Trending Topics

Deafening silence: EMS chiefs’ response to triage best practices

Without the right triage training and MCI supplies EMS field personnel are ill prepared to be the masters of disaster


A triage solution needs to be simple, always accessible, and not require specialized hardware.

I recently sent out a query to my EMS management colleagues on the NEMSMA list server. I wanted to learn some best practices – what others were doing – to keep our workforce trained and proficient in the art of triage at multiple patient scenes (MPS) and mass casualty incidents (MCI).

The silence was deafening.

Though there was some discussion, nobody really answered my question about best practices. First, there was agreement that if you don’t train for MPS/MCI operations regularly, you won’t do well when it happens.

Remember it’s not if an MPS happens, but when an MPS happens.

Second, there was a discussion about MPS/MCI hardware and software technology, like triage tags with bar codes and handheld scanners. It was generally agreed that high-tech triage and patient tracking systems are not yet ready for prime time. A system that requires bar code scanners are usually too far away when an incident happens and unlikely to show up in the first hour. By then all the patients are gone.

Need for a simple solution

In the course of the discussion someone quoted the Israeli MCI program philosophy, which is “If it’s not simple, it simply won’t be done!” I believe there is a lot of truth to that.

I envision a simple and easy to use triage system that integrates a smartphone, a triage tag, a photo of the patient, and a voice recording. This system will work with every medic’s phone and can be used all the time. Does this exist?

Beyond those two points I was left with the impression that most of us – EMS chiefs and supervisors – are trusting MPS/MCI preparedness to luck. Other than the well-worn “triage tag Tuesday” approach, which did not get a lot of enthusiasm, there was nothing new offered up about triage training or testing proficiency.

Triage wake-up call

I had my own triage wake-up call a couple of weeks after the online discussion; a multi-agency, multi-scenario drill which called upon EMS to manage 15 simulated patients.

Did we survive? Yes.

Was it pretty? No.

Our line personnel were clearly not “masters of disaster,” even when the disaster was limited to a small EMS branch at a multi-hazard scene.

Yes, Houston, we have identified an issue and it’s time for the three T’s – training, training, and training!

And by the way, boss, if you want personnel to do the job right, you have to provide them the right tools. We did not have all of the vests, boards, tags and other supplies we needed to do the job well. Time to spend some money!

Oh yes, I’m off to the ICS store to buy incident management boards, triage tags, vests and the rest of the whatnot that should be aboard every one of our ambulances.

Skip Kirkwood has been involved in EMS since 1973, as an EMT, paramedic, supervisor, educator, manager, consultant, state EMS director, and chief EMS officer. He is a past president of the National EMS Management Association, is a vigorous advocate for the advancement of the EMS profession, and a frequent speaker at regional and national EMS conferences.