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Triage and the Modified Physiological Triage Tool-24 (MPTT-24)
  1. James Vassallo1,2,
  2. S Horne3 and
  3. J E Smith3,4
  1. 1Division of Emergency Medicine, University of Cape Town, South Africa
  2. 2Institute of Naval Medicine, Hampshire, UK
  3. 3Emergency Department, Derriford Hospital, Plymouth, UK
  4. 4Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
  1. Correspondence to Dr James Vassallo, Institute of Naval Medicine, Hampshire PO12 2DL, UK; vassallo{at}


Major incidents occur on a regular basis. So far in 2017, England has witnessed five terrorism-related major incidents, resulting in approximately 40 fatalities and 400 injured. Triage is a key principle in the effective management of a major incident and involves prioritising patients on the basis of their clinical acuity. This paper describes the limitations associated with existing methods of primary major incident triage and the process of developing a new and improved triage tool—the Modified Physiological Triage Tool-24 (MPTT-24). Whilst the MPTT-24 is likely to be the optimum physiological method for primary major incident triage, it needs to be accompanied by an appropriate secondary triage process. The existing UK military and civilian secondary triage tool, the Triage Sort, is described, which offers little advantage over primary methods for identifying patients who require life-saving intervention. Further research is required to identify the optimum method of secondary triage.

  • major incidents
  • triage
  • emergency medical services

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  • Twitter @jamievassallo, @defprofem

  • Contributors JV drafted the original manuscript with SH and JES reviewing the draft and contributing substantially to subsequent revisions.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.