Distribution of triage categories in terrorist attacks with mass casualties: Analysis and evaluation of European results from 1985 to 2017

Abstract

Background: The incidence and character of civil mass casualty incidents (MCI) has changed in the last decades, in particular because of the rising number of terrorist attacks. As a result, the question arises whether commonly used tools of prevention and prehospital planning, including the distribution of triage categories (T1 severely injured/T2 seriously injured/T3 slightly injured) with 15%/20%/60% have to be modified. The rescue workers make the classification of the triage categories in MCIs at the scene. The aim of this article is to verify the planning size of variable distribution of the triage categories. Material and methods: A total of 244 MCI with >9 casualties from 1 January 1985 to 31 May 2017 in Europe and Turkey were identified by a systematic literature search and analyzed with respect to the distribution of T in the first 24 h. Results: An incidence of 10% T1, 17% T2, 49% T3 and 5% deaths was detected (median). Due to the previously use of the average of the triage categories in the contingency plan, the calculation showed a slightly different distribution from 15%/30%/55%. Of the events 7 were natural disasters, 227 terrorist attacks, 9 accidents and 1 mass panic. Natural disasters showed a higher than average death rate (11%), especially landslide incidents (67%). Civilian accidents showed a distribution of T of 10%/17%/55%, with train derailments having twice as many T1 patients and plane crashes just under twice as many T2 patients. In the case of terrorist attacks, the expected planning parameters were not quite achieved with 14%/15%/39%. Especially “combined hits” and amok driving had high incidences of T1 patients (18% and 21%, respectively). In addition, the T2 patients with 42% in amok driving and 48% in mass panics were well above the planning size of 20% and 30%, respectively. Calculation of the severity factor according to deBoer for amok driving and the result that at S ≥ 1.5 many seriously injured persons can be suspected, amok driving showed the highest degree of severity (S = 1.8) in our study. This indicates the severity of a disaster depending on the number of casualties per triage category.