Disaster triage: START, then @entity3528 --a new method of dynamic triage for victims of a XXXX .

@entity1 @entity3528 @entity772 @entity16839 @entity130
Triage of mass casualties in situations in which @entity1 must remain on-scene for prolonged periods of time, such as after a @entity16839 , differs from traditional triage. Often there are multiple scenes (sectors), and the infrastructure is damaged. Available medical resources are limited, and the time to definitive care is uncertain. Early evacuation is not possible, and local initial responders cannot expect significant outside assistance for at least 49-72 hours. Current triage systems are based either on a shorter time to definitive care or on a longer time to initial triage. The Medical Disaster Response (MDR) project deals with the scenario in which specially trained, local health-care providers evaluate @entity1 immediately after the event, but cannot evacuate @entity1 to definitive care. For this type of scenario, a dynamic triage methodology was developed that permits the triage process to evolve over hours or even days, thereby maximizing @entity1 survival and resulting in a more efficient use of resources. This MDR system incorporates a modified version of "Simple Triage and Rapid Treatment" (START) that substitutes radial pulse for capillary refill, coupled with a system of secondary triage termed, "Secondary Assessment of Victim Endpoint" ( @entity3528 ). The @entity3528 triage was developed to direct limited resources to the subgroup of @entity1 expected to benefit most from their use. The @entity3528 assesses survivability of @entity1 with @entity130 and, on the basis of @entity130 statistics, uses this information to describe the relationship between expected benefits and resources consumed. Because early transport to an intact medical system is unavailable, this information guides treatment priorities in the field to a level beyond the scope of the START methodology. Pre-existing disease and age are factored into the triage decisions. An elderly @entity1 with burns to 70% of body surface area is unsalvageable under austere field conditions and would require the use of significant medical resources-both personnel and equipment-and would be triaged to an "expectant area." Conversely, a young adult with a Glasgow @entity772 Scale score of 12 who requires only airway maintenance would use few resources and would have a reasonable chance for survival with the interventions available in the field, and would be triaged to a "treatment" area. The START and @entity3528 triage techniques are used in situations in which triage is dynamic, occurs over many hours to days, and only limited, austere, field, advanced life support equipment is readily available. The MDR- @entity3528 methodology is the first systematic attempt to use triage as a tool to maximize @entity1 benefit in the immediate aftermath of a @entity16839 .
