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College of Nursing

Validating Triage for Chemical Mass Casualty Incidents - A First Step

The goal of this grant is to develop an Emergency Department Informatics Computational Tool (EDICT) to improve the quality of care and patient outcomes in a chemical mass casualty incident. The College of Nursing, University of South Carolina was awarded a 4-year, $2.5 million grant from NIH/NLM in Fall, 2014 to accomplish this goal.

Our Challenge

Following a mass casualty incident (MCI), a healthcare facility will experience a surge of patients--many of them quickly arriving to the Emergency Department (ED) via their personal vehicles. Emergency responders and hospital personnel will use triage to rapidly assess patients and prioritize their care with the goal of saving as many lives as possible. Following a chemical exposure, local EDs may receive a surge of victims before any chemical identification information is available, thus complicating treatment decisions. Small communities are additionally challenged because they are ill prepared to manage any surge of patients, regardless of the cause.

Our previous research on the Graniteville, SC chlorine disaster in 2005 showed us that three main challenges are encountered in the treatment of victims of Irritant Gas Syndrome Agent (IGSA) mass casualty incidents (MCIs):

  1. Quickly detecting that an MCI has occurred,
  2. Rapidly identifying the chemical involved, and
  3. Identifying, triaging and processing those exposed accurately, precisely and efficiently to improve patient outcomes.

The current study proposes to use a robust computer-based informatics tool to improve early chemical identification and to enhance patient processing and triage in the ED following an MCI. Our continuous triage process will monitor and aggregate data across all patients to provide ongoing situational awareness. Evolving wireless physiologic and mobile sensing technology and associated signal analysis prototypes will be explored and incorporated as appropriate for the ED MCI application.

Mobile-app technology will be combined with sophisticated intelligent systems to develop a new triage algorithm and a new informatics tool, the Emergency Department Informatics Computational Tool (EDICT), to address the shortcomings observed during our research on the Graniteville chlorine incident. The informatics tool, EDICT, using the new triage algorithm, will continuously monitor and evaluate data across ED patients to:

  1. Detect if a mass casualty is occurring,
  2. Identify the probable chemical, and
  3. Report suggested emergency actions.

Challenge the conventional. Create the exceptional. No Limits.