Of interest EMS paramedics, ambulance officers, firefighters, law enforcement and other emergency services personnel, MCI Triage is an iPhone app to help manage mass casualty incidents.It is builds on the Simple Triage and Rapid Treatment (S.T.A.R.T.) system developed in 1983 at the Hoag Hospital and the Newport Beach Fire Department in California.

Triage has always been a challenge during a mass casualty incident (MCI). Using the systematic triage method refined in recent years has been shown to reduce the mortality and morbidity of mass casualty incidents. When resources are limited, or they are overwhelmed by the number of casualties, the system identifies those victims that will most likely die within the first hour and allows rescuers to focus on those most likely to benefit from immediate medical care.

The system can be quickly taught to any one with first aid knowledge and experience. This allows more skilled and qualified responders to work on secondary assessment and treatment of victims.

With simple button prompts and on-the-fly calculation of triage categories, "MCI Triage" makes it easy to determine which colour tag to use and to automatically record each victim's condition as well as their age, gender and location. Even if your MCI triage training was years ago, this application will prompt you through the process and ensure consistent and reliable information is gathered and made available to incident command.

The "Add Victims" tab

As well as calculating the victim's triage category (Alpha, Bravo, Delta or Echo), the application also gathers the victim's age category (Infant, Child, Teen, Adult or Elderly), gender (Male or Female) and if time permits, their name or a brief description (e.g.. "red t-shirt"). Each victim's location is automatically added to their record using the iPhone's built-in GPS.

On the Add Victims tab, you press one or more buttons depending on each victim's age, gender and condition. Each button is a simple on/off button. If you press a button on inadvertently, simply press it again to turn it off. Once you have selected all the appropriate buttons for a victim, simply press "Add" and then move on to the next victim.

You must specify the victim's age group before you can add a record. The default gender is Male. If you are triaging an infant, the "walking" button is disabled. If you set a victim's "breathing" button to red (ie. not breathing), the remainder of the buttons will automatically turn red.

The "Incident Summary" tab

At any time, you can flip to the Summary tab to see how many victims there are in total and how many are in each Category (Alpha, Bravo, Delta and Echo). There is also a button on the summary screen to reset the data ... this erases all victim records and lets you start a new Incident.

The "Edit Details" tab

You can edit victim details at any time, delete duplicates and add names or other details as these become available, using the Edit Details tab.

The "Send Reports" tab

Using the Reports tab At any time you can email full details or an Incident Summary using the iPhone's mail application to incident control, EMS/fire/police dispatch, receiving medical facilities or anyone else who needs timely information on which to make decisions. When you choose to email all details or just an incident summary, the relevant information will be copied into a new e-mail message using the iPhone's email function. You can add any amount of additionalinformation to the e-mail body using the iPhone's keyboard. You will then need to choose one or more e-mail addresses from your Address Book or type in the recipient's e-mail address. An empty e-mail address may be added automatically to the To: line; you can delete this.

You can also send the Incident Summary by SMS to one or multiple mobile or cell phone numbers. When sending a Summary by SMS, a copy of the incident summary is copied into the iPhone's "clipboard". The application will open a new SMS text message, but you must "paste" the clipboard contents into the body of the text message. This is a constraint imposed by Apple that will hopefully be removed in future versions once Apple provides direct access to SMS functionality.

Triage Basics

There are five basic questions/steps used in the MCI Triage application, based on the START flowchart. The important principle is to spend less than one minute per victim during the initial triage sieve phase. You can always go around again and refine your details when your initial triage assessment is complete.

If the victim is not breathing, try to clear the airway and perform any airway manoeuvres to get the victim breathing. If all attempts fail, then the victim is presumed dead, and tagged with a black Category Echo label (or in some jurisdictions a white label with a black border).

If the victim is breathing, then calculate the breathing rate; if the victim’s breathing rate is greater than 30 per minute or less than 6 per minute, use a red Category Alpha tag indicating immediate care because these are primary indicators for shock.

If the victim’s breathing rate is greater than 6 and less than 30 per minute then check perfusion; if the victim lacks a radial pulse, then immediate attention is required and you should use a red Category Alpha tag.

If the radial pulse is present, evaluates the victim’s mental status; ask the victim to follow simple commands; if they are unable to do so, use a red Category Alpha tag.

If all previous tests are normal and the victim is walking, use a green Category Delta tag; if the victim cannot walk and all the other tests are normal, use a yellow Category Bravo tag.

FEEDBACK & TECHNICAL SUPPORT:

We welcome your comments on MCI Triage for iPhones. If you have any problems, suggestions for improvements or ideas for additional features in future versions, please let us know by sending an email to info@islandsoftware.com.au

DISCLAIMER:

You should consult the many resources available on MCI Triage or obtain suitable training before downloading and using this application. It has been written and is intended only for use by EMS paramedics, ambulance officers, firefighters, law enforcement and other emergency services personnel who have been suitbly trained.

No responsibility whatsoever is accepted for the accuracy, completeness, or relevance to the user's purpose, of this application or the information it contains or collates. The authors, designers, developers and publisher of this application, and all the aforementioned's officers, employees and agents, are not responsible for any actions taken on the basis of any information provided in or collated by this application, nor for any errors or omissions. The authors, designers, developers and publisher disclaim all and and liability to any person howsoever arising, including liability for negligence, in respect of anything and of the consequences of anything done or omitted to be done by any person who relies solely or partially on the whole or any part of the application and/or reliance on its availability at any time. Nothing in this application should be taken as professional medical advice which should only be obtained from an appropriate practicing professional service provider. No warranty is given that this application is free of infection by computer viruses or other contamination, nor that access to the application or any part of it will not suffer from interruption from time to time. PURCHASING AND USING THIS APPLICATION INDICATES THAT YOU HAVE READ AND ACCEPT THE TERMS & CONDITIONS IN THIS DISCLAIMER. IF YOU DO NOT ACCEPT THE TERMS & CONDITIONS IN THIS DISCLAIMER, YOU ARE NOT AUTHORISED TO USE THIS APPLICATION.

MCI Triage was created by David Godfrey-Smith with assistance from Matthew Smith and the instructors from iPhone Boot Camp in New York. Graphics by Josh Lamont Design, Hobart.