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Agency for Healthcare Research Quality

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Limited evidence on best strategies during a mass casualty event

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There is limited evidence to help policymakers and health care professionals identify the most effective strategies to allocate scarce resources during mass casualty events, according to a new report from the Agency for Healthcare Research and Quality (AHRQ). A mass casualty event, whether a natural event such as a hurricane, flood, or disease outbreak, or man-made event such as a bioterrorism attack, can occur suddenly and severely challenge highly experienced and well-equipped health care providers and systems.

Researchers at the AHRQ-supported Southern California RAND Evidence-based Practice Center conducted an evidence review to identify the most effective strategies available to health care providers and policymakers during mass casualty events. They found that it remains unclear which of the many options will be most effective.

Led by Justin Timbie, Ph.D., and Art Kellerman, M.D., M.P.H., the researchers also found that commonly used field triage measures do not perform consistently during mass casualty events. However, evidence did suggest that specific strategies influence the speed and efficiency of biological countermeasures during a bioterrorism attack or influenza pandemic. For example, delivering medical countermeasures to the public via postal carriers reaches more people faster than making them available at a centralized location.

Researchers noted that, although some promising strategies exist, additional research is needed to identify the optimal methods, techniques, and technologies to employ during mass casualty events. A copy of the report, Allocation of Scarce Resources During Mass Casualty Events, is available at

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