Mohammad,

Interesting question! First, based on the number of patients the appropriate level of additional EMS personnel and ambulances must be requested including mutual aid. Second, receiving hospitals need to be notified of the number and general types of injury so they can activate their mass causality systems. Third, provide quick treatment to the red victims such as opening airways and applying tourniquets to the extent possible depending on staffing. Depending on the number of red victims and the time needed for additional resources to arrive, it may be prudent to conduct a secondary triage of these victims as some will likely have died or be expectant and can be re-triaged as black. There is no "text book" answer to your question but these are my thoughts based on my years of experience working in public safety.

The thing with triage is that it is a dynamic process. If you end up having lots of RED patients, you should then re-triage them and prioritize evacuation within the group of patients. Some of them may become BLACK patients over time, and some RED may be suffering more emergent conditions than others

In mass causality management, where we use START triage algorithm, almost all non-walking patients will be red, most of them lower extremity injury with non-life threatening condition. Since triage is a continuous process, we have to re-triage them with SORT triage algorithm and evacuate the ER by sending to emergency patients to OR,for those who can wait (blue,yellow)to ward.

- Request additional help, if needed. Assign roles, use ICS/IMS.

- Retriage, using revised trauma score (RTS) components (GCS, SBP, RR) & injuries, to determine transport priority, if able & needed (e.g. due to lack of immediate transport capability for all reds).

- Begin life saving interventions, as able, depending on resources available.