Portable ultrasonography in mass casualty incidents: The CAVEAT examination

Table 1 Classification of multiple casualty incidents

Natural disasters	Man-made disasters
Causes of large scale physical destruction to manmade objects and infrastructure	Hazardous material incidents and Industrial accidents
Earthquakes	Radiation exposure
Volcanoes	Chemical exposure
Mudslides	Inhalation injury
Avalanches	Explosive disasters
Floods
Tsunami	Transportation accidents
Tropical storms, hurricanes, tornadoes	Aircraft
	Marine
Climatic	Railroad
Extreme heat, cold	Highway
Famine
	War related
Fire related	Military casualties
Thermal injury	Civilian casualties
Inhalation injury	Innocent bystanders
Infrastructure, agriculture, and domiciliary damage	Military targets
	Terrorism
	Mass casualty
Epidemics	Bioterrorism
	Genocide
	Major societal dislocations and refugee populations
	Malnutrition, epidemics

Disasters that cause gross physical damage (most likely to cause injuries identifiable by ultrasound) are in bold: There can be a certain degree of overlap between the two categories (“gross physical trauma” and “no gross physical trauma”). Detailed history of the incident should be gathered to determine whether “physical trauma” is present alone, in combination with other factors, or not at all.

Table 2 Commonly accepted triage coding categories

Priority	Need for treatment	Color code	Characteristics
1	Immediate	Red	Life-threatening shock or hypoxia is present or imminent, but the patient can be likely stabilized and will probably survive if given immediate care
2	Urgent	Yellow	Injuries have systemic effects or implications, but the patient is not yet in life-threatening shock or hypoxia. Despite the chance that systemic decline may ensue, this group can likely withstand a 45- to 60-min wait without immediate risk. Patient likely to survive if given appropriate care
3	Non-urgent	Green	Localized injuries without immediate systemic implications. With minimal care, these patients are unlikely to deteriorate for several h (or not at all)
4	Expectant	Black	Most severely injured patients who have poor chance for survival regardless of care rendered. No distinction is made between clinical and biological death. In multiple casualty incidents, any patient who is unresponsive or who has no spontaneous ventilation or circulation is classified as dead

Modified from[70].

Table 3 The chest, abdomen, vena cava, and extremities for acute triage protocol summary

Description	Identification of immediately and potentially life-threatening injuries (FAST + pneumothorax)	Intravascular status evaluation (IVCCI)	Hemothorax assessment	Extremity assessment (lower → upper extremity sonography)
Skill level	Easy	Intermediate		Difficult
Urgency	Primary triage & assessment (Mandatory)		Secondary triage & assessment (Optional)

The protocol is divided into two-tiered system of urgency (primary and secondary) and three skill levels (basic, intermediate, and advanced). Note that the chest, abdomen, vena cava, and extremities for acute triage examination can be performed after the primary survey, with the serial assessment performed, as indicated at a later time. FAST: Focused Assessment with Sonography in Trauma; IVCCI: Inferior vena cava collapsibility index.