-PLUS prehospital mass-casualty triage: a strategy for addressing unusual injury mechanisms.

Introduction: Simple Triage and Rapid Treatment (START) and more recently developed prehospital casualty triage algorithms are widely used, in part because they are easy to teach and learn, and can be performed rapidly. Every rapid triage protocol has inherent, significant limitations: (1) no mechanism of injury (MOI) considerations; (2) limited assessment points; and (3) no refinement in truly mass-casualty situations where transport of "minor" or "moderate" patients may be delayed.

Hypothesis: When rapid initial triage protocols are utilized, a significant triage deficiency ("under-triage") may occur when "minor" or "moderate" casualties actually are more severely injured than initially triaged.

Understanding organizational safety using value-focused thinking.

Decision analysis is recognized as the right way to make risk management decisions, using probabilistic techniques to assess the accident risk. It is also accepted that the decisions that individuals in the organization make affect the likelihood of an accident and thus managerial and organizational factors should be included in the risk modeling process. However, decision analytic techniques have not been used to understand the decisions that are made by these individuals.