Maryland MarylandTriageTriageSystemSystem

MIEMSS 1999

MARYLAND TRIAGE SYSTEM This program focuses on the use of the triage This program focuses on the use of the triage

system in multi-casualty situations. It doessystem in multi-casualty situations. It doesnot address incident management or clinicalnot address incident management or clinicaltriage procedures. For further information ontriage procedures. For further information onthese topics, MIEMSS recommends the usethese topics, MIEMSS recommends the useof :of :

ll National Fire Academys IncidentNational Fire Academys IncidentManagement System for EMSManagement System for EMS

ll Newport Beach Fire and MarinesNewport Beach Fire and MarinesS.T.A.R.T. (S.T.A.R.T. (SSimple imple TTriage riage AAnd nd RRapidapidTTreatment) - A Race With Timereatment) - A Race With Time

Capabilitiesll Multiple triage assessments of each patient.Multiple triage assessments of each patient.

ll Continuous patientContinuous patientinformation recordinginformation recording

ll Continuous patientContinuous patientaccountability and trackingaccountability and tracking

ll Designed for easy interfaceDesigned for easy interfacewith patient hospital recordswith patient hospital records

ll Flexible, difficult to tear, waterproof materialFlexible, difficult to tear, waterproof material

Triage Tagll Patient InformationPatient Information

ll Triage StatusTriage Status

ll Chief ComplaintChief Complaint

ll TransportationTransportation

ll Peel - off Bar CodesPeel - off Bar Codes

ll Transport RecordTransport Record

ll Vital SignsVital Signs

ll HistoryHistory

ll TreatmentTreatment

MIEMSS

HOSP NOTIFIEDMaryland Emergency

Medical Services

TRIAGE TAG

A V P U

A V P U

A V P U

Inflated at _______________PASG

Gauge

Tourniquet @ _______

Extremity Splint

Gross Decon. Final Decon.

Maryland Department of Transportation

Patient Information Section

ll During MCIs this information is not alwaysDuring MCIs this information is not alwaysobtainable.obtainable.

ll Information is not a priority, can be addedInformation is not a priority, can be addedthroughout triage, treatment, transportation,throughout triage, treatment, transportation,and hospital reception phases.and hospital reception phases.

Triage Status Section

ll Universal color coding systemUniversal color coding system

ll Space provided for four individual evaluationsSpace provided for four individual evaluations

Initial assessment - apply tag for priority assignmentInitial assessment - apply tag for priority assignment

Secondary reassessment (in treatment area)Secondary reassessment (in treatment area)

Blank - can be used in the treatment area or duringBlank - can be used in the treatment area or duringtransportationtransportation

HospitalHospital

Chief Complaint Section

ll Major obvious injuries or illness can be circledMajor obvious injuries or illness can be circled

ll Indicate injuries on the human figureIndicate injuries on the human figure

ll Additional information is added on theAdditional information is added on thecomments linecomments line

Transportation Line

ll The The transporting unittransporting unit notes its agency notes its agencyinformation, destination facility, and the timeinformation, destination facility, and the timethe patient physically arrives at destinationthe patient physically arrives at destinationfacilityfacility

Peel-off Label Section

ll A total of eight labels are providedA total of eight labels are provided

ll Two are marked for:Two are marked for: Treatment - to document on patient information worksheetsTreatment - to document on patient information worksheets

Hospital - to link the triage tag and scene patient number toHospital - to link the triage tag and scene patient number tothe patients hospital recordsthe patients hospital records

Peel-off Label Sectionll Remaining six labels can be used for aRemaining six labels can be used for a

variety of purposes, based on incident needs:variety of purposes, based on incident needs: Other tactical worksheet needs on scene,Other tactical worksheet needs on scene,

including transportation accountabilityincluding transportation accountability Marking personal effectsMarking personal effects Use within the hospitalUse within the hospital

MAIS Runsheetll Affix label over ABG recording area on theAffix label over ABG recording area on the

OfficialOfficial and and HospitalHospital copies of the runsheet, copies of the runsheet,which will tie in the MAIS report to thewhich will tie in the MAIS report to thetriaged patienttriaged patient

Transportation Record Sectionll Detachable by tear-off ticket and as a peel-Detachable by tear-off ticket and as a peel-

off labeloff labelll Used to document patients removed from theUsed to document patients removed from the

scene to a hospital or other facilityscene to a hospital or other facilityll Transportation record label can be fixed toTransportation record label can be fixed to

the transportation tactical worksheet - makethe transportation tactical worksheet - makecertain unit, priority, and destination iscertain unit, priority, and destination ismarked and initialedmarked and initialed

HOSP NOTIFIED

Vital Signs Section

Medical History Section

ll Information can be obtained anytime duringInformation can be obtained anytime duringthe incidentthe incident

ll Information can be obtained from MedicInformation can be obtained from MedicAlert identification devicesAlert identification devices

ll Relevant medical history & medicationsRelevant medical history & medications

Treatment Record Section

ll Documents treatment sequence and progressDocuments treatment sequence and progress

ll Quick documentation of common treatmentsQuick documentation of common treatments

ll Space provided for additional treatments andSpace provided for additional treatments andremarksremarks

ll Spaces provided for time treatment actionsSpaces provided for time treatment actionsare taken and for provider initialsare taken and for provider initials

Treatment Record Layout

When to Use The Tag To remain familiar with the tags, To remain familiar with the tags,

MIEMSS recommends they be usedMIEMSS recommends they be usedoften.often.

Establishing the System

Safety Liason

Information

Staging

Fire SuppressionBranch

RescueDivision A

RescueDivision B

RescueDivision C

RescueBranch

MedicalGroup D

MedicalGroup E

MedicalGroup F

PatientTransportation

Group

MulticasualtyBranch

OperationsSection

PlansSection

LogisticsSection

Admin/FinanceSection

Incident CommandNational Fire AcademyNational Fire Academy

Incident ManagementIncident ManagementSystemSystem

Expanded OrganizationalExpanded Organizational Structure Structure

Staging

TriagePersonnel

MorguePersonnel

TriageUnit Leader

Treatment DispatchManager

Immediate TreatmentManager

Delayed TreatmentManager

Minor TreatmentManager

TreatmentUnit Leader

Medical Group /Division Supervisor

MedicalCommunications

Coordinator

Air AmbulanceCoordinator

Ground AmbulanceCoordinator

Patient TransportationGroup Supervisor

MulticasualtyBranch Director

Air OperationsBranch Director

OperationsSection Chief

IncidentCommander

Incident CommandIncident CommandOrganizational Chart forOrganizational Chart fora Multi-casualty Brancha Multi-casualty Branch

Full Branch Response LevelFull Branch Response Level

Organizational Lines

Communication Lines

Incident SiteTreatment Unit Coordinator

Morgue

Priority Red Patients Priority Yellow Patients Priority Green Patients

Transportation Group Supervisor

Transport Unit

StagingDisposition and

Medical Communications

North Hospital

South Hospital

East Hospital

West Hospital

Mass Casualty Branch

First Unitll Assess & Secure the SceneAssess & Secure the Scene

ll Establish Areas as Outlined in theEstablish Areas as Outlined in theSchematicSchematic

ll Communicate &Communicate &Direct Incoming UnitsDirect Incoming Units

ll Requests AdditionalRequests AdditionalResourcesResources

ll Notify HospitalsNotify Hospitals

ll Establish TriageEstablish TriageUnit CoordinatorUnit Coordinator

Triage Unit Coordinator

ll Direct Crews & Litter BearersDirect Crews & Litter Bearers

ll Determine & Request ResourcesDetermine & Request Resources

ll Primary Triage (ribbons only)Primary Triage (ribbons only)

Incident SitePriority Red Patients Priority Yellow Patients Priority Green Patients

Transportation Group Supervisor

Transport Unit

StagingDisposition

and Medical Communications

Incident Site Treatment Unit Coordinator Morgue

North Hospital

South Hospital

East Hospital

West Hospital

During Initial TriageUse Ribbons Only

Treatment Unit Coordinatorll Establish Areas For Each Priority of Patient and aEstablish Areas For Each Priority of Patient and a

MorgueMorguell Assign Treatment Area ManagersAssign Treatment Area Managersll Establish Central Entry StationEstablish Central Entry Stationll Prepare Log(s) For Each Area & MorguePrepare Log(s) For Each Area & Morguell Ensure Safety and Security for Patients andEnsure Safety and Security for Patients and

ProvidersProvidersll Gathers Tags & PensGathers Tags & Pens

Treatment Unit Coordinator Priority Red Patients Priority Yellow Patients Priority Green Patients

Transportation Group Supervisor

Transport Unit

StagingDisposition

and Medical Communications

Incident Site Treatment Unit Coordinator Morgue

North Hospital

South Hospital

East Hospital

West Hospital

INCIDENT TIME DATE TIME

AREA: PATIENT STATUS

(CIRCLE ONE)

TIME ENTERING AREA

NOTES TIME DEPARTED AREA

1

R Y G B2

R Y G B

3

R Y G B

4

R Y G B

5

R Y G B

6

R Y G B

7

R Y G B

8

R Y G B

9

R Y G B

10

R Y G B

11

R Y G B

12

R Y G B13

R Y G B

Patient Tracking Log

Treatment Area / Morgue Managers

ll Identify Boundaries of AreasIdentify Boundaries of Areas

ll Clearly Identify Which Area It Is.Clearly Identify Which Area It Is.

ll Defined Entry and Exit PointsDefined Entry and Exit Points

ll Prepare EquipmentPrepare Equipment

ll Brief Treatment Crew(s)Brief Treatment Crew(s)

ll Prepare Log SheetPrepare Log Sheet

Treatment/Morgue Areas

Priority Red Patients Priority Yellow Patients Priority Green Patients

Transportation Group Supervisor

Transport Unit

StagingDisposition

and Medical Communications

Incident Site Treatment Unit Coordinator Morgue

North Hospital

South Hospital

East Hospital

West Hospital

Transportation Group Supervisorll Establish One Way Traffic FlowEstablish One Way Traffic Flow: There Should Always: There Should Always

Be a Clear, Unobstructed Flow of Transport Units to andBe a Clear, Unobstructed Flow of Transport Units to andFrom the Transport AreaFrom the Transport Area

ll Prepare Log SheetPrepare Log Sheet

ll Establish Exit PointEstablish Exit Point

ll Assign Communication And Disposition CoordinatorsAssign Communication And Disposition Coordinators

Transportation Group SupervisorPriority Red Patients Priority Yellow Patients Priority Green Patients

Transportation Group Supervisor

Transport Unit

StagingDisposition

and Medical Communications

Incident Site Treatment Unit Coordinator Morgue

North Hospital

South Hospital

East Hospital

West Hospital

CommunicationCoordinator

ll Contact EMRC/Communications CenterContact EMRC/Communications Center Advise Of IncidentAdvise Of Incident Provide LocationProvide Location Describe IncidentDescribe Incident Provide Approximate Patient CountProvide Approximate Patient Count Request Call Down Of HospitalsRequest Call Down Of Hospitals

ll Establish Communication LogEstablish Communication Logll Receive Bed Availability FromReceive Bed Availability From

EMRC/Communications CenterEMRC/Communications Centerll Communicate Availability To Disposition CoordinatorCommunicate Availability To Disposition Coordinatorll Update Hospitals on Incident Status Every 30 MinutesUpdate Hospitals on Incident Status Every 30 Minutesll Advise Hospital(s) When Incident is TerminatedAdvise Hospital(s) When Incident is Terminated

Disposition Coordinatorll Receive Bed Availability FromReceive Bed Availability From

Communication CoordinatorCommunication Coordinator

ll Prepare Log Sheet For Each HospitalPrepare Log Sheet For Each Hospital

Dispositionand Medical Communications

Priority Red Patients Priority Yellow Patients Priority Green Patients

Transportation Group Supervisor

Transport Unit

Staging Disposition and Medical Communications

Incident Site Treatment Unit Coordinator Morgue

North Hospital

South Hospital

East Hospital

West Hospital

TRANSPORTATION/Disposition Coordinator LOG PAGE_____OF_____HOSPITAL_______________________

CAPACITY- RED______ YELLOW______ GREEN______ TRANSPORTED- RED______ YELLOW______ GREEN______

RED YELLOW GREEN

Tracking Patient Flow

Incident Sitell Assess PatientAssess Patient

RespirationsRespirations

PulsePulse

Mental StatusMental Status

ll Assign PriorityAssign Priority

ll USE COLOREDUSE COLOREDRIBBONS ONLY!RIBBONS ONLY!DO NOT APPLYDO NOT APPLYTAGS IN INCIDENTTAGS IN INCIDENTSITESITE

Treatment UnitCoordinator

ll Attach Tag To RibbonAttach Tag To Ribbon & Circle Priority at & Circle Priority at Initial Assessment Initial Assessment

Treatment UnitCoordinator

ll Remove Remove TreatmentTreatmentPeel-off LabelPeel-off Label

ll Place on Place on Treatment Treatment LogLog

ll Note TimeNote Time

Treatment Unit Coordinator

ll Direct Crew to AppropriateDirect Crew to AppropriateAreaArea

Priority Red Patients

Priority Yellow Patients

Priority Green Patients

Morgue

Priority Red Patients Priority Yellow Patients Priority Green Patients

Transportation Group Supervisor

Transport Unit

StagingDisposition

and Medical Communications

Incident Site Treatment Unit Coordinator Morgue

North Hospital

South Hospital

East Hospital

West Hospital

Treatment Area Managersll Log Patient Into Area &Log Patient Into Area &

Take Take Other Other Label Label

Treatment Area Managersll Assign Crew to Care For PatientAssign Crew to Care For Patient

Reassess PatientReassess Patient

Provide Gross StabilizationProvide Gross Stabilization

ABCsABCs

BackboardBackboard

Major FracturesMajor Fractures

Note Assessment & Treatment Interventions on TagNote Assessment & Treatment Interventions on Tag

Prepare Patient for Transport to Appropriate FacilityPrepare Patient for Transport to Appropriate Facility

ll Ensures Patient Can Be Transported SafelyEnsures Patient Can Be Transported Safely

Transportation GroupSupervisor

Is Responsible For. . .

ll LoadingLoading

ll Assigning Disposition &Assigning Disposition &CommunicationCommunicationCoordinatorsCoordinators

Loading

ll Call Staging for Transport Units &Call Staging for Transport Units &Treatment Areas for Patients for LoadingTreatment Areas for Patients for LoadingPatientsPatients

ll Note Unit Number & Priority On Note Unit Number & Priority On EachEach Tear- Tear-off off Transportation Section Transportation Section Part Of Part Of EachEach Tag Tag

ll Peel Off Peel Off OtherOther Label, Place on Log Sheet Label, Place on Log SheetTreatmentTreatmentAreaArea

EMS - 1

Loading

ll Tear Off Transportation Tickets and Hand toTear Off Transportation Tickets and Hand toDriverDriver

Loadingll Remind Provider to Complete Transport Remind Provider to Complete Transport

Line on Tag Once Hospital is Assigned &Line on Tag Once Hospital is Assigned &Place Barcode labels on Place Barcode labels on HospitalHospital and and OfficialOfficialcopies of the MAIS Formscopies of the MAIS Forms

Treatment Treatment AreaArea

EMS - 1

Loading

ll Direct Unit To Disposition CoordinatorDirect Unit To Disposition Coordinator

ll Maintain One Way Traffic FlowMaintain One Way Traffic Flow

DispositionDisposition

Treatment Treatment AreaArea

Tria ge

Inciden t

Tra nspo rta tion

Dispos ition

Dispos ition

Dispos ition

EMS - 1EMS - 1

Disposition Coordinator

ll Receive Tickets From DriverReceive Tickets From Driver

DispositionDispositionTreatmentTreatment

AreaArea

Tria ge

Inciden t

Tra nspo rta tion

Dispos ition

Dispos ition

Dispos ition

EMS - 1EMS - 1

CommunicationCommunication

Disposition Coordinator

ll Discuss Next Available Hospital, AppropriateDiscuss Next Available Hospital, Appropriatefor Patients, With Communication Coordinatorfor Patients, With Communication Coordinator

DispositionOfficer

ll Tell DriverTell DriverDestination &Destination &Confirm DirectionsConfirm Directions

ll Write Write ReceivingReceivingFacilityFacility and andTime OutTime Out on Ticket on Ticket

ll Give Ticket toGive Ticket toCommunicationCommunicationCoordinatorCoordinator

Communication Coordinator

ll Receive Ticket From DispositionReceive Ticket From DispositionCoordinatorCoordinator

ll Communicate Information To HospitalCommunicate Information To Hospital Unit Jurisdiction and NumberUnit Jurisdiction and Number Number of Patients With Priority of EachNumber of Patients With Priority of Each

ll Initial Ticket in Notified areaInitial Ticket in Notified area

Communication Coordinator

ll Receives and Discusses Hospital StatusReceives and Discusses Hospital StatusChanges With Disposition CoordinatorChanges With Disposition Coordinator

ll Keeps HospitalsKeeps HospitalsUpdated onUpdated onIncident StatusIncident Status

Disposition Coordinator

ll Receive Ticket(s) Back From CommunicationsReceive Ticket(s) Back From CommunicationsOfficerOfficer

ll Tracks Available Beds at HospitalsTracks Available Beds at Hospitalsll Places TicketPlaces Ticket

Label on HospitalLabel on HospitalDestinationDestinationLogs and NotesLogs and NotesTimeTime

PROGRAM SUMMARY

ll Triage tag allows forTriage tag allows forcontinuous:continuous: Triage assessments of patientTriage assessments of patient

Patient information recordingPatient information recording

Patient accountability & trackingPatient accountability & tracking

PROGRAM SUMMARY

ll The Triage Tag Contains:The Triage Tag Contains: Eight peel-off tracking labels for field &Eight peel-off tracking labels for field &

hospital usehospital use

Seven sections in which to record patientSeven sections in which to record patientinformation, triage status, chief complaint,information, triage status, chief complaint,transportation record, vital signs, medicaltransportation record, vital signs, medicalhistory, and treatment recordhistory, and treatment record

PROGRAM SUMMARY

ll One Tag = One PatientOne Tag = One Patient Tags are not interchangeable, as eachTags are not interchangeable, as each

possesses a unique numberpossesses a unique number Tags cannot be thrown away once peel-Tags cannot be thrown away once peel-

off label becomes part of the trackingoff label becomes part of the trackingsystemsystem

Tags may not be altered by field personnelTags may not be altered by field personnel Pick-up Any Loose Tags and Report ThemPick-up Any Loose Tags and Report Them

to Treatment Unit Coordinatorto Treatment Unit Coordinator

PROGRAM SUMMARY

EstablishingEstablishingThe System Of PatientThe System Of Patient

Triage, Treatment, and Tracking Triage, Treatment, and TrackingEarlyEarly in Any Multi Casualty in Any Multi Casualty

Incident Is the Key to EffectivelyIncident Is the Key to EffectivelyCoordinating Patient FlowCoordinating Patient Flow

Program Summary

Incident SiteTreatment Unit Coordinator

Morgue

Priority Red Patients Priority Yellow Patients Priority Green Patients

Transportation Group Supervisor

Transport Unit

StagingDisposition and

Medical Communications

North Hospital

South Hospital

East Hospital

West Hospital

Program Summary

Attention to the detailed stepsAttention to the detailed stepsmustmust

be executed exactly as describedbe executed exactly as describedin this program in order toin this program in order to

accurately track accurately track eacheach individual individualpatientpatient

FUTUREll Pen based computers and software to replacePen based computers and software to replace

paper logspaper logs

ll Wireless local area networks to provideWireless local area networks to provideofficers accurate real time status of patientofficers accurate real time status of patientflowflow

ll Wide area network to communicate hospitalWide area network to communicate hospitalstatus and medical communicationstatus and medical communication

Perfect Practice Makes Perfect

Practice the Use of ThesePractice the Use of TheseProcedures in Mock Situations,Procedures in Mock Situations,

BeforeBefore

You Really Need ItYou Really Need It

Produced By MIEMSSExecutive DirectorExecutive Director

Robert R. Bass, MD FACEP Robert R. Bass, MD FACEP

Project CoordinatorProject Coordinator

John Donohue, Region III Administrator John Donohue, Region III Administrator

Educational Support ServicesEducational Support Services

James BrownJames Brown

Brian SlackBrian Slack

Al RaisonAl Raison

Triage Tag DesignAdapted From That Designed by

Virginia Department of HealthVirginia Department of HealthOffice of Emergency MedicalOffice of Emergency Medical

ServicesServices

Walter G. Green III, Project CoordinatorWalter G. Green III, Project Coordinator

Funding Provided By

Maryland Department ofTransportation

State Highway Administration

Maryland Institute forEmergency Medical Services

Systems

MIEMSSGratefully Acknowledges

Newport Beach Fire And MarineNewport Beach Fire And Marinefor thefor the

START Simple Triage and Rapid TreatmentSTART Simple Triage and Rapid Treatment

A Race Against Time A Race Against TimeCopyright 1983, 1984 Hoag Hospital; Copyright 1994 Newport Beach Fire DepartmentCopyright 1983, 1984 Hoag Hospital; Copyright 1994 Newport Beach Fire Department

National Fire AcademyNational Fire Academyfor thefor the

Incident Management System for EMSIncident Management System for EMS

Program Development CommitteeJim Brown,Jim Brown,

Director, Educational Director, EducationalSupport/MIEMSSSupport/MIEMSS

Captain Joseph Brown,Captain Joseph Brown, Baltimore County Fire Department Baltimore County Fire Department

Captain Bruce Conrad,Captain Bruce Conrad, Baltimore County Fire Department Baltimore County Fire Department

Captain Dale CrutchleyCaptain Dale Crutchley Annapolis Fire Department Annapolis Fire Department

Lieutenant Michael FaithLieutenant Michael Faith Howard County Fire & Rescue Howard County Fire & Rescue

Captain Michael HenryCaptain Michael Henry Fort George Fort George MeadeMeade, EMS, EMS

Rick Rick HimesHimesEMS Coordinator, Fredrick Co.EMS Coordinator, Fredrick Co.Public SafetyPublic Safety

Rick Rick MeighenMeighenAssociate Administrator, MIEMSS RegionAssociate Administrator, MIEMSS RegionVV

Captain Frank StammCaptain Frank StammAnne Arundel County Fire DepartmentAnne Arundel County Fire Department

Battalion Chief Bill TerryBattalion Chief Bill TerryPrince Georges County Fire DepartmentPrince Georges County Fire Department

Harry Harry WallettWallett Associate Administrator, MIEMSS Associate Administrator, MIEMSSRegion IIIRegion III

Charlie WillsCharlie Wills Maryland State Firemens Association, Maryland State Firemens Association,

Ken Young,Ken Young, Associate Director, Associate Director, MIEMSSMIEMSSEducation & CertificationEducation & Certification

UMBC EmergencyHealth Services

EditingEditing

Eric Eric ClaflinClaflin

Tim Tim GarityGarity

David GoodmanDavid Goodman

Joshua Joshua MaseniorMasenior

Department ChairDepartment Chair

Bruce Walz, PHDBruce Walz, PHD

Management TrackManagement TrackCoordinatorCoordinator

William Hathaway,William Hathaway,MSMS

Slide FormattingSlide Formatting

Eric Eric ClaflinClaflin

Initial ResearchInitial Research

Steven Stone Steven Stone