Selected topic: Disaster medicine| Volume 35, ISSUE 2, P181-187, August 2008

Reliability of the Primary Triage Process after the Volendam Fire Disaster


      In a major incident, correct triage is crucial to emergency treatment and transportation priority. The aim of this study was to evaluate the triage process pursued at the site of the fire disaster in Volendam, the Netherlands on January 1, 2001. On-site (OS) and Emergency Department (ED) data regarding total body surface area burned (TBSA) and inhalation injury (INH) were compared with the final (FIN) assessment of these two parameters after hospital admission. Finally, the effect of OS intubation and the time of arrival at a hospital were evaluated. There were 245 injured. Mean age was 17.3 years. Final median TBSA was 12%; 96 patients (39%) had inhalation injury. Agreement between TBSA-OS (n = 46) and TBSA-FIN was poor (Pearson's correlations coefficient [PCC] = 0.77; R2 = 0.60). TBSA-ED (n = 78) was more accurate (PCC = 0.96; R2 = 0.93). INH-OS (n = 79, sensitivity 100%, specificity 24%) and INH-ED (n = 198, sensitivity 99%, specificity 36%) were sensitive but not specific. Eight patients were intubated on-site. No differences in outcome were found between this group and the patients who were intubated in the hospital. There was no difference in time of arrival at a hospital (p = 0.55). TBSA was not estimated reliably in a non-clinical environment. The diagnosis of inhalation injury was adequate but resulted in over-triage on-site and at the ED. Triage did not lead to transport priorities for the severely wounded. In a major burn accident, a field triage protocol for rapid evaluation of burn injuries may be useful. Detailed assessment of injuries of burn casualties is practical only in a specialized clinical setting.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Allister C.
        • Hamilton G.M.
        Cardowan coal mine explosion: experience of a mass burns incident.
        Br Med J (Clin Res Ed). 1983; 287: 403-405
        • Brough M.D.
        The King's Cross fire.
        Burns. 1991; 17: 6-9
        • Buerk C.A.
        • Batdorf J.W.
        • Cammack K.V.
        • Ravenholt O.
        The MGM Grand Hotel fire: lessons learned from a major disaster.
        Arch Surg. 1982; 117: 641-644
        • Carley S.
        • Mackway-Jones K.
        • Donnan S.
        Major incidents in Britain over the past 28 years: the case for the centralised reporting of major incidents.
        J Epidemiol Community Health. 1998; 52: 392-398
        • Cassuto J.
        • Tarnow P.
        The discotheque fire in Gothenburg 1998.
        Burns. 2003; 29: 405-416
        • Gill J.R.
        • Goldfeder L.B.
        • Stajic M.
        The happy land homicides: 87 deaths due to smoke inhalation.
        J Forensic Sci. 2003; 48: 161-163
        • Gomez Morell P.A.
        • Escudero N.F.
        • Palao D.R.
        • Sospedra C.E.
        • Banuelos Roda J.A.
        Burns caused by the terrorist bombing of the department store Hipercor in Barcelona.
        Burns. 1990; 16: 423-425
        • Hart R.J.
        • Lee J.O.
        • Boyles D.J.
        • Batey N.R.
        The Summerland Disaster.
        Br Med J. 1975; 1: 256-259
        • Mackie D.P.
        • Koning H.M.
        Fate of mass burn casualties: implications for disaster planning.
        Burns. 1990; 16: 203-206
        • Saffle J.R.
        The 1942 fire at Boston's Cocoanut Grove nightclub.
        Am J Surg. 1993; 166: 581-591
        • Sharpe D.T.
        • Roberts A.H.
        • Barclay T.L.
        • et al.
        Treatment of burns casualties after fire at Bradford City football ground.
        Br Med J (Clin Res Ed). 1985; 291: 945-948
        • Hartman J.A.M.
        • Lichtveld R.A.
        • Stiphout van ThA.G.W.
        • Wolde ten W.L.M.
        Landelijk Protocol Ambulancezorg 2000. 2000; 5e: 1-218
        • Frykberg E.R.
        Medical management of disasters and mass casualties from terrorist bombings: how can we cope?.
        J Trauma. 2002; 53: 201-212
        • Gewalli F.
        • Fogdestam I.
        Triage and initial treatment of burns in the Gothenburg fire disaster 1998.
        Scand J Plast Reconstr Surg Hand Surg. 2003; 37: 134-139
        • Simko S.
        Reflections on the organization of mass burns treatment.
        Acta Chir Plast. 1981; 23: 197-200
        • Magliacani G.
        • Masellis M.
        Guidelines for fire disasters medical management in the mediterranean countries.
        Ann Burn Fire Dis. 1999; 12: 44-47
        • Bland J.M.
        • Altman D.G.
        Statistical methods for assessing agreement between two methods of clinical measurement.
        Lancet. 1986; 1: 307-310
        • Allison K.
        The UK pre-hospital management of burn patients: current practice and the need for a standard approach.
        Burns. 2002; 28: 135-142
        • Ashworth H.L.
        • Cubison T.C.
        • Gilbert P.M.
        • Sim K.M.
        Treatment before transfer: the patient with burns.
        Emerg Med J. 2001; 18: 349-351
        • Spies M.
        • Herndon D.N.
        • Rosenblatt J.I.
        • Sanford A.P.
        • Wolf S.E.
        Prediction of mortality from catastrophic burns in children.
        Lancet. 2003; 361: 989-994
        • Kay A.R.
        • Rickard R.F.
        Trauma resuscitation.
        2nd edn. BIOS Scientific Publishers, Oxford, UK2003
        • Smith J.J.
        • Malyon A.D.
        • Scerri G.V.
        • Burge T.S.
        A comparison of serial halving and the rule of nines as a pre-hospital assesment tool.
        Emerg Med J. 2002; 19: 26
        • Allison K.
        • Porter K.
        Consensus on the prehospital approach to burns patient management.
        Emerg Med J. 2004; 21: 112-114
        • Rocca B.
        • Crosby E.
        • Maloney J.
        • Bryson G.
        An assessment of paramedic performance during invasive airway management.
        Prehosp Emerg Care. 2000; 4: 164-167
        • Marichy J.
        • Chahir N.
        • Peres-Tassart C.
        • Abeguile R.
        Prehospital management of burns.
        Pathol Biol (Paris). 2002; 50: 74-81