The management of large numbers of injured patients expected during catastrophic events - either from natural, unintended or deliberate incidents (e.g. 'all hazards events') could quickly overwhelm existing healthcare resources jeopardizing the lives of victims and healthcare providers. No consensus currently exists on standardized definitions or data needed for effective mass casualty triage. No outcome studies validate data needed for incidents involving chemical, radiological, or biological material, and none are appropriate for use with victims of all ages. Our broad long-term goal is to validate the accuracy of triage systems that are appropriate for use in chemical events with adult victims. We propose a study using health outcome data from a large chlorine leak to determine whether the data collected in four triage systems accurately predict actual clinical status. Six datasets collected from a chlorine leak that occurred in 2005 include patient demographics, exposure estimates, symptoms, outcome categories, and physiological measurements for more than 900 victims. Research studies published on these data indicate that oxygen saturation was predictive of acute medical outcomes. These data will be used to address the following specific aims: 1) Generate a research dataset useful for further analysis by linking actual data from six chlorine leak datasets to explore measures for completeness and robustness (to test RQ1). 2) Develop a statistical model using medical outcome categories and oxygen saturation levels as measures of medical outcome to compare four adult triage systems (to test RQ1). 3) Evaluate the ability of four adult triage systems to accurately predict medical outcomes using the statistical model (SA2) and research dataset (SA1). 4) Explore the development of a data driven model to triage patients using the research dataset (SA1) to predict medical outcomes for adults (to test RQ2). Research questions that frame the study: 1) What is the association between data collected in the four adult triage systems most frequently used in the U.S. and severity of respiratory signs/symptoms necessitating medical intervention from chlorine leak patient datasets? 2) What additional information in an adult mass casualty triage system sufficiently improves the prediction of an accurate triage classification for initial treatment that involves a chemical incident?

Public Health Relevance

There is a gap in disaster research in the development of accurate quality measures and assessments of triage tools. This is the first outcomes-level study conducted following an actual mass casualty event involving a chemical incident to determine whether triage data from the four most frequently used adult triage systems correlate with patient outcomes. This research will help to close the gap by identifying valid data points that can be used to benchmark initial triage decisions.

National Institute of Health (NIH)
National Library of Medicine (NLM)
Exploratory/Developmental Grants (R21)
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Biomedical Library and Informatics Review Committee (BLR)
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Sim, Hua-Chuan
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University of South Carolina at Columbia
Schools of Nursing
United States
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Culley, Joan M; Svendsen, Erik; Craig, Jean et al. (2014) A validation study of 5 triage systems using data from the 2005 Graniteville, South Carolina, chlorine spill. J Emerg Nurs 40:453-60
Culley, Joan M; Svendsen, Erik (2014) A review of the literature on the validity of mass casualty triage systems with a focus on chemical exposures. Am J Disaster Med 9:137-50
Runkle, Jennifer R; Zhang, Hongmei; Karmaus, Wilfried et al. (2013) Long-term impact of environmental public health disaster on health system performance: experiences from the Graniteville, South Carolina chlorine spill. South Med J 106:74-81
Craig, Jean B; Culley, Joan M; Tavakoli, Abbas S et al. (2013) Gleaning data from disaster: a hospital-based data mining method to study all-hazard triage after a chemical disaster. Am J Disaster Med 8:97-111
Culley, Joan M; Polyakova-Norwood, Vera (2012) Synchronous online role play for enhancing community, collaboration, and oral presentation proficiency. Nurs Educ Perspect 33:51-4
Culley, Joan M (2011) Use of a computer-mediated Delphi process to validate a mass casualty conceptual model. Comput Inform Nurs 29:272-9
Culley, Joan M; Effken, Judith A (2010) Development and validation of a mass casualty conceptual model. J Nurs Scholarsh 42:66-75
Culley, Joan M (2010) The role of the Medical Reserve Corps in nursing education. J Nurs Educ 49:708-11