Triage

Triage Class # - 3.04.1 © Copyright 2006 JSL Communications LLC

Triage


Learning Objectives

Cognitive1. Discuss the criteria of MCI

implementation. 2. Discuss the goals and purpose of

triage. 3. Identify appropriate patient care

activities during an MCI. 4. Define the components of the START

acronym.


Learning Objectives

Cognitive

5. State how patients are categorized in START triage.

6. Explain the role of the Triage Unit Leader.

7. Discuss the role of the EMT in an MCI.


Learning Objectives

Psychomotor

1. Given an MCI scenario, perform triage.

2. Demonstrate rapid patient assessment.


Key Vocabulary

Disaster Multiple casualty incident Scene-size up START Triage System

Triage Triage officer Triage tag Walking wounded


Overview

Regardless of the amount of training,will not be immune to the psychologicalimpact or emotional stress of disaster


Overview (continued)

Your best defense is an automaticresponse, the tools and the confidence

that comes from the ongoing practice oftriage


Triage

Good triaging immediately identifies: Patients to be transported first Patients who can assist you Patients impossible to save without

further resources Scene safety and your safety are first

priority Do not become a victim or part of the

problem


MCI vs. Disaster

MCI: any incident in which the number of patients places excessive demands on personnel or equipment

Disaster: any incident which exceeds the capacity of a system’s resources - including mutual aid

The number of patients constituting an MCI is locally defined


MCI’s The EMT role in an MCI:

Recognize incident is an MCI Request additional assistance Establish IMS Identify hazards Perform triage Treat patients according to triage priority Transport patients according to triage priority Document:

Patients, conditions and care


Triage French word means “to sort” To do the most good for the greatest

number of patients Goals:

How many patients? Classify, label, track Assess needs Best utilize scene resources Coordinate with hospitals


START Triage

Simple Triage And Rapid Transport


START Triage (continued)

All Walking Wounded



National standard Developed by City of Newport Beach

(CA) Fire Department and Hoag Hospital Used to triage large numbers, simply and

rapidly



Key assessment elements: Respirations Perfusion Mental status


30-2-Can Do

Mnemonic Any patient who cannot walk but has:

Respiratory rate less than 30 per minute Capillary refill less than 2 seconds, and Can follow commands is a “yellow”

category patient All others who cannot walk are “red”


Triage

Sort multiple casualties into four priorities for emergency care or transportation to definitive care Red Yellow Green Black


Priority 1 - Red

Immediate Patients with readily correctable life-

threatening conditions Airway and breathing difficulties Uncontrolled or severe bleeding Decreased mental status Patients with severe medical problems


Priority 2 - Yellow

Delayed Patients with serious, but not life-

threatening conditions Burns without airway problems Major or multiple bone or joint injuries Back injuries with or without spinal cord

damage


Priority 3 - Green

Minor “Walking Wounded”

Minor painful, swollen, deformed extremities

Minor soft tissue injuries


Priority 4 - Black

Deceased Dead or moribund patients

Respiratory or cardiac arrest


Triage Begins as the first unit pulls up on

scene Use the PA to direct all “walking

wounded” to gather in a certain area Walking wounded are triaged as

Green initially Can be re-triaged later

Use three basic assessment criteria to triage remaining patients


Triage (continued)

Respirations Is the patient breathing? If no, reposition airway, re-assess

breathing If breathing starts, triage Red If no breathing, triage Black

Is the respiratory rate greater than 30 per minute? If yes, triage Red If no, assess perfusion


Triage (continued)

Perfusion Are radial pulses present and capillary

refill less than 2 seconds? If no, triage Red If yes, assess mental status

Control any profuse bleeding


Triage (continued)

Mental Status Can the patient follow simple

commands? If no, triage Red If yes, triage Yellow

If there are injuries incompatible with life, triage black


Triage Officer Most knowledgeable provider, on-

scene first, becomes triage officer Request additional help Perform initial triage assessment


Triage Officer (continued)

Use Triage system per protocols Place color-coded triage tag or tape on

patient Do not render any treatment more

complex than: Repositioning airway Stop major bleeding

Use the patient or a Green patient to assist with any bleeding control

Move on to next patient and continue until all receive initial triage


Triage Duties Assign available personnel and equipment to

highest priority patients Re-triage patients as resources allow Patient transport decisions based on variety of

factors: Patient priority Destination facilities Patient load and resources Transport distance Transportation resources

Triage officer remains at scene to assign and coordinate personnel, supplies and vehicles


Hospital Communications

Incident nature Size location Number / types of injuries Hospital capacity Update regularly Notify when incident ends


Summary

Knowing how to triage fast and effectively is vital to saving greatest number of lives

Practice, drill and use a triage system every time you have more than one patient


Applications

Local protocols for triage Recent case review of MCI Lessons of Scenario drill


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Triage

Documents

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