Table BSummary of strategies addressing Key Question 2, by category

Strategies
Reduce or manage less urgent demand for health care servicesBiological countermeasures (2 studies)
  • Emergency mass clinic based on CDC guidelines
  • POD strategies (e.g., dynamic staffing)
Public information (1 study)
  • Automated central information distribution system for families
Optimize use of existing resourcesCase managers (1 study)
  • Hospital-based case managers to ensure care coordination
Decontamination (1 study)
  • Strategies to increase decontamination effectiveness (e.g., instructions, providing washcloths)
Health care worker prophylaxis (1 study)
  • Influenza prophylaxis for health care workers
Health information technology (2 studies)
  • Electronic triage tags to monitor vital signs and transmit information to first responders
  • Regional telemedicine hub to support delivery of specialty care
Imaging (4 studies)
  • Focused assessment of sonography for trauma (FAST) for triage
  • Sonographic screening for abdominal/pelvic injury or bleeding for triage
  • Accelerated CT protocols
Load sharing (4 studies)
  • Load-sharing protocols
  • Central allocation of patients to hospitals based on available resources
Medical interventions (2 studies)
  • Medical interventions for the prevention of acute renal failure in crush victims
  • Novel drug infusion devices
Space optimization (3 studies)
  • Conversion of lobbies, clinics, and other units to accommodate surge
  • Reverse triage to create surge capacity (e.g., early discharge, increasing use of community care options)
Training (6 studies)*
  • Hospital staff training (e.g., disaster drills, computer simulations, tabletop exercises)
  • Triage training (e.g., JumpSTART training program, virtual reality, podcasts, computer games)
Triage (24 studies)*
  • Triage systems (e.g., START, mSTART, American College of Surgeons Committee on Trauma criteria, Radiation Injury Severity Classification, CBRN-specific system, Revised Trauma Score, Sacco triage method, SALT, Influenza-Like Illness Scoring System, TAS Triage Method, Simple Triage Scoring System, Model of Resource and Time-based Triage)
  • Triage strategies (e.g., combining triage categories, adding categories, one- vs. two-stage triage)
  • Simplified biodosimetry protocol to triage exposed victims
Augment existing resourcesResource conversion (1 study)
  • Conversion between formulations of nerve agents to augment supply
Crisis standards of careGeneral (1 study)
Orthopedics (1 study)
  • External fixation of fractures rather than definitive orthopedic care
Pediatrics (1 study)
  • Provision of only “essential” interventions
Trauma surgery (2 studies)
  • “Damage control” approach (e.g., for orthopedic surgery or more generally)

CBRN = chemical/ biological/radiological/nuclear; CDC = Centers for Disease Control and Prevention; CT = computed tomography; POD = point of dispensing; mSTART = modified simple triage and rapid treatment; SALT = sort, assess, life-saving interventions; START = simple triage and rapid treatment; TAS = triage assessment system

*

Includes one meta-analysis.

From: Executive Summary

Cover of Allocation of Scarce Resources During Mass Casualty Events
Allocation of Scarce Resources During Mass Casualty Events.
Evidence Reports/Technology Assessments, No. 207.
Timbie JW, Ringel JS, Fox DS, et al.

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