# Green Triage: A Curtain in Front of Possible Serious Injuries

## TL;DR

This study examines green triage patients from an earthquake to show that serious injuries like crush syndrome can occur without visible signs or entrapment.

## Contribution

It highlights the importance of rethinking triage protocols to account for hidden injuries in mass casualty events.

## Key findings

- 32.2% of green triage patients developed crush syndrome.
- 7.1% required renal replacement therapy despite no obvious injuries.
- Creatine kinase levels were a significant predictor of crush syndrome regardless of entrapment.

## Abstract

Objective: The human body cannot withstand intense mechanical forces generated by an earthquake. The shaking effect of an earthquake, as the human body absorbs it, produces both visible and invisible injuries. Therefore, it is essential to provide accurate triage in the process of mass casualties. Hence, this study aims to characterize green triage patients of the 2023 Kahramanmaraş, Turkey, earthquake and emphasize the need to reconsider mass casualty triage. Methods: A retrospective cross-sectional study was conducted on green triage patients who did not receive first-aid medical attention and attended the emergency department (ED) of a tertiary care hospital. The development of crush syndrome (CS), the receipt of renal replacement therapy (RRT), and associated injuries were considered. Results: Among 295 individuals, CS occurred in 32.2%, and RRT was required in 7.1% of cases. In addition to the traditional markers of CS, non-trapped green triage patients developed both CS and required RRT, as well as sustained injuries. Whether trapped or not, CK levels emerged as a significant predictor of CS. Conclusions: Green triage patients may acquire CS even in the absence of obvious injuries or entrapment. Accurate triage can be life-saving even in the absence of obvious injuries.