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Prioritized criteria for casualty distribution following trauma-related mass casualty incidents

Mohammad Reza Khajehaminian, Ali Ardalan, Sayed Mohsen Hosseini Boroujeni, Amir Nejati, Omid Mahdi Ebadati E, Mahdi Aghabagheri




In the aftermath of mass casualty incidents, many resolutions need to be made in a fast and influential manner within high pressure environment to assign the limited resources among the numerous demands. This study was planned to rank the criteria influencing casualty’s distribution following trauma-related mass casualty incidents.

Material and Methods

This study utilized a modified Delphi methodology, concentrating on extracted criteria attained from preceding systematic literature review. All 114 extracted criteria classified into eight sections including space, staff, stuff, system and structures, triage, treatment, transport, and uncategorized criteria and were imported into an online survey tool. In first round experts were asked to rank each criteria on a five-point Likert scale. Second round incorporated feedbacks from first round stated as percent and median scores from the panel as a whole.  Experts then were called upon to reassess their initial opinions regarding uncertain remarks from first round, and once again prioritize presented criteria.


Fifty-seven criteria were accepted relevant to the following sections: space: 70% (7/10); staff: 44% (4/9); system / structure: 80% (4/5); stuff: 39.1% (9/23); treatment; 66.7% (6/9); triage: 73.7% (14/19); transport: 38.7% (12/31) and other sections: 12.5% (1/8). The first round achieved nearly 98% (n=48) response rate. Of 114 criteria which were given to the experts, 68 (almost 60%) were approved. The highest percentage of agreement was relevant to the system and structures sections (4/5=80%). The response rate for the second round was about 86% (n=42). From the 68 criteria presented to experts, nearly 84% (57) criteria could obtain consensus.


 “Casualty Level of Triage on the Scene” and “Number of Available Ambulance” were two criteria that obtained the maximum level of consensus. On the other hand, “gender of casualty”, “Number of Non-Medical staffs in each Hospital” and “Desire to transport family members together” got lowest level of consensus. In this modified Delphi study, the criteria that have been identified influential on the distribution of casualties following trauma-related MCIs, were prioritized. This sorted list could be used as a catalogue for developing decision support system or tool for casualty distribution following mass casualty incidents.


Mass Casualty; Casualty Distribution; Patient Distribution; Trauma; Decision Making


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DOI: https://doi.org/10.22037/aaem.v8i1.561

DOI (PDF): https://doi.org/10.22037/aaem.v8i1.561.g771

DOI (HTML): https://doi.org/10.22037/aaem.v8i1.561.g799