Table 3.

Triage, Prehospital Life Support and Damage Control, and Prehospital Process Statements that Achieved Consensus

Theme	Statements	Mean Score	Standard Deviation
Triage	Triage is an on-going and repetitive process throughout the continuum from the initial assessment through definitive care.	6.6	0.7
	Each triage system should allow for dynamic triage decisions based on changes in available treatment and transportation resources.	6.4	1.0
	Each triage system should be inclusive of all populations.	6.3	1.0
	Each triage system should be simple, easy to remember, amenable to quick memory aids, and just-in-time training for trained first responders.	6.7	0.7
	Each triage system should be practical for use in an austere environment.	6.5	0.7
	Each triage system should require that the assigned triage category for each patient be visibly identifiable and/or by patients being sent to a specific assigned location as a group of similar triaged patients.	6.3	0.9
	It should be possible to perform the initial assessment without diagnostic equipment.	6.5	0.8
	Patients categorized or considered as expectant should be provided with treatment and/or transport as resources become available.	6.6	0.7
	Efficient use of transport assets may include mixing categories of patients and using alternate forms of transport.	6.2	0.5
	Use of ultrasound may be incorporated in the continuum of prehospital care.	6.2	1.0
	Each jurisdiction should require that all first response agencies utilize the same triage system for any mass-casualty incident response in that jurisdiction.	6.5	0.9
	Each triage system should allow for dynamic triage decisions based on changes in patient conditions.	6.6	0.7
	Each triage system should be inclusive of all ages.	6.0	0.7
	The field trauma score may be used to guide life-saving and damage control interventions.	5.0	0.9
	Each jurisdiction should develop clinical guidelines for priority transportation decisions to match the patient to the appropriate definitive health care facility.	5.7	0.9
	Each triage system should develop a continuum of repeated assessments of available vital signs.	5.8	0.9
	Each jurisdiction should develop clinical guidelines for priority life support and damage control intervention.	5.4	1.0
	Each first response agency should develop protocols for use of monitoring equipment.	5.2	0.9
Prehospital Life Support and Damage Control	Pain management should be considered for the injured and when performing interventions.	6.7	0.7
	Each jurisdiction should document life support and damage control intervention in a patient care record.	6.3	0.6
	Each medical first response agency should develop crush injury treatment guidelines, education, and training to achieve and maintain competencies.	6.2	1.0
	Each medical first response agency should develop clinical guidelines, education, and training to achieve and maintain competencies to utilize intraosseous access to achieve rapid vascular access.	6.4	0.9
	Each first response agency should utilize a formal evidence-based framework for post-incident evaluation that defines and assesses key performance indicators.	6.0	1.0
	Each jurisdiction should create guidelines to utilize spontaneous first providers/bystanders.	5.6	0.9
	Each medical first response agency should develop permissive hypotension clinical guidelines, education, and training to achieve and maintain competencies.	5.9	1.0
	After life-saving interventions are performed, the continued monitoring of the patient can be assigned to a provider of lesser training (ie, physician to paramedic or Emergency Medical Technician/EMT, paramedic to EMT or first responder with medical training).	5.4	1.0
Prehospital Processes	Each jurisdiction’s prehospital processes should be inclusive of all populations.	6.4	0.9
	Each jurisdiction should develop contingency plans for casualty collection points (ie, advanced medical posts, field hospitals, alternate care sites, repurposing health care facilities) to meet the demand of mass-casualty incident response.	6.6	0.5
	If available, each jurisdiction should apply technology to recognize and locate emergency response vehicles at all times.	6.2	1.0
	Transport information management systems enhance coordination of patient distribution.	6.6	0.8
	Information management systems enhance coordination of resources (ie, staff, stuff, structures).	6.5	0.8
	Each jurisdiction should have contingencies to manage transport disruption caused by a mass-casualty incident (ie, earthquake destroying road/rail).	6.5	0.6
	Each jurisdiction should apply evidence-based key performance indicators to evaluate and improve the mass-casualty incident response.	6.4	0.8
	The mass-casualty incident response plan should be based on the jurisdiction hazard vulnerability and risk analysis.	6.3	1.0
	Each jurisdiction mass-casualty incident response plan should include a structured debrief of the exercise or actual mass-casualty incident by all participating first response agencies, where possible.	6.4	0.8
	Each jurisdiction should ensure mass-casualty incident response plan education, training, and competencies are consistent across first response agencies.	6.6	0.6
	Assessment, observation, and monitoring technology and devices that have capacity for storing and transmitting data enhance mass-casualty incident response.	5.9	0.8
	Each jurisdiction should define mass-casualty incident response terminology utilized by all first response agencies in this jurisdiction.	6.6	0.6
	Each jurisdiction’s prehospital processes should be inclusive of all ages.	6.5	0.7
	Each jurisdiction should develop search and rescue guidelines.	6.2	1.0
	Each jurisdiction should develop search and rescue education, training, and competencies.	6.2	1.0
	Each jurisdiction should develop mass-casualty incident Chemical, Biological, Radiological, and Nuclear (CBRN) decontamination education, training, and competencies.	6.2	0.9
	Each jurisdiction should develop communication technology backup for all first response agencies in the jurisdiction.	6.6	0.7
	Each jurisdiction should develop a single patient identification method utilized across all first response agencies.	6.3	1.0
	Evaluation of an exercise or actual mass-casualty incident event should be completed by all participating first response agencies.	6.5	0.6
	Each jurisdiction mass-casualty incident plan should be designed to be consistent with the jurisdictional incident management system.	6.8	0.4
	Each jurisdiction mass-casualty incident response plan should be designed to be consistent with the jurisdictional health authority legislation and regulations.	6.4	0.9
	Unmanned aerial vehicle/UAV technology enhances mass-casualty incident response situational awareness.	5.5	0.8
	Unmanned aerial vehicle/UAV technology enhances mass-casualty incident response operations.	5.7	0.9

Abbreviations: EMT, emergency medical technician; CBRN, Chemical, Biological, Radiological, and Nuclear; UAV, unmanned aerial vehicle.