ERTRIAGE Crisis Module

ERTRIAGE Crisis Module Library

ERTRIAGE · CRISIS MODULE

// ERTRIAGE · Emergency Response Triage System · Crisis Module

Crisis Medical Protocol Library

A structured, decision-support framework for mass-casualty events, infectious outbreaks, trauma incidents, and burn emergencies — engineered for deployment under austere and degraded field conditions.

Trauma
Burns
Infection Outbreaks
START Protocol
MCI Response

4 Protocol Modules

60sec Target Triage Time / Patient

START Triage Algorithm

3 Deployment Phases

OFFLINE Capable Operation

01 // System Overview

The ERTRIAGE Crisis Module:
Purpose & Architecture

The ERTRIAGE Crisis Module is a structured medical decision-support system embedded within the broader ERTRIAGE emergency response platform. It is purpose-built for scenarios where conventional healthcare infrastructure is overwhelmed, inaccessible, or destroyed — mass-casualty incidents (MCIs), natural disasters, industrial accidents, epidemic outbreaks, and armed conflict zones.

The Crisis Protocol Library operationalizes four core emergency domains into executable clinical workflows: Trauma, Burns, Infection Outbreaks, and the internationally recognized START mass-casualty triage algorithm. Each protocol module provides first responders, field medics, and emergency physicians with standardized, evidence-based decision trees that function under conditions of reduced staffing, supply shortages, communication failures, and time pressure.

Design Philosophy
ERTRIAGE Crisis protocols are designed for the three lows: low light, low bandwidth, low cognitive load. Every protocol is actionable in under 3 minutes of reading, executable without specialist hardware, and operable fully offline on tablet or mobile devices carried by field teams.

Protocol Library Structure

Each module contains an Activation Criteria checklist, a tiered Response Algorithm, Resource Minimum Requirements, Documentation Templates, and an Escalation Pathway. Protocols are versioned and linked to the WHO Emergency Response Framework and TCCC (Tactical Combat Casualty Care) standards.

Integration with ERTRIAGE Platform

The Crisis Module interfaces directly with ERTRIAGE’s patient tracking database, resource dispatch engine, and communications layer. In degraded connectivity scenarios, protocols operate in standalone mode with local data sync queued for transmission when connectivity is restored.

User Roles & Access

Protocol access is role-stratified: First Responder (field view — action steps only), Field Medic (full clinical detail + dosing), Medical Officer (complete + analytics dashboard), and Incident Commander (operational overview, resource allocation, inter-agency comms).

Interoperability

Designed to interface with FEMA ICS, NATO STANAG 2228, WHO HEOC protocols, and civilian hospital EMS systems. Supports HL7 FHIR patient data export and NIMS-compatible resource tagging for seamless coordination with external response agencies.

// Core Protocol Modules

Four Critical Domains
of Crisis Medicine

// MODULE A · CPL-TRM-001

Trauma Response Protocol

Mass-Casualty Traumatic Injury Management

CRITICAL

The Trauma module governs the clinical management of penetrating and blunt force injuries, hemorrhagic shock, spinal trauma, and multi-system traumatic injury in mass-casualty events. It is built on the MARCH protocol (Massive hemorrhage → Airway → Respiration → Circulation → Hypothermia) and integrates with the START triage output to prioritize resources toward survivable critical casualties.

Activation Criteria

  • 3+ simultaneous traumatic casualties at a single scene
  • Hemorrhagic shock suspected (systolic BP <90 mmHg)
  • Penetrating torso, neck, or head injury
  • Suspected spinal compromise with neurological deficit
  • Multiple blunt trauma with altered consciousness (GCS <14)
  • Amputation or near-amputation of limb

MARCH Response Algorithm

  • M — Massive Hemorrhage: Tourniquet (proximal to wound, 2–3 cm), wound packing with hemostatic gauze, junctional hemorrhage control
  • A — Airway: Head-tilt/jaw-thrust; NPA insertion; consider surgical airway if obstruction unresolvable
  • R — Respiration: Seal open chest wounds (3-sided occlusive dressing); needle decompression for tension pneumothorax
  • C — Circulation: IV/IO access; fluid resuscitation (1:1:1 blood product ratio if available)
  • H — Hypothermia: Remove wet clothing; space blanket; warm IV fluids if available

Field Resource Minimums

  • Combat Application Tourniquets (CAT) — 2 per casualty
  • Hemostatic gauze (Combat Gauze or QuikClot)
  • Nasopharyngeal airways (NPA) + lubricant
  • Chest seals (vented, 2 per kit)
  • 14g needle + 3.25″ catheter for decompression
  • SAM Pelvic Sling or improvised pelvic binder
  • Hypothermia prevention kit (space blanket + HPMK)
  • IO access device (EZ-IO or FAST-1) + saline flush

Escalation & Documentation

  • MIST handover report mandatory at every transfer point (Mechanism / Injuries / Signs / Treatment)
  • ERTRIAGE patient ID tag generated at point-of-injury
  • Tourniquet application time recorded in permanent marker ON TOURNIQUET
  • Escalate to surgical support if: penetrating abdominal trauma, GCS deterioration, systolic BP unresponsive to 2L resuscitation

// MODULE B · CPL-BRN-002

Burns Management Protocol

Thermal, Chemical & Inhalation Injury Response

HIGH

Burns represent a uniquely complex crisis injury type requiring immediate, time-critical intervention across three dimensions: wound management, fluid resuscitation, and airway protection. This module applies to thermal burns (flame, steam, contact), chemical burns (acid/alkali), electrical burns, and inhalation injury, using the Rule of Nines TBSA assessment and the Parkland Formula for resuscitation in environments where precise monitoring is feasible.

Severity Classification (TBSA)

  • >40% TBSA full-thickness: Critical — immediate fluid resuscitation, airway management priority, evacuation urgent
  • 20–40% TBSA: Severe — Parkland Formula IV fluids, wound coverage, pain management
  • 10–20% TBSA: Moderate — aggressive wound care, oral hydration if conscious, monitor airway
  • <10% TBSA: Minor — wound irrigation, dressing, analgesics, outpatient capable
  • Burns to face/hands/genitalia/feet = upgrade severity regardless of TBSA

Parkland Formula — Fluid Resuscitation

  • Formula: 4 mL × kg body weight × % TBSA (2nd/3rd degree burns)
  • 50% delivered in first 8 hours from time of burn (NOT time of arrival)
  • Remaining 50% over next 16 hours
  • Use Lactated Ringer’s solution — NOT dextrose
  • Target urine output: 0.5–1.0 mL/kg/hr adults; 1.0 mL/kg/hr children
  • Reassess hourly; adjust rate to maintain urine output target

Airway & Inhalation Protocol

  • Suspect inhalation injury: facial burns, singed nasal hair, carbonaceous sputum, hoarse voice, stridor
  • Early intubation if any inhalation signs — airway edema progresses rapidly and forecloses intubation window within hours
  • 100% O₂ via NRB mask — all suspected smoke inhalation patients
  • CO poisoning: maintain O₂ until carboxyhemoglobin <5% or minimum 4 hours
  • Cyanide toxicity (industrial fires): hydroxocobalamin 5g IV if available

Chemical Burns — Special Handling

  • DO NOT neutralize chemical burns with opposing agent — exothermic reaction worsens injury
  • Copious water irrigation minimum 20 minutes (60 min for alkali/cement)
  • Hydrofluoric acid: calcium gluconate gel topically + IV calcium supplementation
  • Remove all contaminated clothing/jewelry before irrigation — PPE mandatory for rescuers
  • Eye exposure: irrigate with saline, evert eyelids, measure pH until neutral

// MODULE C · CPL-INF-003

Infection Outbreak Protocol

Epidemic Response, IPC & Mass Prophylaxis

COMPLEX

Infection outbreaks in crisis settings pose a dual threat: they both generate casualties and degrade the responder capacity needed to manage them. The ERTRIAGE Infection Outbreak Protocol activates simultaneous containment and treatment tracks, covering respiratory, gastrointestinal, hemorrhagic fever, and skin/wound outbreak types. It integrates Infection Prevention and Control (IPC) measures with epidemiological tracking and mass prophylaxis logistics.

Activation Triggers

  • Cluster of 3+ unexplained cases with shared epidemiological link (time, place, person)
  • Single case of known high-consequence pathogen (Ebola, Cholera, Plague, Smallpox)
  • Doubling of expected case rate for endemic disease within 72-hour window
  • Symptomatic rate >5% in a defined population or camp setting
  • Death of >1 responder from unexplained febrile illness

Containment Track — IPC Actions

  • Immediate isolation of suspected cases — cohort by symptom type (respiratory / GI / hemorrhagic)
  • PPE mandate: minimum surgical mask + gloves for all patient contact; FFP2/N95 for aerosol-generating procedures
  • Establish clean / dirty / transit zones within treatment area
  • Hands-free chlorine solution stations (0.05% for surfaces, 0.5% for bodily fluid spills) every 10m
  • Contact tracing activation — ERTRIAGE auto-generates exposure list from patient encounter logs
  • Safe and dignified burial protocol if fatalities — body bag + 0.5% chlorine application

Treatment Track — Syndromic Approach

  • Respiratory outbreak: Supportive care, O₂ if SpO₂ <94%, empiric antibiotics (azithromycin 500mg) if bacterial etiology suspected
  • Acute watery diarrhea (Cholera-like): ORS priority; IV Ringer’s lactate for severe dehydration; doxycycline 300mg single dose for adults
  • Viral hemorrhagic fever: Strict isolation, no IV lines unless critical — capillary leak risk; supportive fluid management; ribavirin if Lassa/Crimean-Congo suspected
  • Meningitis cluster: Empiric ceftriaxone 2g IV q12h immediately; chemoprophylaxis (ciprofloxacin 500mg single dose) for close contacts within 24h

Surveillance & Reporting

  • ERTRIAGE daily case tally auto-generates WHO Event Information Site–compatible line list
  • Alert national health authority within 24h of confirmed outbreak — IHR 2005 obligation
  • Attack rate, case fatality rate, and R-estimate updated every 6 hours in system dashboard
  • Sample collection for pathogen identification: nasopharyngeal swabs (respiratory), stool (GI), EDTA blood (hemorrhagic) — cold chain requirements logged

Concurrent Hazard
During outbreak response in crisis settings, responders face simultaneous risk of trauma incidents. Protocol C must not displace trauma triage capacity — maintain parallel activation of Protocol A with strict PPE to prevent cross-contamination of trauma casualties.

// MODULE D · CPL-MCI-004

START Triage Algorithm

Simple Triage and Rapid Treatment — Mass Casualty Incidents

FOUNDATIONAL

START (Simple Triage And Rapid Treatment) is the master triage framework that orchestrates resource allocation across all other ERTRIAGE Crisis protocols. It enables a single trained responder to assess and categorize casualties at a rate of approximately one patient per minute, producing a four-tier color classification that drives treatment prioritization, transport sequencing, and resource deployment across a mass-casualty scene.

Core Principle — Do The Most Good For The Most People
START triage explicitly de-prioritizes unsalvageable casualties to preserve resources for those with survivable injuries. This is not abandonment — it is strategic allocation. Black-tagged patients receive comfort care within available resources.

The RPM Assessment — 60 Seconds per Casualty

  • Step 1 — Walking: “Can you walk?” All who walk → GREEN (Minor). Direct to collection point. Move on immediately.
  • Step 2 — Respirations (R): If not breathing after repositioning airway → BLACK. If breathing: count rate. >30/min → RED. 10–30/min → continue assessment.
  • Step 3 — Perfusion (P): Check radial pulse or capillary refill. No pulse / refill >2 sec → RED. Pulse present → continue.
  • Step 4 — Mental Status (M): “Squeeze my hand.” Cannot follow simple commands → RED. Can follow commands → YELLOW.

Intervention Rules During START

  • ONLY TWO interventions permitted during START sweep: open airway + control life-threatening hemorrhage with tourniquet
  • Do NOT stop to treat during triage sweep — complete all patients first
  • Tourniquet application does NOT change triage category — tag RED if meets RED criteria
  • Re-triage all patients after initial treatment phase begins — categories can change
  • JumpSTART protocol for pediatric casualties (<8 years / <25kg) — modified respiratory thresholds apply

Triage Category Reference

TagPriorityClinical CriteriaAction
BLACKExpectantNot breathing after airway repositioning; unsurvivable injuriesComfort only
REDImmediateRR >30, no radial pulse, or fails mental status — survivable with urgent interventionTreat first
YELLOWDelayedRR normal, pulse present, follows commands — can wait 1–4 hrsStabilize
GREENMinorWalking wounded; minor injuries; no immediate life threatSelf-care

Scene Sector Organization

  • Casualty Collection Point (CCP): Designated safe area, upwind, marked with color-coded flags — minimum 50m from hazard zone
  • Treatment Area Layout: RED sector proximal to ambulances; YELLOW sector adjacent; GREEN sector farthest (self-ambulatory)
  • Transport Sequence: RED first (helicopter/ALS ambulance); YELLOW second (BLS transport); GREEN last (bus/convoy)
  • ERTRIAGE auto-generates hospital capacity pre-notification based on real-time casualty count by category
  • Safety Officer assigned to scene perimeter — ongoing hazard monitoring throughout rescue operations

// Technical Architecture

ERTRIAGE System
Data Flow & Integration

The ERTRIAGE Crisis Module operates on a hub-and-spoke data architecture designed for resilience under degraded conditions. Patient data, protocol decisions, and resource allocations are captured at the point-of-care, synced to a local incident command hub, and transmitted to regional coordination centers when connectivity permits. All modules operate with full functional capability offline.

Field Device

Rugged tablet/smartphone. Protocol access. Patient ID generation. Offline-capable triage entry.

CCP Hub

Local mesh network or satellite. Aggregates field inputs. Real-time casualty board. Resource tracking.

Incident Command

Tactical dashboard. Multi-agency coordination. Hospital capacity queries. Media management.

Receiving Hospitals

Pre-notification of casualty count, categories, ETAs. FHIR patient record transfer on arrival.

Regional EOC

After-action data. Epidemiological reporting. Resource resupply requests. IHR reporting.

Connectivity Resilience Stack
ERTRIAGE Crisis Module supports five connectivity tiers in order of preference: (1) 4G/5G cellular, (2) WiFi local network, (3) BGAN/VSAT satellite, (4) Iridium satellite SMS bridge, (5) Full offline with sneakernet USB sync. The system automatically degrades gracefully across tiers and resumes full sync when higher-tier connectivity is restored, with no data loss at any tier.

100% Offline Protocol Availability

<2s Patient ID Generation Time

500+ Concurrent Patients Tracked

72hr Battery Life, Field Tablet

// Operational Deployment

Deploying ERTRIAGE
Under Difficult Conditions

Effective deployment of the ERTRIAGE Crisis Module under austere conditions requires adherence to a phased activation sequence that accounts for scene safety, team role assignment, and protocol initialization before patient contact begins. The three phases below define the operational rhythm of a Crisis Module deployment from first responder arrival to patient handoff and after-action documentation.

I

// Phase One · T+0 to T+15 min

Scene Activation & Setup

On arrival, the Incident Commander activates the ERTRIAGE Crisis Module on the command tablet, selects the relevant incident type (MCI Trauma / Burn / Outbreak / Combined), and initiates the scene layout template.

Actions: Confirm scene safety perimeter. Designate CCP location upwind/uphill of hazard. Assign triage team roles (1 START lead per 20 casualties estimated). Establish color-coded sector flags. Issue field devices to triage team. Open ERTRIAGE offline mode if no connectivity. Initiate resource inventory check.

Difficult condition adaptations: In darkness — chemical lightsticks mark sector boundaries (green/yellow/red). In active hazard (fire, chemical) — establish hot/warm/cold zones; no patient contact until safe zone confirmed. In extreme weather — tent or vehicle overhead cover establishes improvised treatment area before triage begins.

II

// Phase Two · T+15 to T+90 min

Active Triage & Treatment

START triage sweep proceeds with one assessor per sector. Each casualty is tagged and entered into ERTRIAGE within 90 seconds. Treatment teams follow RED → YELLOW priority sequence. ERTRIAGE dashboard provides Incident Commander real-time casualty counts by category.

Protocol cross-activation: If burns identified during triage → auto-prompt to activate CPL-BRN-002. If outbreak symptoms observed alongside trauma → simultaneous CPL-INF-003 activation with PPE upgrade notification pushed to all field devices.

Difficult condition adaptations: Mass-casualty with overwhelmed resources — document ALL patients even if untreated (ERTRIAGE maintains expectant log). Language barrier — ERTRIAGE visual triage cards load in 12 languages. Supply shortage — system recalculates treatment protocols against logged available inventory and flags substitutions.

III

// Phase Three · T+90 min → Closeout

Evacuation, Handoff & Documentation

Transport prioritization executes per START category. ERTRIAGE generates MIST handover records for each casualty transmitted to receiving hospitals on departure. If outbreak confirmed, IHR notification template auto-populates from surveillance data.

Actions: All patients accounted for in ERTRIAGE (RED treated/evacuated, YELLOW stabilized, GREEN documented, BLACK dignified). CCP decontamination if infectious/chemical incident. Full data sync to regional EOC on restoration of connectivity. After-action report auto-generated from timestamped incident log.

Difficult condition adaptations: No helicopter available — ERTRIAGE reprioritizes transport based on road asset inventory. Hospital capacity exceeded — system queries regional hospital network for next available facility and recalculates transport routing. Prolonged incident >12 hours — responder fatigue protocol triggered with mandatory rotation alerts.

// Adverse Condition Adaptations

Operating in Degraded
Environments

ERTRIAGE Crisis Module protocols include specific adaptation layers for nine categories of degraded operating environment. These adaptations modify workflow, equipment substitutions, and communication protocols while preserving fidelity to the underlying clinical standards.

No Light / Night Operations

  • Chemical lightstick sector marking (color-coded by triage category)
  • ERTRIAGE device screen auto-dims to red-light mode (preserves night vision)
  • Tactile triage tags with embossed category indicators for zero-light environments
  • Buddy system mandatory — no solo patient assessment in darkness

No Power / Comms Failure

  • ERTRIAGE field devices operate 72hrs on battery; solar charging backup panels in go-bag
  • Paper triage tag backup kit mandatory — printed START decision cards included
  • ERTRIAGE satellite bridge: SMS-based minimal dataset sync over Iridium if all other comms lost
  • Runner/relay system for inter-sector communication if all electronic comms fail

Flooded / Inaccessible Terrain

  • ERTRIAGE waterproof device case standard in flood-response kit (IP68 rated)
  • Float-capable supply cache — protocol kits sealed in dry bags for water deployment
  • Helicopter LZ designation tool built into ERTRIAGE mapping layer
  • Boat-based CCP protocol: modified triage for rolling/unstable platform

CBRN / Contaminated Scene

  • ERTRIAGE CBRN triage mode activates full PPE and decontamination corridor workflow
  • No electronic devices beyond warm zone — paper documentation only in hot zone
  • Antidote auto-injector protocol (nerve agent: atropine + pralidoxime) embedded in system
  • Decontamination station setup guide with water volume calculations by casualty count

Active Threat / Hostile Environment

  • Warm Zone Triage mode — abbreviated assessment; movement to cover prioritized over treatment
  • TCCC protocols replace standard MARCH when under fire — Hemorrhage control only in Care Under Fire
  • ERTRIAGE silent mode: no audio alerts, screen brightness minimum
  • Casualty drag/carry distance calculator for extraction planning

Extreme Cold / Mountain

  • Hypothermia assessment integrated into START — modified consciousness criteria in severe cold
  • Fluid warming protocol: no cold IV fluids; improvised warming sleeves from body heat
  • Frostbite triage category separate from START — do not re-warm in field if refreezing risk
  • ERTRIAGE battery warming sleeve alert — cold reduces device battery life; carry insulated

// Training & Certification

Readiness &
Competency Framework

Protocol library effectiveness is directly proportional to the frequency and fidelity of training. ERTRIAGE mandates a three-tier competency framework for all Crisis Module users, with certification levels tied to system access permissions. Training is delivered via embedded simulation scenarios within the ERTRIAGE platform, enabling realistic MCI drills without requiring external simulation resources.

Tier 1 — Awareness (4 hrs)

START algorithm walkthrough. Protocol module overview. Device familiarization. Patient ID tagging. Triage category criteria. Completion unlocks field device read-only access. Recommended: all emergency personnel, community first responders, trained laypersons.

Tier 2 — Operational (16 hrs)

Full protocol module training (Trauma MARCH, Burns Parkland, Outbreak IPC, START lead). Tabletop MCI exercise. ERTRIAGE data entry proficiency. MIST handover practice. Completion unlocks full field device access + documentation. Recommended: paramedics, nurses, EMTs, NGO field health workers.

Tier 3 — Command (32 hrs)

Incident Command integration. Multi-agency coordination. Hospital pre-notification management. Protocol override authority. Full-scale simulation exercise with 20+ simulated casualties. Completion unlocks command dashboard + IHR reporting. Recommended: physicians, incident commanders, EOC staff, senior NGO coordinators.

Continuous Refresher Requirement

All certifications expire 24 months from issue. ERTRIAGE system flags expired certifications and restricts access accordingly. A minimum of two tabletop exercises per 12-month period recommended to maintain procedural fluency. Protocol library updates auto-push training notifications to all certified users when clinical guidance changes.

Embedded Simulation Capability
ERTRIAGE Crisis Module includes a fully offline Simulation Mode with 14 pre-built MCI scenarios (earthquake mass casualty, industrial explosion, outbreak in a displacement camp, shipwreck, CBRN incident, and more). Simulation generates synthetic patient data and injects complications — resource shortage, responder fatigue, communication failure — to stress-test team performance without real-world risk. After-action analytics identify decision latency, protocol deviations, and resource allocation efficiency.

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