(2) Triage A. Triage is the sorting and allocation of treatment to patients, especially disaster victims, according to a system of priorities designed to maximize the number of survivors. The diagnosis and mitigation of illness and injury caused by radiological terrorism is a complex triage process that involves numerous partners and activities. Meeting this challenge will require special emergency preparedness in all communities throughout the U.S. Triage A: Planning for Triage: (a) In most mass casualty incidents: (a-1) A large majority of people will self-triage and go directly to the closest and most familiar hospitals; they will probably bypass field triage and treatment whether contaminated or not. Therefore, hospitals often have little, if any, advance notification of incoming patients. (a-2) Most of the individuals who come to the hospital are ambulatory, minimally injured, or those who are concerned about potential contamination. (a-3) The general community medical needs to continue despite the occurrence of a disaster. (b) Hospitals should have plans in place to transfer patients (if conditions allow) to other hospitals or other medical facilities during disasters according to pre-arranged formal agreements. Hospitals are protected from having to transfer unstable patients under the provisions of the Emergency Medical Treatment and Active Labor Act (EMTALA) (2). (c) Every individual involved in the response to a mass casualty incident, especially the Fire and Police, should be familiar with the triage process and how to determine who should be sent to the hospital. (d) The triage plan should include a process for establishment of an assessment center, separate from the emergency department. The assessment center can be used to rapidly screen victims for injury and contamination, as well as to serve as a location removed from the emergency department where decontamination of victims can take place. The assessment center should also be used for observation, limited treatment and evaluation and reuniting with family members where possible. (e) Consideration should be given to setting up a temporary primary assessment center that would be located on the hospital campus, removed from the Emergency Department, or depending upon logistics and the magnitude of the event, a temporary secondary assessment center that would be located within the community but removed from the hospital. If practical, any outside assessment center should be set-up upwind from the patient arrival area (3). (f) Hospitals must ensure that the triage process has an efficient record-keeping process to be sure injured persons are not missed. The Armed Forces Radiobiological Research Institute (AFRRI) and the Radiation Emergency Assistance Center/Training Site (REAC/TS) have developed and tested a record-keeping process and a system of tagging for triage, AFFRI's Biodosimetry Assessment Tool software application. (g) Hospitals need to take into consideration that corpses from a radiological event may be contaminated with radioactive material. Guidance on handling contaminated corpses is provided by the National Council of Radiation Protection and Measurements (NCRP Report No. 37, "Precautions in the Management of Patients Who Have Received Therapeutic Amounts of Radionuclides," 1970, NCRP, Washington, D.C.) and by the National Health and Medical Research Council of Australia (1986;AGPS Press, Australian Government Publishing Service, G.P.O., box 84, Canberra, A.C.T. 2601)