Anr D 23 00993

Applied Nursing Research
A Systematic Review: Evaluation of Triage System in Emergency Departments during

Disaster Situations
--Manuscript Draft--
Manuscript Number: ANR-D-23-00993
Article Type: Research Paper
Keywords: Prehospital triage systems; Early mortality; Disaster settings; Resource allocation;
Triage effectiveness
Corresponding Author: Wawan Febri Ramdani

Aisyiyah Yogyakarta University
INDONESIA
First Author: Wawan Febri Ramdani
Order of Authors: Wawan Febri Ramdani
Renaldi M
Endah Tri Wulandari
Abstract: Background During natural disasters, an accurate and efficient triage system in the ED
is crucial. This review evaluates the effectiveness of triage systems in disaster
conditions, informing the development of optimal systems for managing patients and
enhancing emergency management. Methods In this study, the method used is a
systematic approach or systematic review. This approach involves specific steps to
systematically gather, filter, and analyze relevant studies and evidence regarding the
reliability of the triage system in the Emergency Department (ED) during disaster
situations. Inclusion and exclusion criteria are determined using PICOS, and literature
search is conducted through various sources of information. Data from selected
studies are analyzed and synthesized to generate research conclusions related to the
reliability of the triage system in the ED during disaster situations. Results Various
triage systems were evaluated in this study, including NEWS2, GAP, START,
JumpSTART, STM, META, CRAMS, RTS, SI, ISS, CTAS, SALT, Triage Sieve,
CareFlight, TTAS, TPTS, and FDNY. Conclusion The study concludes that triage
systems in EDs during disasters vary in accuracy. They can effectively allocate
resources but have weaknesses leading to errors. Inconsistency in assessment criteria
and limited resources are challenges. Recommendations include clear guidelines,
training, technology use, and ongoing evaluation. Consistent and reliable triage
systems are crucial for disaster response. Efforts to improve accuracy ensure
appropriate care despite resource limitations.
Suggested Reviewers: Idyatul Hasanah

idyatulhasanah@gmail.com
I Made Saifudin
yanuar.ikadek@stikessuryaglobal.ac.id
Setyowati Rahma
wati123@ui.ac.id
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Cover Letter
Dear Editor's, Applied Nursing Research
I would like to submit my article titled "A Systematic Review: Evaluation of Triage System in
Emergency Departments during Disaster Situations" for consideration as a contribution to the
Journal of Applied Nursing Research. I am confident that this paper will be a valuable addition to
your esteemed journal.
In this paper, I conducted an in-depth systematic review to evaluate the triage system in emergency
departments during disaster situations. This study examines various aspects of the triage system,
including its effectiveness in identifying patients in need of immediate care, efficient resource
allocation, and the medical team's response during emergency situations. We also identified trends
and significant findings that can provide valuable insights for nursing practitioners in dealing with
patients during demanding emergency situations.
Some key points discussed in this paper include:
1. A comprehensive review of various triage methods used during disaster situations.
2. Evaluation of the effectiveness of different triage methods in identifying patients in need of
immediate care.
3. Analysis of resource allocation and the medical team's response during emergency situations.
I believe that this paper will provide valuable insights to the readers of the Journal of Applied
Nursing Research Nursing and has the potential to influence nursing practice in handling patients
during emergencies.
I highly appreciate the opportunity to publish this paper in your esteemed journal. I kindly request
guidance on the review process and your journal's editorial requirements. Attached, I have
included the complete article along with a comprehensive list of references.
Thank you for considering my submission. I look forward to the possibility of collaborating with
the Journal of Applied Nursing Research in exploring this important topic.
Sincerely,
Wawan Febri Ramdani

Title Page (with Author Details)
Systematic Review: Evaluation of Triage System in Emergency Departments during

Disaster Situations
Authors: Wawan Febri Ramdani1, Renaldi. M2, Endah Tri Wulandari3
Afiliation:1Departments of Nursing, Faculty of Health and Science, Universitas Aisyiyah
Yogyakarta, Indonesia, wawanramdani@unisayogya.ac.id/
https://orcid.org/0000-0002-4499-5519
1
Center Studies for Women, Family and Disaster, Universitas Aisyiyah
Yogyakarta, Indonesia, wawanramdani@unisayogya.ac.id/
https://orcid.org/0000-0002-4499-5519
2
Co-Author: Departments of Nursing, Sekolah Tinggi Ilmu Kesehatan Makassar,
Indonesia, renaldi@stikmks.ac.id/https://orcid.org/0000-0001-9409-7808
3
Bachelor of Applied Anesthesiology Nursing, Faculty of Health and Science,
Universitas Aisyiyah Yogyakarta, Indonesia,
endahtriwulandari@unisayogya.ac.id
Background: During natural disasters, an accurate and efficient triage system in the ED is
crucial. This review evaluates the effectiveness of triage systems in disaster conditions,
informing the development of optimal systems for managing patients and enhancing
emergency management.
Methods: In this study, the method used is a systematic approach or systematic review. This
approach involves specific steps to systematically gather, filter, and analyze relevant studies
and evidence regarding the reliability of the triage system in the Emergency Department (ED)
during disaster situations. Inclusion and exclusion criteria are determined using PICOS, and
literature search is conducted through various sources of information. Data from selected
studies are analyzed and synthesized to generate research conclusions related to the reliability
of the triage system in the ED during disaster situations.
Results: Various triage systems were evaluated in this study, including NEWS2, GAP, START,
JumpSTART, STM, META, CRAMS, RTS, SI, ISS, CTAS, SALT, Triage Sieve, CareFlight,
TTAS, TPTS, and FDNY.
Conclusion: The study concludes that triage systems in EDs during disasters vary in accuracy.
They can effectively allocate resources but have weaknesses leading to errors. Inconsistency
in assessment criteria and limited resources are challenges. Recommendations include clear
guidelines, training, technology use, and ongoing evaluation. Consistent and reliable triage
systems are crucial for disaster response. Efforts to improve accuracy ensure appropriate care
despite resource limitations.
Keywords: Prehospital triage systems; Early mortality; Disaster settings; Resource allocation;
Triage effectiveness
Manuscript (without Author Details) Click here to view linked References
A Systematic Review: Evaluation of Triage System in Emergency Departments during

Disaster Situations
Background:
Natural disasters often cause massive destruction and affect the availability of limited medical
resources.1–5 In such situations, it is important to have an accurate and efficient triage system
in the Emergency Department (ED) to manage patients appropriately and provide urgent care
to those in need.5–7
Trauma management in the ED during disaster conditions is a crucial aspect of providing

emergency care to patients with serious injuries.8,9 Natural disasters such as earthquakes,
floods, or fires often result in complex injuries that require prompt and precise treatment10,11.
In disaster situations, the primary priority in trauma management in the ED is to ensure the
safety and stabilization of patients as quickly as possible.8,9 Medical teams face challenges in
terms of resource availability, including limited or damaged medical personnel, equipment, and
facilities due to the disaster.3,5,12 Therefore, medical teams need to adopt adaptive and creative
approaches to provide the most effective care under constrained conditions.6,13–15
Triage systems involve the categorization of patients based on the severity of their injuries or
illnesses, with the aim of identifying patients who require immediate care and prioritizing
them.13,16–18 The accuracy of the triage system becomes crucial during disaster situations,
where the severity of injuries and medical needs can drastically increase.13,14,16–19
During disaster conditions, medical triage plays a vital role in determining the priorities for
trauma management.20–24 Patients with life-threatening injuries requiring immediate
intervention should receive primary attention. This may include addressing respiratory injuries,
life-threatening bleeding, or injuries that impair other vital functions.25–27 Additionally, patients
with less severe injuries but still requiring emergency care also need to be identified and
provided with appropriate treatment.24–27
However, despite the importance of an accurate triage system, its effectiveness in identifying
patients in need of immediate care remains a subject of debate among medical professionals
and researchers.28 Several triage systems have been developed and used in various countries,
but the comparison of accuracy and performance among these systems is not yet fully
understood.21,29–31
Therefore, the aim of this systematic review is to evaluate the accuracy of existing triage
systems in the Emergency Department (ED) during disaster situations. By analyzing the
available studies and evidence, we aim to provide a comprehensive understanding of the
accuracy of different triage systems in identifying patients in need of immediate care during
disasters.
This research is expected to provide valuable insights to medical practitioners and decision-
makers in the development, selection, and implementation of appropriate and optimal triage
systems in the ED when facing disaster situations. By improving the accuracy and performance
of the triage system, it is hoped that the ED's ability to respond quickly and provide appropriate
care to patients in challenging emergency conditions will be enhanced.16,32
The systematic approach in this systematic review method provides advantages in

comprehensively and objectively combining existing evidence. It allows for in-depth insights
and stronger information about the reliability of the triage system in the emergency department
during disaster situations, which can be used to enhance understanding and practices in
emergency management under challenging conditions.24,32,33
METHOD:
In this study, the research method used is a systematic approach or systematic review. This
approach involves specific steps to systematically gather, filter, and analyze relevant studies
and evidence34, regarding the reliability of the triage system in the Emergency Department
(ED) during disaster situations.
The guideline used to conduct this systematic review is The Preferred Reporting Items for
Systematic Review and Meta-Analysis (PRISMA).34 This systematic review has been
registered with PROSPERO under registration number CRD42023388815.
The first step in this systematic review method is to formulate clear and well-defined research
questions. The research question in this study focuses on the reliability of the triage system in
the ED during disaster situations.35 Next, inclusion and exclusion criteria are determined using
PICOS:36
Inclusion and exclusion criteria using PICOS:

Population (P): Inclusion: Studies involving patients in the Emergency Department during
disaster situations. Exclusion: Studies involving patients outside the Emergency Department
or outside the context of disasters.
Intervention (I): Inclusion: Studies evaluating the accuracy of the triage system. Exclusion:
Studies focusing on interventions other than the triage system or not evaluating accuracy.
Comparison (C): Inclusion: Studies comparing different triage systems or evaluating the
accuracy of one triage system. Exclusion: Studies without comparisons or not evaluating
accuracy.
Outcome (O): Inclusion: Studies reporting on the accuracy of the triage system in identifying
patient severity or resource allocation. Exclusion: Studies not reporting on accuracy or
evaluating outcomes unrelated to the performance of the triage system.
Study Design (S): Inclusion: Systematic reviews, randomized controlled trials, observational
studies, retrospective, prospective, and other relevant study designs. Exclusion: Case reports,
editorials, opinions, and studies with insufficient data or methodology. After that, search
keywords are created. The keywords used are ("emergency department" OR "emergency
departments") AND ("triage system" OR "triage systems") AND ("reliability" OR "accuracy"
OR "effectiveness") AND ("disaster" OR "disaster situations").
Once the research questions are defined, a comprehensive literature search is conducted to
identify relevant studies and resources. This search can be done through electronic databases,
scientific journals, related publications, and other sources of information. The databases used
include PubMed, ProQuest, EBSCOhost, and an additional database source, Google Scholar.
Once the appropriate studies are selected, data analysis and synthesis are performed. Data
obtained from the selected studies are extracted and analyzed to gather information about the
reliability of the triage system in the ED during disaster situations. This data is then synthesized
and combined to obtain an overall understanding of the research topic.
Next, the results of the data analysis and synthesis are used to formulate research conclusions.
These conclusions include key findings related to the reliability of the triage system in the ED
during disaster situations, existing weaknesses, and recommendations for the development of
a better triage system in the future.
Results:
The results of the journal database search are presented in the table below.
Table 1 Search on PubMed
Search Query Action Item

term found
#2 ("emergency department" OR Filter: 8
"emergency departments") AND ("triage - Year: 2013-2023
system" OR "triage systems") AND - Species: Human
("reliability" OR "accuracy" OR - Source type: Journal
"effectiveness") AND ("disaster" OR - Language: English
"disaster situations") and Indonesian
"emergency departments") AND ("triage -
system" OR "triage systems") AND
("reliability" OR "accuracy" OR
"effectiveness") AND ("disaster" OR
"disaster situations")
Table 2 Search on ProQuest

term found
"effectiveness") AND ("disaster" OR - Language: English
"disaster situations") and Indonesian

Table 3 Search on EBSCOhost

term found
- Language: English
and Indonesian
In this study, various types of triage systems were evaluated, including the National Early
Warning Score 2 (NEWS2), Glasgow Coma Scale-Age-Pressure Score (GAP), Simple Triage
and Rapid Treatment (START), JumpSTART, Sacco Triage Method (STM), Prehospital
Advanced Triage Method (META), CRAMS score (circulation, respiration, abdomen, motor,
speech), Revised Trauma Score (RTS), Shock Index (SI), Glasgow Coma Scale-Age-Pressure
Score (GAP), Injury Severity Score (ISS), Canadian Triage Acuity Scale (CTAS), Sort, Assess,
Lifesaving interventions, and Treatment/Transport (SALT), Triage Sieve, CareFlight, Taiwan
Triage and Acuity Scale (TTAS), Triage and Patient Transfer System (TPTS), and New York
City Fire Department (FDNY).29,37–45 The results of the resume are presented in the table 4
below, and Flowchart selecting studies using PRISMA (Preferred Reporting Items for
Systematic Review and Meta-Analyses) Figure 1 beow.
Research identification through the main database Research identification through other methods
Identified database Manual identified from

Identification
search records
Google scholar (n= 2.400)
(N=467) Duplicates exclude
PubMed (n=8) (n=20)
ProQuest (n=277)
EBSCOhost(n=182)
Exclude (n=434)
Titel and abstract Title and abstract not relevant to: Articles assessed for
Screen Population (P), Intervention (I), eligibility (n=10)
(n =447) Comparation (C), Outcome (O),
and Design (D)
Full text screen Research included (n= 3)

Screening
Reports not retrieved (n = 0)

(n =13)
Exclude (n=7)
Second full-text screen - Wrong study population (n=2)

and assessed for - wrong intervention (n=1)
eligibility (n =6) - wrong outcome (n=1)
- Wrong study design (n=1)
Research included
(n =6)
Included
Total Research included

(n =9)
Figure 1. Flowchart used in selecting studies using PRISMA (Preferred Reporting Items for
Systematic Review and Meta-Analyses) (Page et al., 2021)46
Table 4 Article Resume
N Author, Sample Participant and

Country Design Research Objective Type of Triage Result
o year size (n) setting
1 Lin et al., Taiwan Retrosp 47 This study Evaluating the Simple Triage and There is a suboptimal agreement between
(2022)44 ective patient involves a total of accuracy of the Rapid Treatment the START triage categories determined in
47 patients who Simple Triage and (START) the emergency department and the
presented to the Rapid Treatment consensus standards for minor and delayed
emergency (START) protocol as triage categories. However, the START
department during a method for mass protocol has achieved appropriate
the response to a casualty triage. sensitivity, specificity, and accuracy
train accident (>90%) in predicting the need for surgery
disaster. and placement in the emergency
department.
2 Cross & United retrospe 530.695 Trauma patients Comparing various  Simple Triage and Metode Simple Triage and Rapid
Cicero, State ctive patient whose records are disaster triage Rapid Treatment Treatment (START) dan New York City
(2013)43 included in the methods and (START) Fire Department (FDNY) memiliki area di
National Trauma evaluating their  New York City Fire bawah kurva receiver operating
Data Bank. effectiveness in Department characteristic (AUC) tertinggi dalam
predicting mortality (FDNY) memprediksi mortalitas, sementara metode
in trauma patients.  Sacco Triage Sacco Triage memiliki AUC tertinggi
Method dalam memprediksi hasil sekunder.
 others.
3 Lin et al., Taiwan Retrosp 63.155 adult patients examine the  Triage and Patient Taiwan Triage and Acuity Scale (TTAS)
(2022)42 ective transported via effectiveness of the Transfer System was more effective than the two-level
the EMS system five-level triage (TPTS) Triage and Patient Transfer System
to the ED during system over the  Taiwan Triage and (TPTS) in predicting outcomes such as
the period from conventional two- Acuity Scale hospitalization rate and ED medical
July to December level prehospital (TTAS). resource utilization.
2012 in a medical triage system in
center in northern Taiwan.
Taiwan
4 Bolduc et Kanada RCT 30 Paramdedis, to evaluate the  Computer-based Computer-based (electronic) START triage
al., dokter dan preference of (electronic) START has the same accuracy as paper-based
(2018)38 perawat di Rumah healthcare providers  Paper-based (manual) START triage, regardless of the
Sakit Montreal and patients for each (manual) START type of healthcare provider or severity level
General (MGH) method of patient presentation.
di Montreal,
Quebec, Kanada.
5 Lin et al., Taiwan Retrosp Tidak Tertiary center of compare the  Simple Triage and Both triage systems have similar
(2020)39 ective disebutk Eastern Taiwan performance of two Rapid Treatment predictions regarding placement in the
an Victims of the triage systems (START) emergency department, and there is
Hualien  Taiwan Triage and moderate agreement between START and
earthquake Acuity Scale TTAS in differentiating emergency and
(occurred on (TTAS), non-emergency patients.
February 6, 2018)
6 McKee et United Prospec 125 Adult patients Determining which  SALT The SALT triage system is more accurate
al., States tive who present to the triage system is the  START and has the lowest under-triage rate
(2020)45 observa emergency most accurate and  Triage Sieve compared to other triage systems, with an
tional department (ED) identifying  CareFlight accuracy rate ranging from 36% to 37%.
at a tertiary care limitations or areas However, SALT also has the highest over-
facility. This study for further research triage rate compared to other systems.
was conducted at in mass triage. When each level is compared to SALT
a level 1 trauma triage using a two-sample test for equality
center in the of proportions with continuity correction,
United States. p-values were found to be less than 0.05,
indicating that the differences are
statistically significant.
7 Heffernan Prospec 115 Pediatric patients Determining which  SALT None of the triage systems examined were
et al., tive presenting to a triage system is the  JumpSTART found to have a high level of accuracy, and
(2019)40 observa pediatric specialty most accurate.  Triage Sieve each exhibited unacceptable levels of
tional emergency  CareFlight under-triage.
department that is SALT triage was found to have the highest
also a verified accuracy rate, with 59% of patients
level 1 trauma correctly classified. The accuracy rates
center serving ranged from 56% to 59% for all four triage
southeastern systems. The under-triage rates varied from
Wisconsin. 33% for SALT triage to 39% for the other
triage systems. SALT triage had the highest
over-triage rate at 6%, compared to 4% for
JumpSTART and 5% for Triage Sieve and
CareFlight.
8 Yuksen., et Thailand retrospe 218 Patients who Determining the  shock index (SI), This study found that the National Early
al., ctive received need for  Glasgow coma scale Warning Score (NEWS) is the most
(2023)37 cross- prehospital care standardized triage (rSIG) accurate pre-hospital screening tool for
section and were tools to screen for predicting Emergency Severity Index (ESI)
al transported to the injuries outside of 1-2 and activation of massive transfusion
ED of hospitals and  national early protocol (MTP) in trauma patients. The

Ramathibodi determining whether warning score optimal cutoff value, maximizing
Hospital by the injured individuals (NEWS) specificity and sensitivity to predict ESI 1-
EMS team, should be 2, was NEWS >6, with a discrimination
including the transported to performance (AuROC, 95% CI) of 0.74
basic and appropriate trauma (95% CI, 0.70-0.65), respectively, p <
advanced life centers. 0.001. The optimal cutoff value,
support teams, maximizing specificity and sensitivity to
from January predict MTP activation, was NEWS >6,
2015 to with a discrimination performance
September 2022. (AuROC, 95% CI) of 0.76 (95% CI, 0.67-
0.85), respectively, p = 0.111. This study
also found that the optimal cutoff value,
maximizing specificity and sensitivity to
predict ICU admission, was NEWS >6,
with a discrimination performance
(AuROC, 95% CI) of 0.77 (95% CI, 0.68-
0.86), respectively, p < 0.001. The study
concluded that NEWS should be
implemented as a standard triage tool in
pre-hospital trauma settings, especially in
areas like Thailand where there is currently
no standardized triage tool available.
9 Martin- Spain observa 1.288 Four provinces in Evaluating the  Early Warning All evaluated triage systems demonstrated
Rodhuurez sional Spain (Burgos, effectiveness of Score 2 (NEWS2) high ability in predicting early mortality,
et al., prospek Salamanca, different prehospital  Simple Triage and with the National Early Warning Score 2
(2019)29 tif Segovia, and triage systems based Rapid Treatment (NEWS2) and the Glasgow Coma Scale-
Valladolid) during on physiological (START) Age-Pressure Score (GAP) identified as the
the period from parameters in  Sacco Triage best overall triage systems. NEWS2 proved
April 1, 2018, to predicting early Method (STM) to have excellent diagnostic capacity for all
February 28, mortality within 48  Prehospital pathological groups and is easy to
2019. Patients hours after a major Advanced Triage implement, making it an ideal system for
brought to the disaster incident and Method (META) use in prehospital settings. The best cutoff
Emergency identifying the most  CRAMS points for various triage systems were
Department (ED). reliable system for (circulation, determined in terms of sensitivity and
the initial assessment respiration, specificity, with the NEWS2 scale having a
of high-risk patients abdomen, motor, sensitivity of 79.7% and specificity of
and determining their speech). 84.5% for a score of nine or higher.
triage level  Revised Trauma
effectively and Score (RTS), Shock
efficiently. Index (SI)
 Glasgow Coma
Scale-Age-Pressure
Score (GAP)
 Injury Severity
Score (ISS)
 Canadian Triage
Acuity Scale
(CTAS)
DISCUSSION
A. Study Findings:
Studies conducted in this domain depict various aspects related to effectiveness, early
mortality prediction, diagnostic capability, evaluation outcomes, cutoff values, sensitivity,
specificity, best triage systems, alignment with pathological conditions, and ease of triage
system implementation.29,37–45
1. National Early Warning Score 2 (NEWS2)
National Early Warning Score 2 (NEWS2) is an effective triage system that uses
physiological parameters to predict patient severity in disaster triage.29 It has shown
good diagnostic capability in predicting early mortality and can be used effectively in
disaster situations. NEWS2 helps medical personnel make prioritized decisions in
allocating limited resources, improving patient safety and efficiency in disaster
management. However, the system's reliance on physiological parameters influenced
by non-pathological factors may lead to overtriage or undertriage. Adequate training
and understanding are crucial for the proper application of NEWS2 in disaster triage.47–
49
NEWS2 is a beneficial triage system for identifying high-risk patients in disasters. It

detects early signs of clinical deterioration, utilizes comprehensive physiological
parameters, and enables continuous patient monitoring. 29,48 However, limitations such
as the impact of non-pathological factors and the need for adequate training and
understanding by medical personnel should be considered when implementing NEWS2
in disaster triage.48 Clinical assessment and a thorough understanding of the system are
essential for its effective use in disaster settings.30,47,48
2. Simple Triage and Rapid Treatment (START):
START is a triage system specifically designed for disaster situations with a large
number of casualties.50–54 This system uses a rapid assessment of the patient's breathing,
circulation, and level of consciousness to determine treatment priorities.19,32,55,56
START helps identify victims who require immediate medical intervention. The main
advantage of START is its simplicity, with four easily understood triage categories:
"immediate," "delayed," "minor," and "deceased." Medical personnel in the field can
quickly evaluate patients and assign triage categories based on clear criteria such as
breathing, circulation, and consciousness.57,58
However, START places more emphasis on physiological aspects and treatment
urgency rather than specific diagnoses.39 Therefore, it may not provide a complete
picture of the patient's medical condition. Additionally, in complex disaster situations
with varying levels of severity, START may not provide accurate and adequate
assessments for every patient. Nevertheless, START remains widely used in disaster
contexts due to its simplicity and ability to conduct triage quickly.19 However, it is
important to remember that START should be used as an initial tool in the triage
process, and more detailed medical assessments should be performed to provide
appropriate and tailored care for each patient.14,19,55,56,28,31,32,37,39,43–45
Computer-based (electronic) START and Paper-based (manual) START are two
methods used in the START triage system.58 START is a triage system used in disaster
situations to categorize patients based on the severity of their injuries and prioritize
treatment.50–54,59 Computer-based START utilizes computer technology or electronic
devices to perform triage using specialized software. In this method, patient data is
entered into the system, and the software automatically analyzes the information to
provide the appropriate triage category.38,60 The advantage of this method is the speed
and accuracy in determining patient priorities. Data can be processed quickly, and triage
results can be communicated directly to the medical team.26,31,38,56
On the other hand, Paper-based (manual) START utilizes printed triage forms and
protocols. In this method, triage personnel manually fill out forms with patient
information and conduct assessments based on established triage criteria.38 The
advantage of this method is its ease of use and not requiring complex electronic devices.
However, this method can be slower and more susceptible to human errors in the form-
filling and assessment process61.
Both methods have the same goal, which is to identify patients with high severity of
injuries for immediate care and prioritize patients who require further treatment. The
choice between using computer-based START or paper-based START may depend on
resource availability, technological capabilities, and the context of the disaster
situation.38
3. JumpSTART
JumpSTART is a pediatric triage system utilized in disaster situations to prioritize and
categorize injured children based on their medical needs and the severity of their
injuries.62–66 The system is designed to allocate resources efficiently and ensure timely
treatment for the most critically injured patients. It employs a simple color-coded
system to classify patients into four categories: immediate, delayed, minimal, and
expectant.62,64,66 The primary focus of JumpSTART is to identify and prioritize patients
in need of immediate life-saving interventions. While the system has proven effective
in various disaster scenarios, it primarily focuses on physiological criteria and may not
encompass other critical factors.40,43 Additionally, its implementation relies heavily on
the experience and training of triage personnel, introducing potential variations.40,43,62,64
JumpSTART is a valuable triage system for pediatric patients in disaster situations. Its
simplicity and effectiveness in swiftly identifying and prioritizing critically injured
children make it an invaluable tool for emergency responders.62–66 However, further
research is needed to address its limitations and enhance its accuracy in various disaster
scenarios.40,43,44 This will ensure that the system can accommodate additional factors
such as special healthcare needs or emotional trauma, and provide the best possible care
for pediatric patients during challenging circumstances.63,65,67,68
4. Sacco Triage Method (STM)
The Sacco Triage Method (STM) is a triage system that combines assessments based
on vital signs, level of consciousness, and medical intervention needs. STM has proven
effective in predicting early mortality and can be used in disaster situations to prioritize
care.69,70
STM, a triage system developed for use in mass casualty incidents, aims to identify
patients at high risk of death and provide appropriate treatment priorities based on a
rapid assessment of physiological and anatomical parameters.69–72,43 One major
advantage of STM is its more comprehensive approach to patient
assessment.28,29,41,43,69–73 In addition to considering physiological parameters such as
respiration, circulation, and consciousness, STM also takes into account anatomical
parameters such as head injuries, limb injuries, and chest injuries. By considering these
factors, STM can provide a more complete picture of the patient's medical condition
and assist in making more accurate triage decisions.69–72
STM also emphasizes the importance of effective communication between triage
personnel and the medical team.69,71 The system involves collaboration between triage
personnel and more experienced medical personnel to ensure that triage decisions are
based on accurate and reliable information.74
However, there are some limitations to consider in using STM. The system requires
intensive training and sufficient medical knowledge to implement it effectively.43 This
can be challenging in disaster situations where triage personnel may have limited time
and resources for adequate training. Additionally, STM may take longer in the triage
process compared to simpler triage systems.35,43,44
Nevertheless, STM can be a good choice in disaster situations where a more
comprehensive assessment is needed to prioritize patients at high risk of death. When
using it, it is important to consider the availability of resources, time, and expertise
required to implement STM effectively.40,65,69–72,74,75
5. Prehospital Advanced Triage Method (META)
Prehospital Advanced Triage Method (META) is a triage system specifically developed
for field use by prehospital medical personnel. The system utilizes assessments based
on vital signs, level of consciousness, and medical intervention needs to categorize
patients into different triage categories.76
META is designed specifically for use in disaster scenarios with a large number of
casualties. It employs a comprehensive approach to evaluate and categorize patients
based on physiological, anatomical, and injury mechanism parameters.76 One of the
main advantages of META is its inclusivity of various important parameters in patient
assessment. In addition to considering physiological parameters such as respiration,
circulation, and consciousness, META also takes into account anatomical parameters
such as head injuries, limb injuries, and chest injuries.77,78 Furthermore, META
considers injury mechanisms, such as severe impact or explosions, which can provide
additional information about the severity of injuries.77
Another advantage of META is its flexibility in adapting to different disaster

conditions.78 The system allows for better adaptation to the ongoing emergency
situation, including the availability of medical resources and the required treatment
priorities. This enables triage teams to allocate resources more efficiently and prioritize
patients in need of immediate care.77–79
However, there are several factors to consider in the use of META. The system requires
intensive training and adequate medical knowledge to implement it correctly.29
Additionally, the time required for assessment and triage using META may be longer
compared to simpler triage systems. Therefore, in disaster situations where time is
crucial, META may not be the most efficient choice.29,78
META can be a good option in complex disaster situations that require more in-depth
assessment. However, its implementation requires adequate resources, intensive
training, and sufficient medical knowledge. It is important to evaluate resource
availability and the emergency context when deciding whether META is an appropriate
triage system to be used in a specific context.29,78,80–82
6. CRAMS Score (Circulation, Respiration, Abdomen, Motor, Speech):
The CRAMS Score (Circulation, Respiration, Abdomen, Motor, Speech) Is A Triage
System That Utilizes A Quick Assessment Based On The Patient's Circulation,
Respiration, Abdomen, motor function, and speech. This system assists in identifying
patients who require immediate treatment in disaster situations.82 The CRAMS score is
a triage system used to evaluate patients in disaster situations and prioritize them based
on several important physiological and neurological parameters.82
The CRAMS score takes into account several crucial aspects in patient assessment.
First, "circulation" evaluates the patient's circulatory status, including pulse, blood
pressure, and tissue perfusion. Next, "respiration" assesses respiratory function,
including the rate and depth of breathing.83 "Abdomen" is used to identify injuries to
the abdominal cavity and the presence of abdominal tenderness. "Motor" evaluates the
patient's strength and ability to move, while "speech" assesses the patient's ability to
communicate clearly. The advantage of the CRAMS score lies in its simplicity and
quick assessment. By considering only a few vital parameters, the system allows triage
teams to rapidly assess patient conditions and prioritize treatment according to
severity.84
However, the CRAMS score also has some limitations. The system does not consider
other parameters that may be important in patient assessment, such as the level of
consciousness or the mechanism of injury. Additionally, the CRAMS score may be less
accurate in identifying more complex injuries or directing more specific treatment.85,29
Overall, the CRAMS score can be used as a simple and quick initial triage tool in
disaster situations. However, it should be used cautiously and not relied upon solely. A
more thorough evaluation and the use of a more comprehensive triage system may be
necessary to provide more accurate and effective care to patients in complex disaster
situations.83,85,29,83,84
7. Revised Trauma Score (RTS):
The Revised Trauma Score (RTS) is a triage system specifically used for patients with
traumatic injuries. This system assesses patients based on their neurological response,
respiration, and circulation.84 RTS can aid in a rapid assessment of injury severity and
prioritize appropriate treatment.84
The Revised Trauma Score (RTS) is a triage system used to evaluate trauma patients in
disaster situations. RTS considers three main parameters: neurological response,
respiratory function, and patient's circulation status.86,87
First, the neurological response is assessed using the Glasgow Coma Scale (GCS) to
measure the patient's level of consciousness. GCS provides a score based on the
patient's response to verbal stimulation, motor response, and eye-opening response.88–
90
A higher score indicates a higher level of consciousness. Second, respiratory function
is evaluated by measuring the patient's respiratory rate per minute. Abnormal
respiratory rates may indicate serious breathing problems. Lastly, the circulation status
is assessed using the patient's systolic blood pressure. Higher scores are given to
patients with higher blood pressure, indicating better circulation status.91
The advantages of RTS lie in its simplicity and ease of use in disaster situations. The
system only considers three main parameters that are quick and easy to measure,
allowing triage teams to rapidly assess the severity of patients. However, RTS also has
some limitations. The system may not consider other factors that can influence patient
prognosis, such as specific types of injuries or the presence of medical comorbidities.
Additionally, RTS only provides a general overview of injury severity and may not be
sensitive enough in identifying complex injuries or directing more specific
treatment.87,92–94
RTS can be used as a simple initial triage tool in disaster situations to provide a quick
assessment of patient severity. However, the system should be used as an initial
guideline and should be supported by a more thorough evaluation and the use of a more
comprehensive triage system to ensure appropriate and effective care for trauma
patients.29,37
8. Shock Index (SI)
The Shock Index (SI) is a triage system that uses the ratio of a patient's pulse rate to
their blood pressure. This system can help identify patients at risk of shock and in need
of immediate treatment.95 The Shock Index (SI) is one of the triage systems used to
identify patients at risk of shock or blood volume loss in disaster situations.95–98 SI is
calculated by dividing the patient's pulse rate by their systolic blood pressure.95,97
SI can provide an initial indication of a patient's cardiovascular response to trauma or
injury. An increased SI indicates a decrease in blood volume that may lead to
shock.99,100 The advantages of SI lie in its simplicity and ease of use.96 Measuring pulse
rate and blood pressure can be done quickly and easily in the field. SI can also provide
useful additional information for quickly assessing patient severity.101 The system only
provides an initial indication and does not provide complete information about the
cause or mechanism of shock. Additionally, SI can be influenced by other factors such
as medication use or underlying medical conditions, which can result in inaccurate
results.101
Overall, SI can be used as a simple initial triage tool in disaster situations to indicate
the risk of shock in patients. However, it is important to note that SI should be used as
part of a more comprehensive evaluation and cannot be the sole assessment to
determine patient severity. A more thorough evaluation and the use of a more
comprehensive triage system are still necessary for appropriate and effective care.102,103
9. Injury Severity Score (ISS)
The Injury Severity Score (ISS) is a widely used triage system that assesses the severity
of multiple injuries sustained by a patient in a disaster setting. It is based on an
anatomical evaluation of injuries and assigns a numerical value ranging from 1 to 75,
with higher scores indicating more severe injuries.104,105 The ISS takes into account the
three most severe injuries in different body regions and combines them to calculate an
overall score.106
The ISS is advantageous in that it provides a standardized and objective method for
assessing injury severity, allowing for consistent triage decisions and resource
allocation in disaster situations.37 It considers the anatomical extent of injuries, which
can help prioritize patients who require immediate medical attention and
resources.107,108
However, there are certain limitations to consider when using the ISS. It focuses solely
on anatomical injuries and does not take into account physiological factors or the
overall clinical condition of the patient.109 This means that it may not fully capture the
severity of injuries in some cases, particularly when considering injuries that are not
anatomically severe but still have significant physiological impact.110 Additionally, the
ISS requires detailed and accurate documentation of injuries, which may be challenging
in chaotic disaster settings.108
The Injury Severity Score (ISS) is a valuable triage system for assessing the severity of
injuries in a disaster context. It provides a standardized and objective approach to
prioritize patients based on the anatomical extent of their injuries. However, it should
be used in conjunction with other assessment tools and clinical judgment to ensure
comprehensive and accurate triage decisions in order to optimize patient care and
outcomes.29,37,109–111
10. Canadian Triage Acuity Scale (CTAS):
The Canadian Triage Acuity Scale (CTAS) is a triage system used to categorize the
severity of patients based on symptoms, vital signs, and clinical condition.112 This
system helps prioritize treatment by considering the level of severity of the patient's
condition.113
The CTAS assesses various factors, such as presenting symptoms, vital signs, and
overall clinical condition, to assign patients to different triage levels. These levels range
from Level 1 (most urgent) to Level 5 (least urgent), indicating the priority of care
required.114,115
The CTAS offers a comprehensive approach to triage by considering not only the
severity of the patient's condition but also their expected resource needs and the
potential for deterioration. It provides a standardized framework for triage decisions,
allowing healthcare providers to prioritize patients efficiently and effectively in high-
demand situations.116 However, it's important to note that the CTAS relies on subjective
assessments and clinical judgment, which can introduce some variability in triage
decisions.39 Additionally, it may need to be adapted or supplemented with additional
tools to address the specific challenges and needs of a disaster response.113,116,117
The Canadian Triage Acuity Scale (CTAS) is a valuable triage system for categorizing
the severity of patients based on their symptoms, vital signs, and clinical condition. It
provides a standardized framework for prioritizing treatment based on the level of
severity of the patient's condition.114,116,118,119 However, it should be used in conjunction
with clinical judgment and may require adjustments to suit the unique demands of a
disaster situation.113
11. Glasgow Coma Scale (GCS):
The Glasgow Coma Scale (GCS) is a triage system used to evaluate the level of
consciousness in patients based on motor response, verbal response, and response to
visual stimulation.39,120 This system helps identify the severity of head injuries and
prioritize necessary treatment.120
The GCS assesses three key areas of neurological function: motor response
(movement), verbal response (communication), and eye-opening response (visual
stimulation).120 Each area is assigned a score, and the scores are combined to provide
an overall assessment of the patient's level of consciousness. The GCS is a widely
recognized and standardized tool for assessing the severity of head injuries. It allows
healthcare providers to quickly and objectively evaluate a patient's neurological status,
which is crucial in determining the urgency of treatment and appropriate care
pathways.121
However, it's important to note that the GCS is primarily focused on assessing
consciousness and may not capture other important factors related to head injuries, such
as specific anatomical damage or intracranial pressure. Additionally, it may not be as
effective in assessing patients with pre-existing neurological conditions or those who
are unable to provide verbal responses. the Glasgow Coma Scale (GCS) is a valuable
triage system for evaluating the level of consciousness in patients with head injuries. It
provides a standardized and objective assessment that aids in identifying the severity of
the injury and prioritizing necessary treatment. However, it should be used in
conjunction with other clinical assessments and considerations to ensure
comprehensive and accurate triage decisions.122,123
12. Sort, Assess, Lifesaving Interventions, Treatment/Transport (SALT):

SALT (Sort, Assess, Lifesaving Interventions, Treatment/Transport) is a triage system
used in disaster situations to identify and categorize patients based on the severity of
their injuries and medical needs.124 The system is designed to prioritize the handling
and treatment of patients efficiently, with a focus on those facing immediate life-
threatening situations.124,40,45
SALT utilizes a simple color-coded and vital signs-based approach to evaluate patients.
Patients are assigned red (immediate), yellow (delayed), green (minor), or black
(expectant) tags depending on the severity of their injuries and physiological
response.124 Triage with SALT aims to identify and promptly provide care to patients
with life-threatening conditions, such as compromised breathing or severe
bleeding.56,124–128
The strength of SALT lies in its simplicity and ability to be used in densely populated
and high-pressure disaster situations. The system enables triage personnel to conduct
rapid and effective assessments of patients and allocate resources appropriately to those
in need of immediate attention.124–130
While SALT is a valuable triage tool, there are some limitations to consider. It is more
focused on physiological assessment and may not take into account other factors such
as pre-existing medical conditions. Additionally, proper training is required to ensure
consistency and accuracy in the implementation of SALT by triage personnel. SALT is
an effective and reliable triage tool in disaster situations in Indonesia. Its simple
approach and emphasis on lifesaving interventions make it a valuable instrument in
managing patients in disaster scenarios.56,124,128,130 However, it is important to continue
research and training to enhance the use and accuracy of SALT in various disaster
situations.40,45
13. Triage Sieve:
Triage Sieve is a triage system used in disaster situations to identify and prioritize
patients based on the severity of their injuries. The system is based on the concept of
grouping patients into categories based on clinically observable injury severity. The
primary goal of Triage Sieve is to separate patients into three categories: red (critical),
yellow (serious), and green (minor).131,132
Triage Sieve uses criteria to assess the patient's respiration, circulation, and mental
status. It evaluates three main parameters: respiration, perfusion, and mental state.
Patients with impairments in these parameters receive higher priority for medical
treatment.132
The advantage of Triage Sieve is its simple approach, allowing quick identification of
patients with urgent medical needs. It enables efficient allocation of limited resources
by prioritizing immediate interventions. Triage Sieve's limitations include its focus on
observable clinical assessments and potential subjectivity in triage decisions.132 Triage
Sieve is a useful tool for managing patients in disasters, but ongoing research is
necessary to improve its effectiveness and accuracy.132,37,45
14. Care Flight Triage:
Care Flight triage rapidly assesses patients' conditions to allocate appropriate resources
and prioritize care. It helps identify those needing urgent interventions and ensures
timely transfers to suitable medical facilities.58,69 This process optimizes outcomes,
efficiently utilizes resources, and complements other components of comprehensive air
medical care provided by care Flight. Ongoing research improves effectiveness and
adapts to evolving practices in the field.45
15. Injury Severity Score (ISS):
ISS is a useful tool for triaging patients in disasters. It helps identify those with severe
injuries, ensuring they receive immediate and intensive care.133 By using ISS, medical
teams can efficiently allocate resources, prioritizing patients based on their injury
severity. However, ISS should be used alongside other factors like vital signs for a
comprehensive triage system.15,73,84,134
16. Taiwan Triage Scale Acuity (TTAS)
The Taiwan Triage Scale Acuity (TTAS) is a triage system used in Taiwan to prioritize
patients in emergency units. TTAS utilizes a color-coded system with five severity
levels to ensure efficient allocation of resources and timely care.135,136 This system
enables medical personnel to quickly assess the severity of patients' injuries and make
appropriate decisions. However, it is important to note that the complexity of disaster
triage may not be fully addressed by TTAS.137 Continuous training and ongoing
evaluation are necessary to ensure consistent and accurate implementation of TTAS.
TTAS is an essential tool for prioritizing patients in emergency units in Taiwan. By
employing color-coded categories and a simple approach, TTAS aids in resource
allocation and timely care. However, it is crucial to acknowledge that TTAS may not
encompass all the complexities of disaster triage, necessitating continuous training and
evaluation to ensure consistent and accurate implementation.39,42,55,113,135–137
17. Triage and Patient Transfer System (TPTS)
TPTS involves an initial assessment process of patients, categorizing them according
to the severity of their injuries or medical conditions. Patients are assigned triage
categories that determine the priority of care they should receive. These triage
categories typically consist of high priority (red), medium priority (yellow), low
priority (green), and last priority (black). Each category signifies varying levels of
injury severity or medical conditions.138
The utilization of the Triage and Patient Transfer System (TPTS) can help enhance
efficiency and effectiveness in managing patients during disaster or emergency
situations.42 By conducting proper triage and well-organized patient transfers, this
system can assist medical teams in resource management and providing appropriate
care to patients based on the severity of their conditions.42,136
18. New York City Fire Department (FDNY)
The New York City Fire Department (FDNY) triage is a triage system utilized by the
Fire Department of New York City to handle disaster situations and emergencies in the
city.139 This triage system aims to identify and categorize patients based on the severity
of their injuries or medical conditions, enabling medical teams to provide prompt and
appropriate care.43
FDNY triage is a well-established and widely utilized triage system in emergency
management in New York City. The system ensures that patients receive care
appropriate to the severity of their conditions, thereby enhancing the chances of optimal
rescue and recovery. In situations involving multiple casualties, FDNY triage assists
medical teams in facing significant challenges by providing a structured and efficient
framework for patient management.139,43
In the context of disaster triage, it is important to remember that each mentioned triage system
has its own advantages and limitations. The decision to use a specific triage system should
consider factors such as resource availability, level of training and familiarity of personnel, and
characteristics of the patient population being dealt with.18,28
Furthermore, in disaster situations, dynamic changes in patient numbers, limited resources, and
the need for rapid assessment and intervention can impact the implementation of triage
systems. Therefore, proper training for medical personnel and accurate assessment of patient
conditions are key to maximizing the effectiveness of triage systems in disaster situations.
The selection of an appropriate triage system should also consider local context and disaster
policies in place in the respective region. Collaboration between medical teams, law
enforcement, and other relevant parties is important in planning and implementing an effective
triage system that meets the needs of the community.
Routine evaluation and review of triage system usage following a disaster incident can help
identify strengths and weaknesses of the system and improve future response and management
in similar disaster situations.
B. Implications and Significance:

A systematic review of various triage systems in the context of disasters holds significant
implications and importance. In this review, researchers evaluate triage systems used in
disaster situations and analyze their ability to predict early mortality and identify patients
with high severity levels. The findings of this review have several important implications.
Firstly, this systematic review provides standards and consistency in triage systems. By
identifying effective and standardized triage systems, medical personnel in different
locations and disaster situations can use similar systems. This is crucial to ensure good
communication, efficient coordination, and optimal resource management in responding to
disaster situations.
Secondly, this systematic review reveals triage systems that have good predictive
capabilities in identifying patients at risk of early mortality or with high severity levels. By
utilizing effective triage systems, medical personnel can respond quickly and provide
appropriate care to the most critical patients. This can reduce mortality and morbidity rates
and improve patient safety outcomes.
Moreover, this systematic review also highlights the importance of comprehensive
assessment in triage systems. By considering various factors such as physiological
parameters, age, blood pressure, and neurological response, triage systems can provide a
more comprehensive assessment of patient severity levels. This aids in making better
decisions regarding the care provided.
Furthermore, this systematic review reflects efforts to enhance patient safety in disaster
situations. By using effective and standardized triage systems, medical teams can identify
patients with high severity levels and provide immediate and appropriate care. This can
reduce the risk of complications and ensure patient safety. Additionally, efficient and
standardized triage systems also help manage the influx of patients during disaster
situations, allowing timely care to be provided to each patient.
Lastly, this systematic review provides an opportunity for learning and improvement in the
future. By analyzing the performance of various triage systems in disaster situations, we
can identify the strengths and weaknesses of each system and use them to enhance future
disaster response plans. Learning from past experiences can provide valuable insights in
facing future disaster situations.
C. Study Limitations:
This study has several limitations that need to be considered. Firstly, this research only
takes into account triage systems that have been published and available in scientific
literature. Therefore, there may be other triage systems that are not included in this review.
Additionally, the findings in this study may not directly apply to different disaster
situations, as this review only covers studies conducted on specific populations and
contexts.
Another limitation is that the assessment of triage systems in this study is more focused on
factors such as early mortality prediction and patient severity levels. Other factors such as
efficiency, validity, and patient satisfaction are not fully covered in this review. Therefore,
when selecting and implementing triage systems in disaster situations, other relevant
factors should be taken into consideration.
D. Relevance:
The relevance of this systematic review lies in the importance of a deep understanding of
triage systems in the context of disaster situations. In facing disasters, quick and accurate
decision-making in evaluating and categorizing patients based on their severity levels is
crucial for saving lives and providing appropriate care. This review provides a broader
understanding of the various triage systems available and their capabilities in predicting
early mortality, severity levels, and intensive care needs.
By understanding and implementing the appropriate triage systems, medical personnel in
the field can be more effective and efficient in managing patients during disaster situations.
This review also provides an understanding of the strengths and limitations of each triage
system, which can aid in selecting a system that aligns with the needs and available
resources. By enhancing understanding and implementing good triage systems, we can
ensure that the most critically in need of urgent care receive the highest priority, thus
improving patient safety and outcomes in disaster situations.
E. Recommendations for further research:
Further research in the field of disaster triage will continue to enhance our understanding
of effective, efficient, and reliable triage systems. This will contribute to improving medical
response efforts in disaster situations and enhancing patient safety and outcomes.
Recommendations for further research include:
1. Validation and comparison of triage systems: Further validation and comparison of
existing triage systems are necessary to ensure their reliability and effectiveness in
different disaster situations. Further research can involve larger populations, diverse
environments, and different types of disasters to expand the generalizability of findings.
Additionally, direct comparisons between different triage systems will provide clearer
insights into the relative advantages of each system.
2. Evaluation of triage system implementation: It is important to examine the
implementation and usage of triage systems in the field within the context of actual
disaster situations. Further research can involve direct observation, interviews, and
feedback from medical personnel involved in disaster situations. This will help identify
challenges and barriers that may arise in implementing triage systems and provide
insights on how to improve effective implementation.
3. Development of specialized triage systems for disaster situations: Research can focus
on developing triage systems specifically designed for disaster situations that integrate
unique factors related to scale, complexity, and limited resources. These triage systems
can consider factors such as injury severity level, evacuation priorities, and available
treatment capacity. Developing triage systems that can quickly and accurately identify
patients in need of immediate care will be a significant contribution to the field of
disaster triage.
4. Evaluation of the impact of triage systems on patient outcomes: Furthermore, research
can evaluate the impact of using triage systems on patient outcomes in disaster
situations. This includes measuring mortality rates, long-term disability rates, and
patient recovery. This evaluation will provide a better understanding of the
effectiveness of triage systems in optimizing care and improving patient safety
outcomes in disaster situations.
CONCLUSION
The conclusion of this study indicates that triage systems in Emergency Departments (ED)
during disaster situations have varying levels of accuracy. Some studies have shown that triage
systems are able to accurately identify the severity level of patients and effectively allocate
medical resources. However, the findings also reveal weaknesses in triage systems that can
lead to assessment errors and inappropriate resource allocation.
One of the identified weaknesses is the lack of consistency in the use of assessment criteria and
algorithms in the triage system. Additionally, the limited availability of medical resources
during disaster situations poses a challenge in implementing accurate and effective triage
systems in the ED.
To improve the accuracy of triage systems, it is recommended to develop clear and standardized
guidelines, provide adequate training for medical personnel, and utilize technology to support
the triage process. Ongoing evaluation is also necessary to identify and address weaknesses in
the triage system.
Overall, this study emphasizes the importance of developing consistent, standardized, and
proven reliable triage systems in dealing with disaster situations. Efforts to improve the
accuracy of triage systems through the development of clear guidelines, adequate training, and
the appropriate use of technology can help ensure that patients receive appropriate care based
on their severity level, even in resource-limited conditions.
SOURCE OF FUNDING
This research did not receive any specific grant from funding agencies in the public,
commercial, or not for profit sectors.
ETHICS APPROVAL AND CONSENT TO PARTICIPATE
This research is neither involving humans nor animals, so ethical approval is not required.
CONFLICT OF INTEREST
The authors declare no conflict of interest to disclose.
ACKNOWLEDGEMENTS
The researchers would like to express their gratitude to the Faculty of Medicine, Public Health,
and Nursing, Universitas Gadjah Mada, for the support and facilities provided, including
database access and keyword arrangements from the faculty librarian.
AUTHORS’ CONTRIBUTION
WFR: contributed to the conception and design of the study, conducted the literature review,
analyzed the data, and drafted the manuscript.
ETW: contributed to the conception and design of the study, collected, and analyzed the data,
and critically revised the manuscript for important intellectual content.
RM: contributed to the interpretation of the data, provided critical feedback on the manuscript,
and revised it for intellectual content.
All authors have read and approved the final version of the manuscript.
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Declaration of Interest Statement
ICMJE DISCLOSURE FORM

Date: 11/9/2023
Your Name: Wawan Febri Ramdani, Renaldi M, Endah Tri Wulandari
Manuscript Title: Systematic Review: Evaluation of Triage System in Emergency Departments during Disaster
Situations
Manuscript Number (if known): ANR-D-23-00993
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Applied Nursing Research

A Systematic Review: Evaluation of Triage System in Emergency Departments during

Manuscript Number: ANR-D-23-00993

Article Type: Research Paper

Corresponding Author: Wawan Febri Ramdani

First Author: Wawan Febri Ramdani

Order of Authors: Wawan Febri Ramdani

Endah Tri Wulandari

Suggested Reviewers: Idyatul Hasanah

Dear Editor's, Applied Nursing Research

Wawan Febri Ramdani

Systematic Review: Evaluation of Triage System in Emergency Departments during

A Systematic Review: Evaluation of Triage System in Emergency Departments during

Trauma management in the ED during disaster conditions is a crucial aspect of providing

The systematic approach in this systematic review method provides advantages in

Inclusion and exclusion criteria using PICOS:

Search Query Action Item

Table 2 Search on ProQuest

Search Query Action Item

#1 ("emergency department" OR Filter: 317

Table 3 Search on EBSCOhost

Search Query Action Item

Identified database Manual identified from

Full text screen Research included (n= 3)

Reports not retrieved (n = 0)

Second full-text screen - Wrong study population (n=2)

Total Research included

N Author, Sample Participant and

ED of hospitals and  national early protocol (MTP) in trauma patients. The

NEWS2 is a beneficial triage system for identifying high-risk patients in disasters. It

Another advantage of META is its flexibility in adapting to different disaster

12. Sort, Assess, Lifesaving Interventions, Treatment/Transport (SALT):

B. Implications and Significance:

ICMJE DISCLOSURE FORM

Your Name: Wawan Febri Ramdani, Renaldi M, Endah Tri Wulandari

Manuscript Number (if known): ANR-D-23-00993

Time frame: Since the initial planning of the work

1 All support for the ☒ None

Time frame: past 36 months

1 12/13/2021 ICMJE Disclosure Form

6 Payment for ☒ None

7 Support for ☒ None

8 Patents planned, ☒ None

2 12/13/2021 ICMJE Disclosure Form

3 12/13/2021 ICMJE Disclosure Form

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