RATE - Disaster triage

23 March 2022
Gudrun Reay and Cathy Dobson on the RATE protocol...
Reay G, Rankin JA, Dobson C, Campbell K. Mass casualty triage for the Emergency Department using the RATE protocol: Validation and results of a quasi-experiment. International emergency nursing. 2022 Mar 1;61:101124.

• A group of five triage experts validated the RATE protocol.
• Two RATE training methods were tested in a quasi-experiment with triage RNs.
• A RATE infographic or an e-learning module can be used for staff training.
• The RATE infographic is convenient for resource poor areas or just-in-time training.

Triage practices in the Emergency Department (ED) need to be modified during a mass casualty incident (MCI) to accommodate the influx of patients. A triage protocol known as Rapid Assessment Triage for Emergency Department/Urgent Care (RATE) was developed specifically for use in EDs during MCIs.

Phase 1: validation of the RATE protocol by triage experts. Phase 2: a pretest/ post-test quasi-experiment comparing a RATE infographic with a RATE e-learning module in a convenience sample of 64 triage Registered Nurses from two EDs.

Phase 1: the five experts reached 100% consensus for 20 patient vignettes. Phase 2: there were no statistically significant differences on pre-test and post-test scores within and between RN groups controlling for age, years as an RN, years as an ED RN, and years as a triage RN (all p values > 0.05). There was no group by time interaction (p = 0.49).

The RATE protocol was validated. As there were no statistically significant differences between the groups using the RATE infographic or the elearning module, either method can be used for training purposes. The infographic is cost effective and may be preferred in resource poor environments or when just-in-time training is required.

Keywords: Triage, Mass casualty incident, Emergency department, Infographic, Computer-assisted instruction, Online education, Disasters, Learning methods

James T, Izon-Cooper L, Collins S, Cole H, Marczylo T. The wash-in effect and its significance for mass casualty decontamination. Journal of Toxicology and Environmental Health, Part B. 2022 Apr 3;25(3):113-34.


Decontamination of skin by washing may increase dermal absorption, a phenomenon known as the wash-in effect. The wash-in effect is frequently discussed in studies investigating casualty decontamination where potentially life-saving interventions may enhance the dermal penetration of toxic chemicals, leading to an increase in incidence of morbidity and rates of mortality. However, the wash-in effect is seldom investigated within the context of mass casualty decontamination and real-life consequences are therefore poorly understood. This paper reviews the existing literature on the wash-in effect to highlight the proposed mechanisms for enhanced absorption and evaluate the wash-in effect within the context of mass casualty chemical decontamination.