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College of Nursing

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Research Emphasis Areas

Health Systems Research

We focus on processes and their effects on health care results. We examine emergency preparedness, evaluate the health care workforce and leadership, and study the impact of new tools and techniques in clinics and practices.

Sheared tree trunks, shattered cars, mangled buildings – it’s the typical chaos of a disaster scene in which first-responder crews rely on triage models to save lives.

But the four major triage systems used in the U.S. for the past 50 years might not be the best response tools available, said Joan Culley, a USC College of Nursing assistant professor who specializes in mass casualty research.

“Triage models are often designed for a particular type of disaster, but not everyone uses the same model. In fact, you might have responders from different agencies using different triage standards at the same mass casualty site,” said Culley, who is teaming with researchers at Tulane University School of Public Health and Tropical Medicine, the Medical University of South Carolina, the S.C. Office of Research and Statistics and other institutions to conduct one of the nation’s first outcome-level studies following an actual mass casualty event.

“We need to determine how triage data correlates with patient outcomes. In other words, do the triage models we’re using in disasters achieve the greatest good with the limited resources available?”

Culley and her team are focusing on the health outcomes that followed a massive chlorine spill that claimed nine lives in Graniteville, S.C., in January 2005.

“It’s difficult to get data from a disaster site because that’s not the time for data collection – lives are at stake,” Culley said. “So we’re using the data that was gathered after the crisis to piece together the effectiveness of the emergency response.”

Researchers are using a National Institutes of Health/National Library of Medicine grant to comb through massive data collected in the hours and days after a train derailment in Graniteville sent a plume of deadly chlorine gas across a swath of Aiken County. They want to determine if the triage methods used resulted in the best patient outcomes for survivors of the disaster.

“Major triage systems have never been validated, and what’s appropriate for one disaster– a chemical spill, for example– might not be appropriate for another, like a pileup on the freeway,” Culley said. “The ultimate goal is to come up with a better model, an alternative to the four triage models currently used, that is not disaster specific, is simple and can be communicated quickly.”  


Nathaniel Bell
Katherine Chappell
Joan Culley
Peggy Hewlett
Erin McKinney
Rita Snyder