Summary: Triage systems such as SALT, SMART, and START were developed for prehospital providers to be able to provide consistent and logical sorting when facing a mass casualty event (MCE). In the field, the most important and resource-limited decision is to determine the priority of transport. By contrast, in a hospital, there is potential for overwhelm of other resources, such as available proceduralists and operating rooms. As such, these protocols are less useful when implemented as secondary triage for patients after transfer from the site of the incident. Simplified Management and Resource Triage for Mass Casualty Events (SMART-MCE) is a novel method designed for secondary, in-hospital triage, specifically addressing the intricacies of critical resource management in the emergency department. Description: A triage officer is appointed by the incident commander, with preference for a senior emergency physician. Upon arrival, patients are sorted based on immediate resource needs to address the pathology of circulation (C), airway (A), or breathing (B). Patients who have a problem with C or A+B are triaged to the highest resourced area, zone one. Patients with a single problem with A or B are triaged to the critical area, zone two. Patients with no immediate problems with C, A, or B are triaged to the delayed area, zone three. SMART-MCE was developed at the Samson Assuta Ashdod University Hospital (AA), a 300-bed regional trauma center in Ashdod, Israel, and implemented for the first time during the October 7th massacre in southern Israel. It performed well for maximal resource utilization in an efficient and consistent manner: eighty-five trauma patients were transported to AA, with zero casualties during the initial treatment phase in the emergency department. Based on these preliminary findings, this method warrants further study to establish its usefulness in other hospitals in Israel and internationally.
Wasserman et al. (Sun,) studied this question.