Collaborative Research: In Search of the Greatest Good with Imperfect Triage in the Aftermath of Mass-Casualty Events

这个合作研究项目的目标是使用数学模型来调查在大规模伤亡事件发生后，分类是否以及何时有用。该项目的第一阶段将开发和分析数学模型，以确定在何种条件下，分流是最有用或最不有用的，因为分流需要时间和资源，而且是不完善的。第二阶段将侧重于了解分类错误对预期幸存者人数的影响。特别是，该项目将研究过度分诊是否可以是有用的，在急诊医学文献中的一些建议。鉴于一定程度的错误是不可避免的，本研究将探讨有效管理分诊错误。最后，在第三阶段中，将对前两个阶段的基本方针和政策进行现实的模拟研究，为社会继续完善应急体系做出直接贡献。大规模伤亡事件使社区的应急资源不堪重负，而分类是配给这些资源的手段。然而，病人分诊的潜在好处还不清楚，主要有两个原因。首先，分诊需要时间和资源，这些时间和资源可以用于其他方面，例如稳定患者。第二，分流决策是非常容易出错的一个显着的过度分流率。虽然这些问题已经被认识到之前，一直没有系统的努力，调查是否分流达到其预期的目标。目前的做法在很大程度上依赖于这样一种信念，即分诊一定有一些好处。本研究的目的是质疑这种信念，并在这样做时，确定条件下，分诊是有用/有害的，当它是有意义的，以消除分诊，直接转移到治疗或运输，并调查分诊错误的影响。

The objective of this collaborative research project is to use mathematical models to investigate if and when triage is useful in the aftermath of mass-casualty incidents. The first stage of the project will develop and analyze mathematical models to identify conditions under which triage is most or least useful given that triage takes time and resources, and is imperfect. The second stage will focus on understanding the effects of triage errors on the expected number of survivors. In particular, the project will examine whether overtriage can be useful as suggested by some in the emergency medicine literature. The research will investigate the effective management of triage errors given that some degree of error is inevitable. Finally, in the third stage, a realistic simulation study will be carried out to test the basic principles and policies obtained in the first two stages.This research project will contribute directly to the society's continuing efforts in improving emergency response systems. Mass-casualty incidents overwhelm the emergency response resources of a community and triage is the means by which these resources are rationed. However, potential benefits of patient triage are unclear mainly for two reasons. First, triage takes time and resources, which can be otherwise used, for example, for stabilizing patients. Second, triage decisions are highly error-prone with a significant overtriage rate. Although these problems have been recognized before, there has been no systematic effort to investigate whether triage meets its intended goals. The current practice largely relies on the belief that triage must have some benefits. The objective of this research is to question this belief and in doing that identify conditions under which triage is useful/harmful, when it makes sense to eliminate triage and move directly to treatment or transportation, and investigate the effects of triage errors.