Pre-Hospital Mass Casualty Triage and Trauma Care
Topic Collection
March 11, 2024

Performing triage and trauma care during a mass casualty incident (MCI) requires efficiency and coordination among multiple response entities. Efforts may need to be directed toward doing the greatest good for the greatest amount of people, which is counter to day-to-day trauma triage. Simple actions to control bleeding and manage breathing issues can, and do, save lives, and should be part of on-scene care, as appropriate.

The majority of emergency management services (EMS) MCI plans are very detailed, and often unlikely to be referenced by responding ambulance personnel. Simple job aids should be provided that can be easily referenced and limited to one page to allow crew members to rapidly review their roles and responsibilities. More detailed plans can be used to support training and policy.

Research indicates that the most effective triage is performed by experienced providers using their clinical skill. There are many triage tools and protocols such as Simple Triage and Rapid Treatment (START) and Sort, Assess, Lifesaving Interventions, Treatment/Transport (SALT). These tools are valuable to personnel that do not routinely triage trauma patients but are not likely to be remembered unless incorporated into triage tags. Trauma criteria applied on an everyday basis to categorize patients as critical (e.g., the ABCDE of trauma life support including looking for penetrating injuries) should also be applied during mass casualty situations whenever relevant as this generates practice and familiarity. 

The safety of first responders and pre-hospital providers is always paramount, and when adequate transportation resources are available triage activities should not delay rapid transport to a trauma hospital. Mass shooting and bombing events require a different approach to patient triage and initial treatment as described in Mass Casualty Trauma Triage Paradigms and Pitfalls. This Topic Collection can help hospital emergency planners, EMS personnel, and emergency medicine clinicians understand the basics of field triage and immediate stabilization of MCI victims. Lessons learned from recent incidents are included. For incident-specific information, access our Topic Collections on Burns, Active Shooter and Explosives, and Radiological and Nuclear Events. Information on pre-hospital care during the COVID-19 pandemic/other infectious disease outbreaks is included in the Infectious Disease section of the Pre-Hospital (EMS) Topic Collection.

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.