minor, Expectant
- With significant stress on resources, the usual triage strategy of managing the sickest first may be modified in order to provide the greatest good to the greatest number.
- Categories defining resource availability:
  - IOM Letter Report uses 3 categories: Normal, Good, and Fair/Poor
  - The Nuclear Detonation Scarce Resources Working Group Triage Tool uses 4 categories: Normal, Good, Fair, and Poor
- Categories defining standards of care:
  - Both the IOM Letter Report and the Nuclear Detonation Scarce Resources Working Group Triage Tool use 3 categories: conventional, contingency, crisis.
- See details in the publications.