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Ebola Triage Screening and Public Health: The New “Vital Sign Zero”

  • Kristi L. Koenig (a1)

During public health emergencies of international concern such as the 2014 Ebola event, health care leaders need to educate clinicians on the front lines to make uncomfortable, but real triage decisions that focus on optimization of population health outcomes over individual care. Health care workers must consider their own protection first before direct contact with potentially contagious patients. In an era of globalization and emerging infectious disease, routine triage including evaluation of the standard vital signs must shift to include public health considerations with immediate consequences. A new “vital sign zero” should be taken at the time of initial patient evaluation to assess for risk and exposure to potentially contagious infectious diseases.

Corresponding author
Correspondence and reprint requests to Kristi L. Koenig, MD, Center for Disaster Medical Sciences, Department of Emergency Medicine, UC Irvine Medical Center, 101 The City Drive South, Route 128, Orange, CA 92868 (e-mail:
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2. KL Koenig , CA Kahn , CH Schultz . Medical strategies to handle mass casualties from the use of biological weapons. Clin Lab Med. 2006;26(2):313-327.

4. KL Koenig , S Lim , S Tsai . Crisis standard of care: refocusing health care goals during catastrophic disasters and emergencies. J Exp Clin Med. 2011;3(4):159-165. doi:10.1016/j.jecm.2011.06.003. Accessed October 23, 2014..

5. SJ Davidson , KL Koenig , DC Cone . The daily flow of patients is not surge: “management is prediction”. Acad Emerg Med. 2006;13(11):1095-1096.

6. DC Cone , KL Koenig . Mass casualty triage in the chemical, biological, radiological, or nuclear environment. Eur J Emerg Med. 2005;12(6):287-302.

7. FM Burkle Jr. Mass casualty management of a large-scale bioterrorist event: an epidemiological approach that shapes triage decisions. Emerg Med Clin North Am. 2002;20(2):409-436.

8. KL Koenig , RJ Hatchett , FA Mettler , et al. Medical treatment of radiologic casualties: current concepts. Ann Emerg Med. 2005;45(6):643-652.

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Disaster Medicine and Public Health Preparedness
  • ISSN: 1935-7893
  • EISSN: 1938-744X
  • URL: /core/journals/disaster-medicine-and-public-health-preparedness
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