Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 9
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Hershkovich, Oded Gilad, David Zimlichman, Eyal and Kreiss, Yitshak 2016. Effective medical leadership in times of emergency: a perspective. Disaster and Military Medicine, Vol. 2, Issue. 1,

    Mommsen, Philipp Macke, Christian and Krettek, Christian 2016. Orthopedics in Disasters.

    Bar-On, E. 2015. Handbook of public health in natural disasters.

    Sever, Mehmet Sukru Lameire, Norbert Van Biesen, Wim and Vanholder, Raymond 2015. Disaster nephrology: a new concept for an old problem. Clinical Kidney Journal, Vol. 8, Issue. 3, p. 300.

    Wagner, Jacqueline M. and Dahnke, Michael D. 2015. Nursing Ethics and Disaster Triage: Applying Utilitarian Ethical Theory. Journal of Emergency Nursing, Vol. 41, Issue. 4, p. 300.

    Einav, Sharon Hick, John L. Hanfling, Dan Erstad, Brian L. Toner, Eric S. Branson, Richard D. Kanter, Robert K. Kissoon, Niranjan Dichter, Jeffrey R. Devereaux, Asha V. and Christian, Michael D. 2014. Surge Capacity Logistics. Chest, Vol. 146, Issue. 4, p. e17S.

    Noel Gibney, R.T. Sever, Mehmet S. and Vanholder, Raymond C. 2014. Disaster nephrology: crush injury and beyond. Kidney International, Vol. 85, Issue. 5, p. 1049.

    Lampi, Maria Vikström, Tore and Jonson, Carl-Oscar 2013. Triage performance of Swedish physicians using the ATLS algorithm in a simulated mass casualty incident: a prospective cross-sectional survey. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Vol. 21, Issue. 1, p. 90.

    Ullah, Fasee Khelil, Abdelmajid Sheikh, Adil A. Felemban, Emad and Bojan, Hattan M. A. 2013. 2013 IEEE 15th International Conference on e-Health Networking, Applications and Services (Healthcom 2013). p. 658.


Triage in Mass-Casualty Events: The Haitian Experience

  • Ofer Merin (a1) (a2) (a3), Ian N. Miskin (a1) (a3) (a4), Guy Lin (a5), Itay Wiser (a1) and Yitshak Kreiss (a1)
  • DOI:
  • Published online: 27 January 2011

Introduction: Mass-casualty triage is implemented when available resources are insufficient to meet the needs of all patients in a disaster situation. The basic principle is to do the maximum good for the most casualties with the least amount of resources. There are limited data to support the applicability of this principle in massive disasters such as the January 2010 earthquake in Haiti, in which the number of patients seeking medical attention overwhelmed the local resources.

Objective: To analyze the application of a triage system developed for use in a mass-casualty setting with limited resources. The system was designed to admit only those patients who had medical conditions requiring urgent treatment that were within the capabilities of the hospital and had a good chance of survival after discharge. Priority was given to those whose treatment could be administered within a short hospital stay.

Method: A retrospective, observational review of computerized registration forms of Haitian earthquake victims who sought medical care at a 72-bed field hospital within four to 14 days after the event. An analysis of the efficacy of the triage protocol that was used followed, using length of hospital stay to measure consumption of resources.

Results: A total of 1,111 patients were triaged for treatment in the field hospital within 14 days of the earthquake. The median length of stay for all patients for whom data was available was 16 hours (mean = 29.7 hours). The majority of patients (n = 620, 65%) were discharged within 24 hours. Two hundred five patients underwent surgery and were discharged within a median of 39 hours (mean = 52.6 hours); of these, 124 (62%) were discharged within 48 hours. The total mortality of the treated patients was 1.5% (n = 17).

Conclusions: Currently accepted triage principles for the most part are appropriate for efficiently providing medical care in a disaster area with extremely limited resources, but require extensive adaptation to local conditions.

Corresponding author
Correspondence: Ofer Merin, MD Department of Cardiothoracic Surgery Shaare Zedek Medical CenterPOB 3235, Tel Aviv 91031, Israel E-mail:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1.CM Booth TE Stewart : Severe acute respiratory syndrome and critical care medicine: The Toronto experience. Crit Care Med 2005;33:S5360.

2.M Lemaitre F Carrat : Comparative age distribution of influenza morbidity and mortality during seasonal influenza epidemics and the 2009 H1N1 pandemic. BMC Infect Dis 2010;10:162.

3.JG Cushman HL Pachter HL Beaton : Two New York City hospitals' surgical response to the September 11, 2001, terrorist attack in New York City. J Trauma 2003;54:147154.

4.AV Devereaux JR Dichter MD Christian : Definitive care for the critically ill during a disaster: A framework for allocation of scarce resources in mass critical care. Chest 2008;133:51s66s.

5.CH Schultz KL Koenig EK Noji : A medical disaster response to reduce immediate mortality after an earthquake. N Engl J Med 1996; 334:438444.

8.CA Kahn CH Schultz KT Miller CL Anderson : Does START triage work? An outcomes assessment after a disaster. Ann Emerg Med 2009;54:424430.

10.Y Kriess O Merin K Peleg , : Early disaster response in Haiti: The Israeli field hospital experience. Ann Intern Med 2010;153:4588. Epub 2010 May 4.

11.O Merin N Ash G Levy MJ Schwaber Y Kreiss : The Israeli field hospital in Haiti–ethical dilemmas in early disaster response. N Engl J Med 2010;362:e38.

13.D Benson KL Koenig CH Schultz : Disaster triage: START then SAVE - a new method of dynamic triage for victims of a catastrophic earthquake. Prehosp Disaster Med 1996;11:117124.

14.W Sacco M Navin K Fiedler RK Waddell 2nd WB Long RF Buckman Jr.: Precise formulation and evidence based application of resource constrained triage. Acad Emerg Med 2005;12:759770.

15.N Pesik ME Keim KV Iserson : Terrorism and the ethics of emergency medical care medical care. Ann Emerg Med: 2001;37:642646.

17.Society of Critical Care Medicine Ethics Committee: Consensus statement on the triage of critically ill patients. JAMA 1994;271:12001203.

19.DB White MH Katz JM Luce B Lo : Who should receive life support during a public health emergency? Using ethical principles to improve allocation decisions. Ann Intern Med 2009;150:132138.

20.MD Sztajnkrycer BE Madsen AA Baez : Unstable ethical plateaus and disaster triage. Emerg Med Clin N Am 2006;24:749768.

21.SI Dara JC Farmer : Preparedness lessons from modern disasters and wars. Crit Care Clin 2009;25:4765.

24.ER Frykberg : Principles of mass casualty management following terrorist disasters. Ann Surg 2004;239:319321.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Prehospital and Disaster Medicine
  • ISSN: 1049-023X
  • EISSN: 1945-1938
  • URL: /core/journals/prehospital-and-disaster-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *