• Muhammad Muzzammil Sindh Gov. Services Hospital Karachi
  • Muhammad Saeed Minhas Jinnah Postgraduate Medical Center, Karachi
  • Anser Saeed Khan Jinnah Postgraduate Medical Center, Karachi
  • Jahazeb Effendi Jinnah Postgraduate Medical Center, Karachi
  • Muhammad Owais Minhas Jinnah Postgraduate Medical Center, Karachi
  • Saadia Jabbar Ziauddin University, Karachi-Pakistan


Background: To improve morbidity and mortality outcomes in mass casualty victims it is pertinent that a system of prehospital triage be implemented. The objectives of this study are to determine the knowledge, attitude and practices of emergency care transporters and ambulance personnel towards onsite triage, pre-hospital management and transportation to hospital of critically injured and wounded patients in mass casualty incidents and other emergencies in Karachi, Pakistan. Method: All ambulance personnel and emergency care transporters who transported patients to the hospital were included in the study. Pre-tested questionnaire was self-administered after obtaining written consent. Results: Among 250 emergency care transporters (ambulance personnel), mostly belonged to age group 21–25 years 73 (29.2%). Most of emergency transport provider teams were composed of only 1 person who was the driver of ambulance 22 (80%) and only 44 (17.6%) had the facility of paramedics. Regarding lifesaving equipment facilities in ambulance, 188 (75.2%) ambulances did not have these and only 62 (24.8%) were equipped. Predominantly, the ambulance personnel performed the ‘scoop and run’ practice and the ambulance works as a transport vehicle 188(75.2%), while facilities of basic life support were available in only 45 (18%) and advance life support facility in 17 (6.8%). Among all 203 (81.2%) did not think they are able to decide who is severely injured and 183(73.2%) believe they are unable to do triage in mass causalities. Conclusion: Our study showed significant gaps in the knowledge of the emergency care providers regarding triage of patients especially in mass casualty incidents. Though the response time and time to the hospital center is comparable, no pre-hospital lifesaving interventions are attempted en-route. A coordinated effort by the ambulance services, hospitals and the government are detrimental for a swift functioning of a trauma system.


Mistovich JJ, Karren KJ, Werman HA, Hafen BQ. Prehospital Emergency Care. 10th ed. Boston, MA, United States: Prentice Hall, 2013.

Medical Definition of Triage.” 1996. [online] [cited 2018 Mar]. Available from: URL:http://www.medicinenet.com/script/main/art.asp?articlekey=16736

Robertson-Steel I. Evolution of Triage Systems. Emerg Med J 2006;23(2):154–5.

Gajic V. [(Forgotten great men of medicine—Baron Dominique Jean Larrey (1766-1842)]. Med Pregl 2011;64(1-2):97–100.

Mitchell GW. A brief history of triage. Disaster Med Public Health Prep 2008;2(Suppl 1):S4–7.

Ali M Q, Muzzammil M, Batool Z, Minhas MS. Triage in Mass Casualty Incidents: Our Preparedness and Response – A Cross-sectional Study from a Tertiary Care Hospital, Karachi, Pakistan. Trauma Int 2018;4(3):6–10.

Falzone E, Pasquier P, Hoffmann C, Barbier O, Boutonnet M, Salvadori A, et al. Triage in Military Settings. Anaesth Crit Care Pain Med 2017;36(1):43–51.

Weinerman ER, Ratner RS, Robbins A, Lavenhar MA. Yale studies in ambulatory care V: determinants of use of hospital emergency services. Am J Public Health 1966:56(7):1037–56.

Iserson KV, Moskop JC. Triage in medicine part I: concept, history, and types. Ann Emerg Med 2007;49(3):275–81.

Thompson JM, Irvine HS, Von Hollen BA, Peters ME. Triage system for rural hospital emergency services: Determining how long patients can wait. Can Fam Physician 1991;37:1252–66.

Reporter, The Newspaper’s Staff. 30, 000 Road Accidents Occur in Karachi Every Year. [Internet]. DAWN.COM 2016 [cited 2018 Mar]. Available from: URL: http://www.dawn.com/news/1256089

Minhas MS, Muzzammil M, Effendi J, Jahanzeb S, Bhatti A. Prevalence and nature of trauma and injuries in Karachi national trauma registry of Pakistan “The need of the hour”. J Pak Orthop Assoc 2017;29(3):80–5.

City Badly Needs Designated Trauma Centers, Pre-Hospital Care System: Study.” [Internet]. [cited 2018 Mar]. Available from: URL: http://epaper.dawn.com/DetailImage.php?StoryImage=01_10_2015_117_009

Waheed, Shahzad. “Health System Strengthening.” [Internet]. [cited 2018 Mar]. Available from: URL: http://www.emro.who.int/pak/programmes/health-system-strengthening-hss.html

Mehmood A, Razzak JA, Mir MU, Jooma R. Differences in risk-adjusted outcome of road traffic injuries in urban tertiary care centers of Pakistan. J Pak Med Assoc 2015;65(9):984–9.

Centres of Pakistan: analysis of surveillance data. JPMA: Journal of the Pakistan Medical Association, 65(9), 984-989.

Ismail S, Zia N, Samad K, Naeem R, Ahmad H, Raza A, et al. Prehospital Airway Management in Emergency and Trauma Patients: A Cross-sectional Study of Ambulance Service Providers and Staff in a Low- and Middle-income Country. Prehosp Disaster Med 2015;30(6):606–12.

Razzak JA, Cone DC, Rehmani R. Emergency medical services and cultural determinants of an emergency in Karachi, Pakistan. Prehosp Emerg Care 2001;5(3):312–6.

Winchell RJ, Hoyt DB. Endotracheal Intubation in the Field Improves Survival in Patients with Severe Head Injury. Arch Surg 1997;132(6):592–7.

Ali M, Miyoshi C, Ushijima H. Emergency medical services in Islamabad, Pakistan: a public-private partnership. Public Health 2006;120(1):50–7.

Khan A, Zafar H, Naeem SN, Raza SA. Transfer delay and in-hospital mortality of trauma patients in Pakistan. Int J Surg 2010;8(2):155–8.

Baqir M, Ejaz K. Role of pre-hospital care and ambulance services in Karachi. J Pak Med Assoc 2011;61(12):1167–9.