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

这一合作研究项目的目的是利用数学模型来调查在大规模伤亡事件发生后分诊是否以及何时有用。该项目的第一阶段将开发和分析数学模型，以确定在哪些情况下分诊最有用或最没用，因为分诊需要时间和资源，而且不完美。第二阶段将侧重于了解分诊错误对幸存者预期人数的影响。特别是，该项目将检查过度分类是否如急诊医学文献中所建议的那样有用。该研究将探讨有效的管理分流错误，因为一定程度的错误是不可避免的。最后，在第三阶段，将进行现实模拟研究，对前两个阶段获得的基本原则和政策进行测试。这项研究项目将直接有助于社会继续努力改善应急反应系统。大规模伤亡事件压倒了社区的应急响应资源，而分诊是分配这些资源的手段。然而，病人分诊的潜在好处尚不清楚，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在其他方面，比如稳定病人。其次，分诊决策非常容易出错，而且分诊过度率很高。虽然这些问题以前已经被认识到，但没有系统的努力来调查分诊是否达到了预期的目标。目前的做法很大程度上依赖于这样一种信念，即分诊一定有一些好处。这项研究的目的是质疑这种信念，并在此过程中确定在哪些情况下分诊是有用的/有害的，什么时候可以取消分诊，直接进行治疗或运输，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.