Development of triage strategies for COVID-19 during disaster response

Abstract

The spread of coronavirus disease 2019 (COVID-19) is a serious problem during disaster response to mass casualty events at disaster base hospitals, as preparations must be made to deal with patients who might be positive for COVID-19. Therefore, we considered the case of disaster response at a disaster base hospital during the COVID-19 epidemic and developed COVID-19 triage strategies by carrying out a disaster drill. The results indicated that risk assessment is needed for COVID-19 in addition to traditional triage, as polymerase chain reaction (PCR) testing can be more difficult to conduct than usual in the hyper-acute phase of a disaster. For COVID-19 triage, we classify patients into the following four categories at admission: Category I (navy): positive PCR or antigen test before the disaster; Category II (purple): highly likely to have COVID-19; Category III (pink): not likely to have COVID-19; and Category IV (white): negative PCR test before the disaster. These findings suggest that disaster base hospitals should prepare for patients with COVID-19 who could potentially be mixed within victims of mass casualty events during disaster response. In addition, to minimize the risk of spreading COVID-19, they should clarify and separate such patients on admission based on the COVID-19 risk level.