SURGE SORT SUPPORT: Continuous Integrated Triage

(Click on the link above to be redirected to the 2009 training calendar for this course.)



Course Description

SURGE SORT SUPPORT: Continuous Integrated Triage  provides healthcare leaders and practitioners with a systematic set of eight strategies for dealing effectively with mass casualty events.  These strategies carefully integrate the medical and psychosocial dimensions of disasters and extreme events.  Healthcare leadership is presented with strategic guidance in order to “think behaviorally” about how citizens act and react in disasters.  Melding the physical and psychological dimensions of the disaster experience facilitates reality-based planning and preparedness for the true dimensions of hospital and community surge during a catastrophic casualty event.


During catastrophic casualty events, the complexity and magnitude of the “surge” is likely to exceed the numbers of casualties typically included in hospital/health system disaster plans, drills, and simulations.  SURGE SORT SUPPORT: Continuous Integrated Triage  expands the discussion to include medical and psychological casualties, persons searching for missing loved ones who come to hospitals and community care sites, and family members of the casualties.  Additional consideration is given to the predictable distress experienced by hospital inpatients, family members of inpatients, and hospital personnel.


SURGE SORT SUPPORT: Continuous Integrated Triage  introduces a novel triage approach for efficiently processing the complex surge of casualties.  “Continuous integrated triage” is the only disaster-tested approach that fulfills the five criteria of the ideal mass casualty triage system: 1) rapid, 2) scalable, 3) recurring, 4) integrating medical and behavioral triage, and 5) including criteria for exclusion from care.  Coupled with the continuous integrated triage model, SURGE SORT SUPPORT: Continuous Integrated Triage  describes the activation and operation of a hospital-based Support Center to process the flow of “psychological casualties” and a hospital-affiliated Family Center to accommodate the “surge of the searching.”  SURGE SORT SUPPORT: Continuous Integrated Triage  illustrates how continuous integrated triage in tandem with activation of treatment and support sites effectively “expands the healthcare highway.”  Using this approach, hospitals are able to handle an influx of disaster survivors larger in number than the total bed capacity of the facility!


SURGE SORT SUPPORT: Continuous Integrated Triage  adapts DEEP Center’s SAFETY FUNCTION ACTION framework to the support of both hospital staff (building and maintaining resilience for the workforce) and patients served during a mass casualty incident.  This framework is the basis for the portion of the SURGE SORT SUPPORT: Continuous Integrated Triage  course described as “Supporting Survivors.”  SAFETY FUNCTION ACTION strategies and tactics can be applied by hospital personnel in all treatment sites serving disaster survivors.


Course Objectives

  • SURGE: Identify the five components of the incoming surge during a catastrophic health event.

  • SORT : Describe the sequence of steps that comprise Continuous Integrated Triage: Walk, Wave, START, behavioral triage.

  • SPECIAL SITUATIONS: Describe the "force of fear" aspects of mass panic, exposure to harmful agents, decontamination, quarantine, and social distancing.

  • SUPPORT: Describe the use of six SAFETY FUNCTION ACTION strategies in the hospital-based Support Center.


SURGE SORT SUPPORT: Continuous Integrated Triage  is designed for presentation to hospital and community-based healthcare professionals.  The leadership focus specifically targets health system corporate officers, division directors, department heads, and others with leadership roles.  However, audience members who will find value in this course include all healthcare professionals who will have a response role during disasters, disease outbreaks, pandemics, and other mass casualty events.  Administrators of all types, medical personnel, safety and security personnel, and psychosocial professionals will find value in this course.  With cross-discipline, all-hazards training as a national priority, SURGE SORT SUPPORT: Continuous Integrated Triage  is also highly relevant for pre-hospital responders (paramedics, EMTs, fire/rescue personnel), all ranks of first responders, public health professionals, and mental/behavioral health professionals.

Course Capacity

Typical class size: 30-100 participants (No upper limit.)



During 2009, the Florida Department of Health is funding 20 sessions of SURGE SORT SUPPORT: Continuous Integrated Triage  training throughout Florida. DEEP Center funding from the Florida Department of Health originates from the Centers for Disease Control and Prevention (CDC) and the Office of the Assistant Secretary for Preparedness and Response (ASPR)

Florida Department of Health funding for the DEEP Center is used to support training conducted for public health professionals and their community preparedness and response partners and training for hospital-based health professionals and their community partners in the State of Florida. 

Additional trainings are being conducted in other states upon request for audiences including public health, mental health, healthcare, public safety, and law enforcement professionals.


Training Materials

  • SURGE, SORT, SUPPORT: Disaster Behavioral Health for Health Care Professionals textbook
  • SAFETY FUNCTION ACTION Strategies, Objectives & Tactics Double-sided Handout
  • SURGE SORT SUPPORT: Continuous Integrated Triage PowerPoint Handouts:
    - Adobe Acrobat PDF Part 1: Surge
    - Adobe Acrobat PDF Part 2: Sort
    - Adobe Acrobat PDF Part 3: Special Situations
    - Adobe Acrobat PDF Part 4: Support
    - Adobe Acrobat PDF The Preparedness Balance Sheet

Note: Viewing documents with the Adobe Acrobat PDF symbol requires Adobe Acrobat Reader which may be downloaded for free from

Course Agenda


SURGE SORT SUPPORT for Healthcare Leadership


08:00 AM 

Registration and Pre-Assessment

08:30 AM

SURGE, SORT, SUPPORT: Introduction

Disaster Healthcare Strategic Concepts 

SURGE: The Human Element in a Catastrophic Health Event

10:00 AM


10:15 AM

SORT: Continuous Integrated Triage

12:00 PM


01:00 PM


02:15 PM


02:30 PM

Continuous Integrated Triage Exercise


04:15 PM

Post-Assessment and Evaluation

04:30 PM




Course Faculty

James M. Shultz MS, PhD
Director, Center for Disaster & Extreme Event Preparedness (DEEP Center)
Co-Director, Miami Center for Public Health Preparedness
University of Miami Miller School of Medicine
Miami, FL

Maurice A. Ramirez, DO
President, High Alert, LLC
Kissimme, FL