Disaster triage: An inquiry among first responder health professionals

Background: Disaster response is multi-tiered and requires individuals to collectively work toward the singular goal of mitigating loss. However, research on disaster triage (a tool used in every mass casualty event) remains contradictory; triage methods vary and there is no repository of summative literature that catalogues the triage scheme in the United States (U.S.). Aims: The aim of this research was to describe the type of triage being used in the Appalachian region of the U.S. and the factors that impact the use of triage by first responders. Methods: This dissertation is divided into three manuscripts, each of which spotlighted a nuanced area of disaster response. Manuscript one was a literature review describing triage prevalence in the U.S. Manuscript two outlines a case study examining the socioeconomic characteristics of Appalachia, and how these characteristics impact the provision of healthcare during disaster response. Manuscript three describes a sequential multiple methods descriptive study using quantitative and qualitative tools to examine Appalachian disaster triage. Results: Findings revealed that 12 states have a mandated mass casualty incident triage schema; seven of these are defined as Appalachian (Georgia, Kentucky, Maryland, Mississippi, Tennessee, Virginia, and West Virginia). In surveying Appalachian first responders, a majority were male (68%) and middle age, with most respondents (27%) having 26-35 years of professional experience. When training was provided, it was described as multi modal, including an average of 3.78 hours per annum, and a combination of verbal (56.3%), slides (55.6%), and computer modules/simulation (51%). Respondents reported familiarity with multiple triage methodologies (48.4%) and conveyed that disaster response is complex and lacking standardization, they also advocated for a uniform triage approach. Discussion/Conclusion: As it pertains to disaster triage, Appalachia is a region of disproportionate vulnerability. While not all challenges of a disaster can be mitigated, knowing the triage methods being used and the drivers that affect the provision of mass casualty care are essential in providing judicious healthcare in this austere, and challenging, environment. This study begins to provide that foundation