Major incident triage: comparative validation using data from 7th July bombings.

Area of Science:

• Emergency Medicine
• Public Health
• Trauma Surgery

Background:

• Major incident management requires effective health service planning, highlighted by events like the 7/7 London bombings.
• UK Major Incident guidance mandates casualty triage for equitable treatment.
• Multiple international triage systems exist, but their comparative efficacy lacks evidence.

Purpose of the Study:

• To validate three major incident triage systems (START, Manchester Sieve, CareFlight) using patient data.
• To assess the performance of these systems in identifying critically injured individuals.

Main Methods:

• Retrospective cohort study of patients from the 7/7 London bombings treated at the Royal London Hospital.
• Triage categories were retrospectively assigned using START, Manchester Sieve, and CareFlight systems.
• Sensitivity and specificity were calculated to evaluate system performance in identifying critical injuries.

Main Results:

• 166 patients had outcome data; 8 were critically injured. Triage categories were assigned to 124-128 patients.
• All three systems demonstrated similar performance in identifying critically injured patients (Sensitivity 50-75%, Specificity 99-100%).
• Significant data deficiencies were noted in prehospital and hospital records.

Conclusions:

• Systematic triage of mass casualties is a proven effective strategy.
• Incomplete data recording significantly impedes the evaluation of trauma care quality in major incidents.