Abstract Blancher, Marc, François Albasini, Fidel Elsensohn, Ken Zafren, Natalie Hölzl, Kyle McLaughlin, Albert R. Wheeler III, Steven Roy, Hermann Brugger, Mike Greene, and Peter Paal. Management of multi-casualty incidents in mountain rescue: Evidence-based guidelines of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). High Alt Med Biol. 19:131–140, 2018. Introduction: Multi-Casualty Incidents (MCI) occur in mountain areas. Little is known about the incidence and character of such events, and the kind of rescue response. Therefore, the International Commission for Mountain Emergency Medicine (ICAR MEDCOM) set out to provide recommendations for the management of MCI in mountain areas. Materials and Methods: Details of MCI occurring in mountain areas related to mountaineering activities and involving organized mountain rescue were collected. A literature search using (1) PubMed, (2) national mountain rescue registries, and (3) lay press articles on the internet was performed. The results were analyzed with respect to specific aspects of mountain rescue. Results: We identified 198 MCIs that have occurred in mountain areas since 1956: 137 avalanches, 38 ski lift accidents, and 23 other events, including lightning injuries, landslides, volcanic eruptions, lost groups of people, and water-related accidents. Discussion: General knowledge on MCI management is required. Due to specific aspects of triage and management, the approach to MCIs may differ between those in mountain areas and those in urban settings. Conclusions: Mountain rescue teams should be prepared to manage MCIs. Knowledge should be reviewed and training performed regularly. Cooperation between terrestrial rescue services, avalanche safety authorities, and helicopter crews is critical to successful management of MCIs in mountain areas.

Background: Advances in ultrasound imaging technology have made it more accessible to prehospital providers. Little is known about how ultrasound is being used in the prehospital environment and we suspect that it is not widely used in North America at this time. We believe that EMS system characteristics such as provider training, system size, population served, and type of transport will be associated with use or non-use of ultrasound. Our study objective was to describe the current use of prehospital ultrasound in North America.Methods: This study was a cross-sectional survey distributed to EMS directors on the National Association of EMS Physicians (NAEMSP) mailing list. Respondents had the option to complete a paper or electronic survey.Results: Of the 755 deliverable surveys we received 255 responses from across Canada and the United states for an overall response rate of 30%. Of respondents, 4.1% of EMS systems (95% CI 1.9, 6.3) reported currently using ultrasound and an additional 21.7% (95% CI 17, 26.4) are considering implementing ultrasound. EMS services using ultrasound have a higher proportion of physicians (p < 0.001) as their highest trained prehospital providers when compared to the survey group as a whole. The most commonly cited current and projected applications are Focused Abdominal Sonography for Trauma (FAST) and assessment of pulseless electrical activity (PEA) arrest. The cost of equipment and training are the most significant barriers to implementation of ultrasound. Most medical directors want evidence that prehospital ultrasound improves patient outcomes prior to implementation.Conclusions: Prehospital ultrasound is infrequently used in North America and there are a number of barriers to its implementation, including costs of equipment and training and limited evidence demonstrating improved outcomes. A research agenda for prehospital ultrasound should focus on patient-important outcomes such as morbidity and mortality. Two commonly used indications that could be a focus of standardized training programs are the FAST exam, and assessment of PEA arrest.

OBJECTIVES:The authors sought to determine the diagnostic test characteristics of bedside emergency physician (EP)-performed ultrasound (US) for cholelithiasis in symptomatic emergency department (ED) patients. METHODS:A search was conducted of MEDLINE, EMBASE, the Cochrane Library, bibliographies of previous systematic reviews, and abstracts from major emergency medicine conference proceedings. We included studies that prospectively assessed the diagnostic accuracy of emergency US (EUS) for cholelithiasis, compared to a criterion reference standard of radiology-performed ultrasound (RADUS), computed tomography (CT), magnetic resonance imaging (MRI), or surgical findings. Two authors independently performed relevance screening of titles and abstracts, extracted data, and performed the quality analysis. Disagreements were resolved by conference between the two reviewers. EUS performance was assessed with summary receiver operator characteristics curve (SROC) analysis, with independently pooled sensitivity and specificity values across included studies. RESULTS:The electronic search yielded 917 titles; eight studies met the inclusion criteria, yielding a sample of 710 subjects. All included studies used appropriate selection criteria and reference standards, but only one study reported uninterpretable or indeterminate results. The pooled estimates for sensitivity and specificity were 89.8% (95% confidence interval [CI] = 86.4% to 92.5%) and 88.0% (95% CI = 83.7% to 91.4%), respectively. CONCLUSIONS:This study suggests that in patients presenting to the ED with pain consistent with biliary colic, a positive EUS scan may be used to arrange for appropriate outpatient follow-up if symptoms have resolved. In patients with a low pretest probability, a negative EUS scan should prompt the clinician to consider an alternative diagnosis.

In a previous issue of Wilderness and Environmental Medicine, Bogle, Boyd, and McLaughlin discuss a proposed triage algorithm for use in avalanche incidents in which the number of victims exceeds the capacity of the rescuers to give optimum treatment to each victim.1Bogle L.B. Boyd J. McLaughlin K.A. Triaging multiple victims in an avalanche setting: the Avalanche Survival Optimizing Rescue Triage (AvSORT) algorithmic approach.Wilderness Environ Med. 2010; 21: 28-34Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar They claim that this algorithm, which they call “AvSORT,” will help rescuers “rapidly identify those that will benefit from limited resources.” While a triage algorithm for multiple casualty avalanche incidents might be useful, the proposed algorithm has potential problems. The main difficulty is the assumption that someone who is still buried might have a better chance of suvival than someone who is extricated without obviously lethal injuries. This assumption is contrary to the common wisdom that a bird in the hand is worth two in the bush. The authors quote statistics showing that there have been many fatalities in avalanches with multiple victims, but they have not analyzed past avalanche incidents to see what effects their proposed algorithm might have had if it had been applied in actual incidents. Instead they have modified existing trauma triage algorithms in a data vacuum. While they claim that the AvSORT avalanche would produce desirable percentages of overtriage and undertriage, they present no evidence in support of this assertion. They also present no evidence that their algorithm would result in an increased number of survivors. The authors are not specific about the conditions under which their proposed algorithm should be used. What is the definition of a “mass casualty incident”? For example, does this term apply in the case of 2 avalanche victims and 2 uninjured rescuers? The algorithm also does not define how first responders should determine when they are “overwhelmed,” nor does it give criteria for determining if the area is “remote.” Is an area remote if the response time for rescue is 2 hours? Arrested hypothermic patients have been successfully rewarmed after 4 hours of cardiopulmonary resuscitation (CPR), even in Europe.2Althaus U. Aeberhard P. Schüpbach P. Nachbur B.H. Mühlemann W. Management of profound accidental hypothermia with cardiorespiratory arrest.Ann Surg. 1982; 195: 492-495Crossref PubMed Scopus (177) Google Scholar It is important that the proposed algorithm not be used as a reason to deviate from established resuscitation guidelines except under the most extenuating circumstances. Apneic, severely hypothermic avalanche victims have been successfully resuscitated.2Althaus U. Aeberhard P. Schüpbach P. Nachbur B.H. Mühlemann W. Management of profound accidental hypothermia with cardiorespiratory arrest.Ann Surg. 1982; 195: 492-495Crossref PubMed Scopus (177) Google Scholar It is critical to recognize that victims buried for more than 35 minutes who have a patent airway have a chance of survival. The guiding principle should be not to give up! It would be tragic if a rescuer did not try to resuscitate such a patient due to feeling “overwhelmed.” The proposed algorithm should be modified so that victims buried longer than 35 minutes who have a patent airway but are not breathing not be triaged to the “expectant” category. They should receive CPR and be transferred to a hospital capable of performing cardiopulmonary bypass. Because the authors are advocating a triage guideline, they have not specified all the specifics of treatment in the various triage categories. For this, rescuers will need to follow another algorithm, such as the International Commission for Mountain Emergency Medicine (ICAR MEDCOM) avalanche resuscitation guidelines.3Brugger H. Durrer B. On-site treatment of avalanche victims ICAR-MEDCOM-recommendation.High Alt Med Biol. 2002; 3: 421-425Crossref PubMed Scopus (29) Google Scholar The authors present these guidelines but state that they “rarely” apply to first responders in North America. It is true that the ICAR MEDCOM guidelines cannot be fully applied without the use of cardiac monitoring, but they are predominantly based on clinical criteria that do not require special equipment. The authors note that if the number of rescuers is adequate to search for buried victims as well as treat extricated victims, standard treatment guidelines apply. In this case, there is no need for a triage algorithm. Although the proposed algorithm makes use of the duration of burial to determine treatment, it does not use duration as a prognostic factor for buried victims. Avalanche survival probability of buried victims is 91% at 18 minutes but drops precipitously to 34% after 35 minutes as victims without an air pocket die from asphyxiation.4Falk M. Brugger H. Adler-Kastner L. Avalanche survival chances.Nature. 1994; 368: 21Crossref PubMed Scopus (113) Google Scholar Survival then decreases gradually to a mere 7% at 130 minutes as victims with a “closed” air pocket succumb to slow asphyxia and hypothermia. It makes less sense to divert resources from treating extricated victims with a chance of survival to searching for buried victims after about 2 hours than it does at 35 minutes. Unfortunately, the reality of avalanche incidents, even in Europe, is that increased rescue capabilities have not increased survival. This is because the best chance for an avalanche victim to survive is to be extricated rapidly by other members of the party who were not buried. Another problem with the proposed algorithm is the designation of destination hospital. While the European Alps are dotted with hospitals only a 15-minute helicopter flight from almost any point and referral centers capable of intensive care within 30 minutes, the situation in North America is that even the closest hospital may be an hour or more away by helicopter and “trauma centers” are often beyond the range of helicopter transport at all. In the case of apneic hypothermic patients, the most appropriate destination hospital may not be a trauma center but should be a center capable of performing cardiopulmonary bypass. A recent case report5Oberhammer R. Beikircher W. Hörmann C. et al.Full recovery of an avalanche victim with profound hypothermia and prolonged cardiac arrest treated by extracorporeal re-warming.Resuscitation. 2008; 76: 474-480Abstract Full Text Full Text PDF PubMed Scopus (102) Google Scholar illustrates the major potential pitfall of the proposed triage algorithm. In this case report, 2 skiers were completely buried in an avalanche in the Italian Alps. Uninjured companions activated an emergency response by cell phone. Amazingly, the first victim was breathing when extricated from a depth of 3 m (9.8 ft) after 100 minutes. However, he was unconscious and severely hypothermic with an epitympanic core temperature of 22°C (71.6°F). The second skier was found a few minutes later in asystole without an air pocket. He was declared dead by the emergency physicians on site, according to the ICAR avalanche guidelines. The first patient was intubated and transported to the nearest hospital by helicopter. During transport he went into ventricular fibrillation. He continued to be ventilated, but chest compressions were not administered for 15 minutes. Initial attempts at defibrillation at the destination hospital were unsuccessful because of hypothermia. He was subsequently transferred to a referral hospital where he could be placed on cardiopulmonary bypass. He was successfully resuscitated and rewarmed. He eventually made a complete neurologic recovery. Had there been few rescuers rather than the many who actually responded and had the AvSORT algorithm been applied, the first victim would have been triaged to the “immediate treatment” category and transferred to a trauma center. However, if ventricular fibrillation had started before he was placed in the helicopter and the second victim had not yet been found, the first victim would have been triaged or retriaged into the category of “expectant” management and would have received no further treatment. The result would have been a fatal outcome rather than the complete recovery he actually experienced. Until the authors of the AvSORT algorithm can produce convincing data to show that their proposed triage method would increase survival in multi-casualty avalanche incidents, rescuers should resuscitate potentially live victims who have already been found and not divert necessary medical resources to further searching. In Reply to Avalanche TriageWilderness & Environmental MedicineVol. 21Issue 3PreviewIn reply to the letter by Dr Ken Zafren, we take this opportunity to resolve any confusion with the use of the Avalanche Survival Optimizing Rescue Triage (AvSORT) algorithm.1 Full-Text PDF

In reply to the letter by Dr Ken Zafren, we take this opportunity to resolve any confusion with the use of the Avalanche Survival Optimizing Rescue Triage (AvSORT) algorithm.1Bogle L. Boyd J. McLaughlin K. Triaging multiple victims in an avalanche setting: the Avalanche Survival Optimizing Rescue Triage (AvSORT) algorithmic approach.Wilderness Environ Med. 2010; 21: 28-34Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar On February 1, 2003 in backcountry Canada, 2 mountain guides watch with horror as an avalanche engulfs and buries a school group of 17 participants below them.2Stethem C. Piche M. Winter 2003 in southern BC—perspective, recognition, management.http://www.avalanche.org/∼issw2004/issw_previous/2006/proceedings/data/papers/117Google Scholar, 3Boyd J. Wylie K. Avalanche triage.Avalanche.ca. 2008; 83: 64-67Google Scholar, 4Canadian Broadcasting CorporationWorst case scenario.http://archives.cbc.ca/environment/natural_disasters/clips/9936/Google Scholar They immediately realize their priority for rescue is to uncover as many victims as possible prior to the onset of asphyxia. They “cannot save everybody”4Canadian Broadcasting CorporationWorst case scenario.http://archives.cbc.ca/environment/natural_disasters/clips/9936/Google Scholar but must focus on “the greatest good for the greatest number.”5Waeckerle J.F. Disaster planning and response.N Engl J Med. 1991; 324: 815-821Crossref PubMed Scopus (188) Google Scholar, 6Arnold T. Cleary V. Groth S. Hook R. Jones D. Super G. START. Newport Beach Fire and Marine Department, Newport Beach, CA1994Google Scholar, 7Kennedy K. Aghababian R.V. Gans L. Lewis C.P. Triage: techniques and applications in decision making.Ann Emerg Med. 1996; 28: 136-144Abstract Full Text Full Text PDF PubMed Scopus (153) Google Scholar, 8Hodgetts T. Porter C. Major Incident Medical Management and Support: The Practical Approach. 2nd ed. BMJ Publishing Group, London2002Google Scholar, 9Mackersie R.C. Field triage, and the fragile supply of “optimal resources” for the care of the injured patient.Prehosp Emerg Care. 2006; 10: 347-350Crossref PubMed Scopus (19) Google Scholar, 10Kahn C.A. Lerner E.B. Cone D.C. Triage.in: Koenig K.L. Schultz C.H. Koenig and Schultz's Disaster Medicine: Comprehensive Principles and Practices. Cambridge University Press, New York2010: 174-183Google Scholar, 11Sasser S. Field triage in disasters.Prehosp Emerg Care. 2006; 10: 322-323Crossref PubMed Scopus (15) Google Scholar They decide, as 2 rescuers, they will only dig enough to allow resumption of breathing, to clear airways, and to hand responsive victims their own shovels for self-extrication before moving on. They recognize that to stop and attempt cardiopulmonary resuscitation (CPR) on any one asphyxiated victim will seriously compromise the survival of other victims still buried. The first victim, recovered in the first 5 minutes, is the school teacher who calls on his satellite phone for outside organized rescue. As the avalanche debris sets up “like concrete,”4Canadian Broadcasting CorporationWorst case scenario.http://archives.cbc.ca/environment/natural_disasters/clips/9936/Google Scholar victims who are not buried too deep are uncovered while deep burials are passed over due to the pressure of time. One victim goes on, after fully extricating himself, to locate and uncover 3 of his classmates, resulting in their survival. The first rescue helicopter lands after 55 minutes and of the 17 buried victims 10 survive. The rational action of the 2 mountain guides is credited with the survival of the majority of these victims in this mass casualty avalanche incident.3Boyd J. Wylie K. Avalanche triage.Avalanche.ca. 2008; 83: 64-67Google Scholar, 4Canadian Broadcasting CorporationWorst case scenario.http://archives.cbc.ca/environment/natural_disasters/clips/9936/Google Scholar The development of our proposed AvSORT algorithm is a result of this and other similar incidents that we cite in the text of our article. This algorithm is designed for the “initial management of mass casualty avalanche incidents when manpower is overwhelmed.”1Bogle L. Boyd J. McLaughlin K. Triaging multiple victims in an avalanche setting: the Avalanche Survival Optimizing Rescue Triage (AvSORT) algorithmic approach.Wilderness Environ Med. 2010; 21: 28-34Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar We must re-emphasize this. By comparison Dr Zafren cites an incident in which 3 helicopters with 15 rescuers, 2 emergency physicians, and 2 dog handlers are on scene for 2 buried victims, 1 of whom survives.12Oberhammer R. Beikircher W. Hormann C. et al.Full recovery of an avalanche victim with profound hypothermia and prolonged cardiac arrest treated by extracorporeal re-warming.Resuscitation. 2008; 76: 474-480Abstract Full Text Full Text PDF PubMed Scopus (102) Google Scholar This would never be considered a mass casualty avalanche incident and it would be highly inappropriate to apply our proposed AvSORT algorithm to this event. We must re-emphasize “it is not designed for situations where resources allow for standard resuscitation and treatment of all extracted individuals, such as in the International Commission for Mountain Emergency Medicine (ICAR MedCom) ALS algorithm.”1Bogle L. Boyd J. McLaughlin K. Triaging multiple victims in an avalanche setting: the Avalanche Survival Optimizing Rescue Triage (AvSORT) algorithmic approach.Wilderness Environ Med. 2010; 21: 28-34Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar As stated above, our AvSORT algorithm is derived from experience in the, fortunately few, mass casualty avalanche incidents and by merging concepts from the START6Arnold T. Cleary V. Groth S. Hook R. Jones D. Super G. START. Newport Beach Fire and Marine Department, Newport Beach, CA1994Google Scholar, 7Kennedy K. Aghababian R.V. Gans L. Lewis C.P. Triage: techniques and applications in decision making.Ann Emerg Med. 1996; 28: 136-144Abstract Full Text Full Text PDF PubMed Scopus (153) Google Scholar, 8Hodgetts T. Porter C. Major Incident Medical Management and Support: The Practical Approach. 2nd ed. BMJ Publishing Group, London2002Google Scholar, 9Mackersie R.C. Field triage, and the fragile supply of “optimal resources” for the care of the injured patient.Prehosp Emerg Care. 2006; 10: 347-350Crossref PubMed Scopus (19) Google Scholar, 10Kahn C.A. Lerner E.B. Cone D.C. Triage.in: Koenig K.L. Schultz C.H. Koenig and Schultz's Disaster Medicine: Comprehensive Principles and Practices. Cambridge University Press, New York2010: 174-183Google Scholar, 11Sasser S. Field triage in disasters.Prehosp Emerg Care. 2006; 10: 322-323Crossref PubMed Scopus (15) Google Scholar algorithm and the ICAR MedCom ALS algorithm.13Brugger H. Durrer B. Adler-Kastner L. Falk M. Tschirky F. Field management of avalanche victims.Resuscitation. Oct 2001; 51: 7-15Abstract Full Text Full Text PDF PubMed Scopus (125) Google Scholar We acknowledge there are no with-control outcome data for our AvSORT algorithm. Likewise, although the use of the START algorithm has been documented in the September 2001 World Trade Center attack and many other high-profile mass casualty events, “there are no data in these descriptive papers regarding whether the system was used correctly or improved outcomes.”10Kahn C.A. Lerner E.B. Cone D.C. Triage.in: Koenig K.L. Schultz C.H. Koenig and Schultz's Disaster Medicine: Comprehensive Principles and Practices. Cambridge University Press, New York2010: 174-183Google Scholar The ICAR MedCom algorithm, which was originally proposed in 2001 and which we and Dr Zafren cite, has only recently been analyzed in a systematic literature review.14Boyd J. Brugger H. For avalanche victims in cardiac arrest (P), what factors when present (I), compared with when absent (C), are associated with/predict an increased survival to hospital discharge (O)?.Advanced Life Support Worksheets—Special Circumstances. International Liaison Committee on Resuscitation, Dallas, TX2010http://www.americanheart.org/presenter.jhtml?identifier=3065168Google Scholar, 15Boyd J, Brugger H, Shuster M. Prognostic factors in avalanche resuscitation: a systematic review. Resuscitation. In press.Google Scholar These three valuable tools have been derived from descriptive accounts and should be scrutinized with future experience but would unlikely be examinable by prospectively designed controlled trials. However, they have not been developed in a “data vacuum.” The prime value of companion rescue to avoid asphyxia from prolonged burial is undoubted16Hohlrieder M. Thaler S. Wuertl W. et al.Rescue missions for totally buried avalanche victims: conclusions from 12 years of experience.High Altitude Medicine and Biology. 2008; 9: 229-233Crossref PubMed Scopus (20) Google Scholar and is the principle embodied in the AvSORT algorithm. In this we agree with Dr Zafren, but we disagree with his statement that “increased rescue capabilities have not increased survival,” as the advent of companion equipment such as transceivers and avalanche airbags along with improved companion rescue training has had a major impact on survival.17Hohlrieder M. Mair P. Wuertl W. Brugger H. The impact of avalanche transceivers on mortality from avalanche accidents.High Alt Med Biol. 2005; 6: 72-77Crossref PubMed Scopus (33) Google Scholar, 18Brugger H. Etter H.J. Zweifel B. et al.The impact of avalanche rescue devices on survival.Resuscitation. 2007; 75: 476-483Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar, 19Brugger H. Should strategies for care of avalanche victims change?.CMAJ. 2009; 180: 491-492Crossref PubMed Scopus (4) Google Scholar Although we would agree that organized rescue is, by comparison, limited in success,16Hohlrieder M. Thaler S. Wuertl W. et al.Rescue missions for totally buried avalanche victims: conclusions from 12 years of experience.High Altitude Medicine and Biology. 2008; 9: 229-233Crossref PubMed Scopus (20) Google Scholar we are not aware that increases in organized rescue performance have been demonstrated to have no impact, as this has not been systematically examined. Dr Zafren's “problem” with our recommendation, when manpower and other resources increase, to evacuate “more severely injured patients to an accredited Trauma Center”1Bogle L. Boyd J. McLaughlin K. Triaging multiple victims in an avalanche setting: the Avalanche Survival Optimizing Rescue Triage (AvSORT) algorithmic approach.Wilderness Environ Med. 2010; 21: 28-34Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar where feasible overlooks our next sentence “due to transportation limitations, individuals may be transported to the nearest healthcare facility for stabilization and initial treatment.”1Bogle L. Boyd J. McLaughlin K. Triaging multiple victims in an avalanche setting: the Avalanche Survival Optimizing Rescue Triage (AvSORT) algorithmic approach.Wilderness Environ Med. 2010; 21: 28-34Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar His statement that “trauma centers are often beyond the range of helicopter transport at all” is inaccurate for many if not the majority of avalanche incident locations and is awkward when followed with “in the case of apneic hypothermic patients, the most appropriate destination hospital may not be a trauma center but should be a center capable of performing cardiopulmonary bypass.” Certainly, all hypothermic avalanche victims in cardiac arrest who are recovered with a core temperature of less than 32°C and a patent airway and without unsurvivable injuries should be transported for extracorporeal rewarming when feasible.13Brugger H. Durrer B. Adler-Kastner L. Falk M. Tschirky F. Field management of avalanche victims.Resuscitation. Oct 2001; 51: 7-15Abstract Full Text Full Text PDF PubMed Scopus (125) Google Scholar, 15Boyd J, Brugger H, Shuster M. Prognostic factors in avalanche resuscitation: a systematic review. Resuscitation. In press.Google Scholar In the majority of cases this transport will be, at least in part, by air. We maintain that our proposed AvSORT algorithm is applicable for the “initial management of mass casualty avalanche accidents where manpower is overwhelmed.” We agree that future use of the tool should be examined critically, as with any proposed strategy. We could conclude by stating: “An asphyxiated unresponsive apneic bird in the hand is not worth 10 in the bush.” However, to misuse a simple proverb does not do justice to the complexity of a mass casualty incident nor the valiant efforts of brave rescuers making rational decisions. Avalanche Triage: Are Two Birds in the Bush Better Than One in the Hand?Wilderness & Environmental MedicineVol. 21Issue 3PreviewIn a previous issue of Wilderness and Environmental Medicine, Bogle, Boyd, and McLaughlin discuss a proposed triage algorithm for use in avalanche incidents in which the number of victims exceeds the capacity of the rescuers to give optimum treatment to each victim.1 They claim that this algorithm, which they call “AvSORT,” will help rescuers “rapidly identify those that will benefit from limited resources.” Full-Text PDF