• Nathan A Bostick, Italo Subbarao, Frederick M Burkle, Edbert B Hsu, John H Armstrong, and James J James.
• Center forPublic Health Preparedness and Disaster Response, American Medical Association, Chicago, IL 60610, USA. andy.bostick@ama-assn.org
• Disaster Med Public Health Prep. 2008 Sep 1;2 Suppl 1:S35-9.

AbstractLarge-scale catastrophic events typically result in a scarcity of essential medical resources and accordingly necessitate the implementation of triage management policies to minimize preventable morbidity and mortality. Accomplishing this goal requires a reconceptualization of triage as a population-based systemic process that integrates care at all points of interaction between patients and the health care system. This system identifies at minimum 4 orders of contact: first order, the community; second order, prehospital; third order, facility; and fourth order, regional level. Adopting this approach will ensure that disaster response activities will occur in a comprehensive fashion that minimizes the patient care burden at each subsequent order of intervention and reduces the overall need to ration care. The seamless integration of all orders of intervention within this systems-based model of disaster-specific triage, coordinated through health emergency operations centers, can ensure that disaster response measures are undertaken in a manner that is effective, just, and equitable.

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