Mass Casualty Medical Triage

mass casualty triage

In light of the horrific mass casualty attack in Orlando, here is a review of the medical triage system for mass casualty events.

Thoughts and prayers to the victims, their families, and all those affected.


Triage is used to determine who is most urgently in need of transport to a hospital (i.e. chance of survival, would otherwise expire without immediate treatment).

Red  (immediate) – cannot survive w/o immediate care but has chance of survival

Yellow (observation) – stable currently, not in immediate danger of death, requires observation and possible re-triage later

Green (wait) – “walking wounded”; will need care after more critical patients addressed

White (dismiss) – minor injuries; doctor’s care not required

Black (expectant) – deceased or with survivable injuries




Grand Rounds: Hypothermia and Rescue of Avalanche Victims

This week Dr. Heather White provided us with a fantastic overview of primary accidental hypothermia and the rescue of avalanche victims. Some new and interesting “buzzwords” for me included circumrescue collapse, afterdrop, and paradoxical undressingHypothermia can make people do some crazy things.

Check out this simple summary below and discuss with Heather next time you see her on shift – she has some really cool experiences and a ton of knowledge to share!


To download a pdf of this infographic click here: June 9 Grand Rounds.

Heather is taking her wealth of knowledge and moving onwards and upwards towards a ‘Fellowship in the Academy of Wilderness Medicine’. If this also interests you, check out this website, and feel free to ask Heather for more details!

Critically Appraised Topic Project: Are systemic corticosteroids helpful in treating adults with acute lumbosacral radiculopathy?

Instead of staff rounds this week, Dr. Jeff Wachsmuth presented an overview of his deep dive into the literature behind the use of corticosteroids for acute lumbosacral radiculopathy. He explained a frustratingly heterogeneous group of studies from the literature and did an excellent job of collating the data into a summary that means something to the practicing physician. The take home point: systemic corticosteroids provide mild short-term symptomatic relief of acute lumbosacral radiculopathy at best. They are a reasonable tool to add to the treatment of acute lumbosacral pain from radiculopathy in the ED.


Prospettive e cultural competence: nuove sfide

“Allora, indossi questo camicino, e ritorno tra 5 minuti per fare la mia visita, tutto chiaro?” Durante la prima visita a cui ho assistito nella mia rotazione clinica all’estero, questa frase ha attirato la mia attenzione, e quando ho chiesto se quella fosse la loro routine, la risposta è stata “Qui è pratica standard che...

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L'articolo Prospettive e cultural competence: nuove sfide sembra essere il primo su EMpills - Pillole di medicina d'urgenza.

The CIWA Protocol Demystified

What exactly is the CIWA protocol?

It is a tool used commonly in the US that helps clinicians assess and treat potential alcohol withdrawal. A significant amount of injury in this country is due to the overuse of alcohol. A subset of these patients are admitted and do not have access to alcohol. They may begin to withdraw within a few days, and this condition can lead to dangerous complications.

The Clinical Institute Withdrawal Assessment measures 10 items that are associated with withdrawal:

  • Nausea / vomiting
  • Anxiety
  • Paroxysmal sweats
  • Tactile disturbances (itching, bugs crawling on skin, etc)
  • Visual disturbances
  • Tremors
  • Agitation
  • Orientation
  • Auditory disturbances
  • Headache

All items are measured on a scale of 0-7 with the exception of orientation, which uses a scale of 0-4. All subscores are tallied to arrive at the final score.

The total score is used to determine whether benzodiazepines should be given to ameliorate symptoms or avoid seizures. Typically, a threshold is selected (8 or 10) and no medications are needed as long as the patient is under it. Once it is exceeded, graduated doses of lorazepam or diazepam are given and vital signs and CIWA scores are repeated regularly. The protocol is discontinued once the patient has three determinations that are under the threshold.

The individual dosing scale and monitoring routine varies by hospital. Look at your hospital policy manual to get specifics for your institution.

For a copy of the CIWA scoring criteria, click here.

Tomorrow, precautions when using the CIWA protocol.