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on a triage tag or colored ribbon. Unlike military triage protocols, where the focus is on successful completion of the ''mission," the emphasis in the civilian sector is on saving as many persons as possible.

There are several differences between the triage done for the traditional disaster scenario and that for a hazardous material incident or a chemical/biological terrorist event. Time demands, patient volume, and the PPE being worn by response personnel in the hot and warm zones may preclude normal life-saving measures being rendered quickly, if at all. For example, verbal communication may not be possible because of the responder's PPE. A tactile examination may not be possible for the same reason. Additionally, the whole concept of traditional triage (treating the most seriously injured first) may not be applicable in a chemical or biological incident. Those walking around may need to be among the first to be decontaminated and evacuated because they have the best chance of survival. It is not desirable that victims remain in place in the hot zone until examined. Rather, immediate evacuation efforts should be undertaken and the victims directed towards the decon process established in the warm zone. Also, there will be little, if any, time to indicate a patient's priority on a triage tag in the hot or warm zones. Additionally, the patient data recorded on a triage tag is at risk of getting defaced when the tag becomes wet during decontamination.

Psychological issues also play a part in triage after a mass chemical or biological terrorist attack. Among the most important directions given to victims of nonhazmat incidents is how to evacuate the area, stop bleeding, and stay warm. The mixture of men with women and young and old together in this circumstance poses psychological problems.

R&D Needs

A comprehensive national training program on the medical management of patients injured by weapons of mass destruction (WMD) should be developed for prehospital and hospital personnel. The curriculum should include the following: