Resource-Based Patient Prioritization in Mass-Casualty Incidents

The most widely used standard for mass-casualty triage, START, relies on a fixed-priority ordering among different classes of patients, and does not explicitly consider resource limitations or the changes in survival probabilities with respect to time. We construct a fluid model of patient triage in a mass-casualty incident that incorporates these factors and characterize its optimal policy. We use this characterization to obtain useful insights about the type of simple policies that have a good chance to perform well in practice, and we demonstrate how one could develop such a policy. Using a realistic simulation model and data from emergency medicine literature, we show that the policy we developed based on our fluid formulation outperforms START in all scenarios considered — sometimes substantially.