A systematic review of CBRN vs traditional mass casualty triage system in disaster management

Triage is crucial in disaster management for effective resource allocation, especially in dealing with chemical, biological, radiological, and nuclear (CBRN) events. Specialized triage techniques are needed due to the increased rate of CBRN disasters. However, there is limited evidence on which contemporary modalities can make CBRN-adapted triage more effective in practice.

This study aims to systematically describe, compare, and contrast CBRN-specific triage with traditional mass casualty triage (non-CBRN) and explicitly identifies modern, high-impact but underused modalities that can operationalize a hybrid approach.

This systematic literature review was conducted using databases such as PubMed, EMBASE, Medline, OvidSP, Cochrane Central, Science Direct, and other relevant studies from 1998 to 2024. There were a total of 1,832 articles found, but with further strict screening and quality appraisal through the use of the Quality Assessment of Diagnostic Accuracy Studies and Critical Appraisal Skills Programme checklist, only 28 articles were included in the analysis.

This review compares traditional and CBRN triage systems, focusing on specialized training, personal protective equipment (PPE) donning, and decontamination protocols. CBRN triage systems are more complex and time-consuming, but provide more accurate detection of hidden hazardous material exposures. Traditional triage methods can be faster and easier, but specificity is lost in CBRN scenarios. The systematic review emphasizes the need for additional training and simplified procedures, as well as the complexity of PPE and decontamination protocols. CBRN triage also uses different resource allocations and ethical considerations.

The results highlight the need for advanced training for CBRN triage in disaster management. It suggests that existing CBRN triage systems need to be integrated with optimized training programs. Understanding the differences between CBRN and non-CBRN triage is crucial for effective disaster management. Further research should focus on simplifying the protocol while adapting it for both types of mass casualty events.