Hospital triage tools used during disaster events in Canada over the last four decades: a scoping review

Canadian hospitals often plan to use an alternate triage tool, opposed to the standard Canadian Triage Acuity Scale (CTAS), in the event of a mass casualty incident despite lack of study or validation for this setting. It is not known whether these alternate triage strategies have ever been utilized by hospitals during disaster response. We sought to identify the type and frequency of alternate triage tools used during Canadian mass casualty incident responses.

A scoping review of scientific databases and the gray literature was conducted to find information regarding the triage strategy employed during real mass casualty incidents in Canada from January 1, 1983 to December 31, 2024. A survey of healthcare providers was conducted if data could not be obtained through literature review.

The literature reviews yielded 358 reports: four met inclusion criteria. Twenty-two incidents were identified from media reports and contacts for 15 of these events were surveyed; data were retrieved regarding six events. In total, data were collected for nine separate mass casualty incidents. Five (55.5%) cited a plan to use an alternate triage tool during a disaster, but only 1 (11.1%) utilized it (triage tags) during real-time response. The remaining used CTAS, with or without clinician judgment.

Secondary disaster triage may not require an alternate algorithm, potentially saving time and financial resources associated with training. We strongly suggest the increased publication of reports either in peer-reviewed journals or through the creation of a national repository as available data on this subject are very limited.