Triage and management of mass casualties in a train accident.

OBJECTIVE: The purpose of this study was to assess the practicality and usefulness of different scoring systems of triage process in mass casualty management. DESIGN: Descriptive/observational. PLACE AND DURATION OF STUDY: An experience of management of train accident in Balochistan in the year 2003. SUBJECTS AND METHODS: One hundred and twenty-two patients injured in train accident of Quetta Express were included in the study. A trauma team reached the site of the accident. Triage was done at three levels. "Triage sieve" scoring system was used at the site of accident, "field categories of trauma patients" at Primary Health Care Centre, and "ATLS (Advanced Trauma Life Support) secondary survey" at tertiary referral centre. Helicopters and ambulances were used for evacuation of patients. RESULTS: There were 122 injured patients. " Triage sieve " system scored 14(11.47%) patients in priority I, 21(17.21%) patients in priority II, 80(65.57%) patients in priority III and 7(5.73%) dead individuals in priority IV at the site of accident. Casualties clearing time was three and half hours. By utilizing "field categories of trauma patients" at primary health care centre, 7(5.7%) patients were placed in category I who were air lifted, 19(15.57%) patients in category II, 89(72.95%) patients in category III and 7(5.73%) dead remained in category IV. Application of ATLS secondary survey in CMH, Quetta triaged 4(57.14) patients in priority I and 3(42.85) patients in priority II. There was only one death after the triage process started. CONCLUSION: Proper triage, appropriate resuscitation, and timely evacuation definitively decrease morbidity and mortality in trauma patients, and facilitates utilization of the available resources appropriately.