Responding to a Mass Casualty Incident (MCI) is a traumatic event. It can be a giant wild fire with impenetrable smoke or a massive crash on a highway that's a mile long. It is chaotic and a logistical nightmare. First responders must keep track of patients and make sure those patients arrive at and are treated at the hospital. This is essential for patient survival and vital to the aftermath of an MCI. For a successful MCI response, patient information must be made readily available and communication between the first responders easy and less stressful.

Developed in sponsorship with Battelle and in collaboration with members of the Columbus Fire Department, the PullTagTM is an innovative triage tag that quickly captures crucial patient information without hindering EMS personnel from treating patients during a mass casualty incident (MCI) response. It is used to communicate a patient's condition to other first responders in the field.

Triage is the prioritization and organization of patients according to injury severity. During an MCI, first responders have a window of 30-60 seconds to triage patients. Any more time spent and another patient could die. Implementing the PullTag ensures that vital patient data is captured without losing precious seconds.

Designed to eliminate writing in the field, the PullTag uses a pull tab mechanism. First responders rip off sections of the tag that correspond to injury location, patient treatment, and patient tracking. Additional patient details such as name and date of birth are located on the back for when the patient arrives at the hospital.

The PullTag helps EMS personnel to quickly identify injury severity and treatment applied. By eliminating the need to write down vital information, first responders can spend more time triaging and treating patients.

In a Mass Casualty Incident response, anything can happen. It can be dark, rainy, and bloody. In environments that are unpredictable, low tech solutions are often the best because there are fewer points of failure.

Background

EMS Personnel use triage tags to signify to other providers what condition a patient is in. Currently, there are several triage tags on the market. Triage tags such as the SMART triage tag provide basic information such as priority color (red is priority 1, yellow is priority 2, green is priority 3, and black is dead) and injury location. It is also full of excess information that is not used during triage such as the Glascow Coma Scale. Additionally, it can take up to four minutes (Brownlee 2014) to fill out. This wastes precious time in responding to other patients who are severely injured. The end result is that first responders don't check off any boxes because writing down information takes too much time. Therefore, it has been reduced to priority color only.

Another form of the original triage tag is the triage ribbon. It is easy to tie on but only signifies the priority color of the patient. This hinders EMS response when they want to conduct further treatment because they have to figure out what is wrong with the patient all over again.

Design Overview

The PullTag is a triage tag that combines the two original designs together. It is a ribbon that is easily attachable through a loop and velcro mechanism which securely fastens to a patient's limb. It also provides the basic information that first responders need during triage. Designed using a pull tab mechanism, first responders rip off sections of the PullTag that correspond to injury location, patient treatment, and patient tracking. The tear reveals information that corresponds to that pull tab. The revealed information is in a contrasting color which helps first responders to quickly identify the patient's status.

Additionally, The PullTag comes in strips of different colors so EMS personnel can quickly choose which ribbon applies to the patient he treats. The ribbons are designed to fit into a standard EMS emergency response bag which also holds other triage items such as tourniquet.

During the design process other solutions were suggested such as a QR code. However, first responders didn't want to rely to technology that could easily fail if overwhelmed. While a low tech solution, the PillTag ensures to work regardless of technological failures.

How this design is optimal for mass casualty response

1. This design eliminates the need to write down information.

2. The pull tab mechanism leverages a quick tear off method that is easy and efficient for first responders to use.

3. The PullTag only communicates the most essential information. It informs other first responders of the patient's condition without getting bogged down by further details that are unnecessary during triage.

Design Process

During this design process, I mainly collaborated with the Columbus Fire Department. For my research, I conducted interviews, facilitated two co-design research sessions, toured a couple fire stations, and shadowed a mock mass casualty training at the Columbus Airport.

I had eight participants for my first co-design research session. Through this first session, I discovered that communication during an MCI is vital for the survival of the casualties. Visual communication is the most ideal form of communication.

The mock MCI at the airport was so loud that I could barely hear the person speaking next to me. I noticed that when a first responder went to use the common triage tag, he wasted precious time accessing it and then flipping it over to get to the correct identifier. Additionally, he wrote down no information even though there is space to do so. A different group that used triage ribbons was a lot faster at attending the casualties and getting to everyone on time.

For my second co-design research session, I asked the firemen to create their ideal triage tag. At the end of the activity, I concluded that the most vital information included color (indicating injury severity), injury location, field treatment, and patient tracking. They also wanted to include patient information such as name and date of birth for hospital use. Most importantly, they emphasized that they wanted to eliminate all writing in the field.

I asked first responders to test out the triage tag. They used it during one of their training sessions. The tag was used with different combinations of treatments and injuries. Overall, it got very positive feedback. There were only a couple of suggested changes. One was adding an "unconscious" and "conscious" tab this was to "determine the status of the patient at the time of the first evaluation." Another suggestion was changing the "reposition airway" tab just to "airway" because "it would give the thought of breathing problems that would need to be addressed if nothing is visible to the eye."

Overall Impact

Mass casualties are becoming more prevalent. Therefore, more people are impacted and injured. With the introduction of the PullTag, this design will hopefully speed up the triaging process and even reduce the frequency of re-triaging patients. More patients will survive.

Future improvements

This design would need to be optimized for mass production. Additionally, triage tags are a one time use item because blood and other bodily fluids often stain the tag. The patients cannot return the tag once it has been used. Therefore, questions arise as to how to make this a more sustainable item in other parts of the production process.

Works cited

Andra M. Farcas , Hashim Q. Zaidi , Nicholas P. Wleklinski & Katie L. Tataris (2022) Implementing a Patient Tracking System in a Large EMS System, Prehospital Emergency Care, 26:2, 305-310, DOI: 10.1080/10903127.2021.1883166

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