The MCIT-H Algorithm

The MCIT-H algorithm is the recommended methodology to use for hospital triage during a mass casualty event. The algorithm is implemented for triaging all patients, trauma and non-trauma patients involved in a major trauma event and / or in other extraordinary circumstances. This includes situations in which the sheer number of patients involved or the number of patients with higher acuity presentations may exceed the capabilities of the healthcare organisations to which they are presenting.

The MCIT-H is a tool used by hospital triage staff with clear and valid criteria, using clinical assessment parameters in accordance with the Primary Survey assessment principles (x-A-B-C-D-E) of Emergency Medicine (external hemorrhage – Airway – Breathing – Circulation – Disability – Exposure & Environment).

Table 3 explains the individual criteria and clinical signs for each triage level. Explanations are provided as examples only and are neither exhaustive nor complete.

 

In the event of a Mass Casualty Incident (MCI), it will not always be possible or viable to provide an accurate and detailed assessment of each patient when adhering to the principle of “doing the greatest good for the greatest number”. Incoming patients are therefore likely to be assigned to a triage level based on the same or similar clinical signs. Standard Emergency Department processes or procedures are not designed to cope with the influx that occurs during a MCI, as such the MCIT-H algorithm becomes an essential tool that focuses on staff`s effort, on the patient urgency and best use of available resources.

 

The MCIT-H algorithm is based on established principals for treatment and transport priorities of the pre-hospital triage system. This ensures common ground through institutions involved in the chain of emergency services.

 

During the transport from the scene of the incident to the hospital, the patients’ condition may deteriorate or improve. Pre-hospital priority decisions have to be reevaluated for all patients upon arrival, triage needs to be a dynamic process and each patient needs to be reassessed based on the hospital assessment tool upon first contact within hospital staff. Staffing, room availability and material resources in a pre-hospital setting differ from those in the hospital. Due to these differences, the urgency level for hospital treatment may differ from the initial decision.