Method and system of mass and multiple casualty triage

• US 7,761,309 B2
• Filed: 03/11/2003
• Issued: 07/20/2010
• Est. Priority Date: 03/22/2002
• Status: Expired due to Fees

• Current Assignee: Thinksharp Incorporated
• Original Assignee: Thinksharp Incorporated
• Inventors: Sacco, William J., Navin, D. Michael
• Primary Examiner(s): O'Connor; Gerald J.
• Assistant Examiner(s): LE, LINH GIANG
• Application Number:
  US10/385,829
• Publication Number:
  US 20040078223A1
• Time in Patent Office: 2,688 Days
• Field of Search: 235/385
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/06 Resources, workflows, human or project management; Enterprise or organisation planning; Enterprise or organisation modelling
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 20/70 relating to mental therapies, e.g. psychological therapy or autogenous training
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment
• CPC Class Codes: G16H 50/50 for simulation or modelling of medical disorders
• CPC Class Codes: G16H 50/70 for mining of medical data, e.g. analysing previous cases of other patients
• CPC Class Codes: G16H 70/20 relating to practices or guidelines

Abstract

The present invention is a method and system of triage that assesses a severity score for each casualty, and determines a treatment prioritization plan to maximize the number of survivors. The present invention includes a score-based mathematical algorithm for resource-constrained triage, where an optimal number of survivors is determined through a methodology that can be mathematically modeled and solved, a methodology that considers victim survival probabilities, victim deterioration rates, and resource availability. First, each casualty is assessed and an RPM severity score is assigned based upon a sum of coded values for respiratory rate, pulse rate, and best motor response. Next, treatment priorities are determined from analytical or mathematical techniques, such as dynamic or linear programming, in consideration of survival probabilities associated with each RPM score, and deterioration-with-time rates for each RPM score for victims awaiting transport and treatment and the availability and timing of transport and treatment services.

Claims

1. A method of triage for determining an order of transport from a mass casualty incident that maximizes the number of survivors of the mass casualty incident, the method comprising the steps of:

receiving, from incident personnel at a mass casualty scene, a casualty severity score for each of a plurality of victims at the mass casualty scene;

inputting each casualty severity score into a computer;

receiving information indicative of medical transport resources available for the plurality of victims;

inputting the information indicative of medical transport resources available into a computer; and

determining by a computer implemented decision logic an order of transport for treatment for each of the plurality of victims, wherein the decision logic mathematically factors the casualty severity scores and the resources available for the plurality of victims.

2. The method of claim 1, wherein the casualty severity score includes a sum of coded values, where a coded value is assigned for each of a victim'"'"'s respiratory rate, pulse rate, and best motor response.

3. The method of claim 2, wherein best motor response is a measure of neurological status.

4. The method of claim 1, wherein establishing the casualty severity score includes:

categorizing each of the plurality of victims into one of four categories, wherein the four categories are Ambulatory, Immediate, Expectant, and Delayed, as employed in a triage method known as START;

assessing, for each of the plurality of victims categorized in the Immediate and Delayed categories of START, respiratory, perfusion, and mental status in relation to a physiologic or anatomic region of the body incurring injury;

determining and assigning a survival probability rate for each of the plurality of victims categorized in the Immediate and Delayed categories, wherein the survival probability rate represents the casualty severity score.

5. The method of claim 4, wherein determining the survival probability rate considers the respiratory, perfusion, and mental status assessments in relation to the physiologic or anatomic region of the body incurring injury.

6. The method of claim 1, wherein determining an order of transport for treatment employs a score-based mathematical algorithm for resource-constrained triage.

7. The method of claim 1, wherein determining an order of transport for treatment for each of the plurality of victims involves analytical or mathematical programming techniques.

8. The method of claim 7, wherein the analytical or mathematical programming techniques consider a type of trauma experienced by each victim, a classification of each victim, and/or a type of care center appropriate for and available to each victim, to optimize the order of treatment determined.

9. The method of claim 7, wherein the analytical or mathematical programming techniques use a data-based estimate of casualty survival probability with each casualty severity score.

10. The method of claim 9, wherein the casualty survival probability is determined through consideration of factors selected from the group consisting of an availability of state-of-the-art, or lesser levels of, treatment;

a cause of a casualty incident;

a type of anatomic injury incurred by the victim;

an age of the victim;

treatment available at the incident scene;

treatment available at other facilities;

distances to the other facilities; and

, facilities or equipment available for performance of casualty management.

11. The method of claim 7, wherein the analytical or mathematical programming techniques include victim deterioration-with-time rates for each casualty severity score based upon an amount of time a victim awaits treatment.

12. The method of claim 11, wherein the victim deterioration-with-time rates are determined through consideration of factors selected from the group consisting of an availability of state-of-the-art, or lesser levels of, treatment;

a cause of a casualty incident;

a type of anatomic injury incurred by the victim;

an age of the victim;

treatment available at the incident scene;

treatment available at other facilities;

distances to the other facilities; and

facilities or equipment available for performance of casualty management.

13. The method of claim 1, wherein determining an order of transport for treatment for each of the plurality of victims involves a dynamic programming formulation.

14. The method of claim 13, wherein the dynamic programming formulation determines a subset of the plurality of victims to transport for treatment during each of a plurality of time periods to maximize a total number of survivors over all time periods.

15. The method of claim 1, wherein determining an order of transport for treatment for each of the plurality of victims involves a linear programming formulation.

16. The method of claim 15, wherein the linear programming formulation determines a subset of the plurality of victims to transport for treatment during each of a plurality of time periods, and identifies a severity score to associate with each of the victims in the subset, to maximize a total number of survivors over all time periods.

17. The method of claim 1, wherein:

the casualty severity score for each victim is entered into a portable computing device and communicated to a central processing location;

the information indicative of resources available for care of the victims is received at the central processing location; and

the order of transport for treatment is determined at the central processing location.

18. The method of claim 17, wherein the central processing location communicates the order of transport for treatment for each of the victims to the one or more portable computing devices for display thereon to direct an ordering of the victims at the mass casualty scene for transport for treatment.

19. The method of claim 1, wherein:

the casualty severity score for each victim and the information indicative of medical transport resources available for the victims is entered into a portable computing device; and

the order of transport for treatment is determined using the portable computing device.

20. A triage method for determining an order of treatment, or transport for treatment, for casualties of a mass casualty incident, to maximize the number of survivors of the mass casualty incident, the method comprising the steps of:

receiving, from incident personnel at a mass casualty scene, a casualty severity score for each of a plurality of casualties at the mass casualty scene;

inputting each casualty severity score into a computer;

receiving information indicative of medical transport resources available for the plurality of casualties;

inputting the information indicative of medical transport resources available into a computer;

determining by a computer implemented decision logic an order of treatment, or transport for treatment, for each of the plurality of casualties, wherein the decision logic mathematically factors the resources available for the plurality of casualties, the casualty severity scores, casualty severity score deterioration rates resulting from time periods of treatment delay, and one or more of a type of trauma experienced by each casualty, a classification of each casualty, and a type of care center appropriate for and available to each casualty; and

communicating the order of treatment, or transport for treatment, to incident personnel for their use in directing an ordering of the casualties.

21. The method of claim 20, wherein the casualty severity score includes a sum of coded values, where a coded value is assigned for each of a victim'"'"'s respiratory rate, pulse rate, and best motor response.

22. The method of claim 20, further comprising the step of calculating a number of expected survivors of the mass casualty incident.

23. A triage method for determining an order of transport from a mass casualty incident that maximizes the number of survivors of the mass casualty incident, the method comprising the steps of:

assessing one or more physiological characteristics of each of a plurality of casualties at a mass casualty scene, by incident personnel at the mass casualty scene, and receiving from the incident personnel, or separately assigning, a coded value for each of the one or more physiological characteristics;

receiving from the incident personnel, or separately establishing, a casualty severity score for each of the plurality of casualties at the mass casualty scene using the coded value(s);

inputting each casualty severity score into a computer;

receiving from the incident personnel, or separately assigning, a survival probability to each casualty severity score based upon at least one characteristic of the respective casualty or of an incident responsible for the casualty;

inputting the survival probability for each casualty severity score into a computer;

receiving information indicative of medical transport resources available for the plurality of casualties;

inputting the information indicative of medical transport resources available into a computer;

determining by a computer implemented decision logic an order of transport for treatment for each of the plurality of casualties through analytical or mathematical programming techniques, wherein the programming techniques mathematically consider the casualty severity scores, the time periods of treatment delay resulting from constrained resources available for the plurality of casualties, the survival probabilities, and deterioration rates applied to the casualty severity scores due to the time periods of treatment delay; and

communicating the order of transport for treatment to incident personnel for their use in directing an ordering of the casualties at the mass casualty scene for transport from the mass casualty scene.

24. The method of claim 23, further comprising the step of calculating a number of expected survivors of the mass casualty incident through the analytical or mathematical programming techniques.

25. The method of claim 23, wherein:

the coded value for each physiological characteristic of each casualty is entered into a portable computing device;

the casualty severity score for each of the plurality of casualties is established by the portable computing device and communicated to a central processing location, or the casualty severity score for each of the plurality of casualties is established at the central processing location after reception at the central processing location of the coded value for each physiological characteristic of each casualty;

the information indicative of medical transport resources available for the victims is received at the central processing location; and

the order of transport for treatment is determined by computer implemented decision logic at the central processing location.

26. A computer readable medium that configures a computer system to perform a method of triage for determining an order of transport from a mass casualty incident that maximizes the number of survivors of the mass casualty incident, the method comprising the steps of:

receiving, from incident personnel at a mass casualty scene, a casualty severity score for each of a plurality of victims at the mass casualty scene;

inputting each casualty severity score into the computer system;

receiving information indicative of medical transport resources available for the plurality of victims;

inputting the information indicative of medical transport resources available into the computer system; and

determining an order of transport for treatment for each of the plurality of victims, wherein the determination mathematically factors the casualty severity scores and the medical transport resources available.

27. A computer readable medium that configures a computer system to perform a method of triage for determining an order of treatment, or transport for treatment, for casualties of a mass casualty incident, to maximize the number of survivors of the mass casualty incident, the method comprising the steps of:

receiving, from incident personnel at a mass casualty scene, a casualty severity score for each of a plurality of casualties at the mass casualty scene;

inputting each casualty severity score into the computer system;

receiving information indicative of medical transport resources available for the plurality of casualties;

inputting the information indicative of medical transport resources available into the computer system;

determining an order of treatment, or transport for treatment, for each of the plurality of casualties, wherein the determination mathematically factors the medical resources available for the plurality of casualties, the casualty severity scores, and casualty severity score deterioration rates resulting from time periods of treatment delay.

28. A computer-readable medium that configures a computer system to perform a method of triage for determining an order of transport from a mass casualty incident that maximizes the number of survivors of the mass casualty incident, the method comprising the steps of:

receiving coded values, from incident personnel at a mass casualty scene, for one or more physiological characteristics taken for each of a plurality of victims at the mass casualty scene;

inputting the coded values into the computer system;

receiving information indicative of medical transport resources available for the plurality of victims;

inputting the information indicative of medical transport resources available into the computer system;

establishing a casualty severity score for each of the plurality of victims using the coded values; and

determining an order of transport for treatment for each of the plurality of victims, wherein the determination mathematically factors the medical transport resources available for the plurality of victims and the casualty severity scores.

29. A computer readable medium that configures a computer system to perform a method of triage for determining an order of transport from a mass casualty incident that maximizes the number of survivors of the mass casualty incident, the method comprising the steps of:

receiving, from incident personnel at a mass casualty scene, one or more physiological characteristics taken for each of a plurality of casualties and assigning a coded value for each based on the assessment;

inputting the coded values into the computer system;

establishing a severity score for each of the plurality of casualties by summing the coded values;

receiving information indicative of medical transport resources available for the plurality of victims;

inputting the information indicative of medical transport resources available into the computer system;

assigning a survival probability to each severity score based upon at least one characteristic of a respective casualty or of an incident responsible for the casualty; and

determining an order of transport for treatment for each of the plurality of casualties through analytical or mathematical programming techniques, wherein the programming techniques mathematically factor the severity scores, time periods of treatment delay resulting from constrained resources available for care of the plurality of casualties, the survival probabilities, and deterioration rates applied to the severity scores due to the time periods of treatment delay.

30. The computer readable medium of claim 29, wherein the method further comprises the step of calculating a number of expected survivors of the mass casualty incident through the analytical or mathematical programming techniques.

31. A computer readable medium that stores a program for performing a triage method for determining an order of transport from a mass casualty incident that maximizes the number of survivors of the mass casualty incident, the program comprising:

means for receiving, from incident personnel at a mass casualty scene, a casualty severity score for each of a plurality of victims at the mass casualty scene;

means for receiving information indicative of medical transport resources available for the plurality of victims at the mass casualty scene; and

means for determining an order of transport for treatment for each of the plurality of victims, wherein the determination mathematically factors the casualty severity scores and the medical transport resources available.

32. A computer readable medium that stores a program for performing a triage method for determining an order of transport from a mass casualty incident that maximizes the number of survivors of the mass casualty incident, the program comprising:

means for receiving, from incident personnel at a mass casualty scene, a casualty severity score for each of a plurality of casualties at the mass casualty scene;

means for receiving information indicative of medical transport resources available for the plurality of victims at the mass casualty scene; and

means for determining an order of transport for treatment for each of the plurality of victims, wherein the determination mathematically factors the medical transport resources available for the plurality of victims, the casualty severity scores, and casualty severity score deterioration rates resulting from time periods of treatment delay.

33. A computer readable medium that stores a program for performing a triage method for determining an order of transport from a mass casualty incident that maximizes the number of survivors of the mass casualty incident, the program comprising:

means for receiving coded values, from incident personnel at a mass casualty scene, for one or more physiological characteristics taken for each of a plurality of victims at the mass casualty scene;

means for receiving information indicative of medical transport resources available for the plurality of victims;

means for establishing a casualty severity score for each of the plurality of victims using the coded values; and

means for determining an order of transport for treatment for each of the plurality of victims, wherein the determination mathematically factors the medical transport resources available for caro of the plurality of victims and the casualty severity scores.

34. A computer readable medium that stores a program for performing a triage method for determining an order of treatment, or transport for treatment, for casualties of a mass casualty incident that maximizes the number of survivors of the mass casualty incident, the program comprising:

means for receiving, from incident personnel at a mass casualty scene, one or more physiological characteristics taken for each of a plurality of casualties at the mass casualty scene and assigning a coded value for each based on the assessment;

means for establishing a severity score for each of the plurality of casualties by summing the coded values;

means for assigning a survival probability to each severity score based upon at least one characteristic of a respective casualty or of an incident responsible for the casualty;

means for receiving information indicative of medical transport resources available for the plurality of casualties at the mass casualty scene; and

means for determining an order of treatment, or transport for treatment, for each of the plurality of casualties through analytical or mathematical programming techniques, wherein the programming techniques mathematically factor the severity scores, the information indicative of medical transport resources available, time periods of treatment delay resulting from constrained resources available for care of the plurality of casualties, the survival probabilities, and deterioration rates applied to the severity scores due to the time periods of treatment delay.

35. The computer readable medium of claim 34, wherein the program comprises means for calculating a number of expected survivors of the mass casualty incident through the analytical or mathematical programming techniques.

36. A system for performing a triage method for determining an order of transport from a mass casualty incident that maximizes the number of survivors of the mass casualty incident, the system comprising:

one or more portable computing devices for;

receiving and inputting a casualty severity score for each of a plurality of victims of the mass casualty incident, the casualty severity score based on victim physiological characteristics;

receiving and inputting information indicative of medical transport resources available for the plurality of victims of the mass casualty incident; and

a computer processing unit at a central processing location for;

receiving the casualty severity scores for each of the plurality of victims, and the information indicative of medical transport resources available for the plurality of victims, as transmitted from the one or more portable computing devices; and

determining an order of transport for treatment for each of the plurality of victims, wherein the determination mathematically factors the casualty severity scores and the medical transport resources available.

37. The system of claim 36, wherein the computer processing unit receives the casualty severity score for each of the plurality of victims via radio communication.

38. The system of claim 36, wherein the computer processing unit communicates the order of transport for treatment for each of the plurality of victims to the one or more portable computing devices for display thereon and use during an ordering of the victims at a scene of the mass casualty incident for transport from the scene of the mass casualty incident.

39. The system of claim 36, wherein determining an order of transport for treatment employs a score-based mathematical algorithm for resource-constrained triage that factors victim deterioration-with-time rates for each casualty severity score based upon an amount of time a victim awaits treatment.

40. The system of claim 39, wherein the victim deterioration-with-time rates are determined through consideration of factors selected from the group consisting of an availability of state-of-the-art, or lesser levels of treatment;

a cause of a casualty incident;

a type of anatomic injury incurred by the victim;

an age of the victim;

treatment available at the incident scene;

treatment available at other facilities;

distances to the other facilities; and

facilities or equipment available for performance of casualty management.

41. The system of claim 36, wherein determining an order of transport for treatment employs a score-based mathematical algorithm for resource-constrained triage that factors one or more of a casualty severity score deterioration rate resulting from time periods of treatment delay, a type of trauma experienced by each casualty, a classification of each casualty, and a type of care center appropriate for and available to each casualty.

42. A triage method for determining an order of transport from a mass casualty incident that maximizes the number of survivors of the mass casualty incident, the method comprising the steps of:

assessing one or more physiological characteristics of each of a plurality of casualties at the mass casualty scene, by incident personnel at the mass casualty scene, and receiving from the incident personnel, or separately assigning, a coded value for each of the one or more physiological characteristics;

receiving from the incident personnel, or separately establishing, a casualty severity score for each of the plurality of casualties at the mass casualty scene using the coded value(s);

inputting each casualty severity score into a computer;

receiving from the incident personnel, or separately assigning, a survival probability to each casualty severity score based upon at least one characteristic of the respective casualty or of an incident responsible for the casualty;

inputting the survival probability for each casualty severity score into a computer;

establishing casualty severity score deterioration-with-time rates based upon at least one characteristic of an availability of state-of-the-art, or lesser levels of treatment;

a cause of the casualty incident;

a type of anatomic injury incurred by the casualty;

an age of the casualty;

treatment available at the mass casualty scene;

treatment available at other facilities;

distances to the other facilities; and

facilities or equipment available for performance of casualty management;

inputting the casualty severity score deterioration-with-time rates into a computer;

receiving information indicative of medical transport resources available for the plurality of casualties;

determining by a computer implemented decision logic an order of transport for treatment for each of the plurality of casualties through analytical or mathematical programming techniques, wherein the programming techniques mathematically consider the casualty severity scores, the survival probabilities, the time periods of treatment delay resulting from constrained medical transport resources available for care-ef the plurality of casualties, and the casualty severity score deterioration-with-time rates applied to the severity scores due to the time periods of treatment delay;

communicating the order of transport for treatment to incident personnel; and

ordering the plurality of casualties at the mass casualty scene for transport from the mass casualty scene in accordance with the order of transport for treatment determined.