ReSTART: A Novel Framework for Resource-Based Triage in Mass-Casualty Events

Area of Science:

• Operations Research in Emergency Medicine
• Disaster Triage Protocols
• Healthcare Resource Allocation

Background:

• Current mass-casualty triage guidelines lack explicit consideration of resource availability.
• This limitation is recognized but inadequately addressed in existing protocols.
• Prioritization of critically injured patients is often suboptimal during mass-casualty incidents.

Purpose of the Study:

• To introduce a novel framework for mass-casualty triage that integrates resource limitations.
• To develop and evaluate specific triage methods (ReSTART and Simple-ReSTART) based on this framework.
• To improve patient survival rates by optimizing transportation priorities.

Main Methods:

• Utilized operations research techniques: mathematical analysis, optimization, and discrete-event simulation.
• Developed and tested algorithms (ReSTART, Simple-ReSTART) extending the Simple Triage and Rapid Treatment (START) protocol.
• Conducted 9,000 discrete-event simulations across low, random, and high patient acuity distributions.

Main Results:

• ReSTART demonstrated significantly lower mortality rates compared to START across all tested acuity distributions (p<.01).
• Mean decrease in critical mortality ranged from 8.5% to 9.3%, with variations under 1 percentage point.
• The ReSTART policy showed robustness across different patient severity distributions.

Conclusions:

• Incorporating resource limitations into mass-casualty triage can increase the expected number of survivors.
• The proposed framework offers a foundation for advancing triage strategies in resource-constrained environments.
• Further validation is recommended prior to field implementation of the ReSTART framework.