triage lecture

8/12/2019 Triage Lecture

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TRIAGE

What is triage?

Triage means to sort

Looks at medical needs and urgency of each individualpatient.

Sorting based on limited data acquisition

Also must consider resource availability

THE NEEDS OF THE MANY OUTWEIGH THE

NEEDS OF THE FEW OR THE ONE


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TRIAGE

mass- casualty or multi- casualty incident

Involves >1 patient or situation that places great demandon resources (stretched to limit)

Triage is the sorting of two or more patients based on theseverity of their conditions to establish priorities for care

based on available resources

Scene Safety

1. Size of hazard area2. Safe and sheltered location to move patients

3. Self- protective measures


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TRIAGE

DAILY EMERGENCIES

DO THE BEST FOR EACH INDIVIDUAL

DISATER SETTINGSDO THE GREATEST GOOD FOR THE GREATEST NUMBER.

MAXIMIZE SURVIVAL

TRIAGE IS A DYNAMIC PROCESS AND IS USUALLYDONE MORE THAN ONCE.


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THE TRIAGE PROCESS

A. Sort patients to provide the best outcome for theGREATEST number of patients

1. Rank in order of severity

2. Mark patients for visual identification

B. May need to modify triage process because of environment

1. Weather

2. Equipment

3. Manpower

4. Communication

5. Distance from definitive care


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CONTINUOUS INTEGRATED TRIAGE

A. PRIMARY TRIAGEB. SECONDARY TRIAGE

C. TERTIARY TRIAGE

PRIMARY DISASTER TRIAGE

-Goals: to sort patient based on probable needs for immediate care.

-Triage based on physiology


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B. SECONDARY DISASTER TRIAGEIncorporates:

-A reassessment of physiology

-An assessment of physical injuriesInitial Treatment and assessment of patient responses

Further knowledge of resource availability

-

SECONDARY TRIAGE TOOLS

Goals is to distinguish between:

Victims needing life saving treatment that can only be provided in

a hospital setting.

Victims needing life saving treatment initially available on scene.


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B. SECONDARY TRIAGE TOOLSVictims with moderate non life-threatening injuries, at risk for

delayed complications

Victims with minor injuries

TERTIARY DISASTER TRIAGE

Goals: To optimize individual outcomes

Incorporates:

-Sophisticated assessment and treatment

-Further assessment of available medical resources

-Determination of best venue for definitive care.


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C. The 5 Ss1. Safety Assessment

Assess scene for safety

2. Simultaneous scene size up

Size and severity

Type of incident

Approximate number of patients

Severity of injuries

Area involved, access

3. Send information Contact dispatch with your scene size-up

Request assistance and additional resources

4. Setting up scene

Obtain triage ribbon

Identify triage areas

Consider scene access and egress

5. START triage process

Begin where you are

Relocate green-tagged patients

Move in an orderly pattern

Maintain a patient count of casualties

Provide minimal treatment


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D. Triage Priorities

1. Red-

- highest priority patients need immediate care (usuallycirculatory or respiratory)

2.Yellow- second highest priority

able to wait longer before transport (45 minutes)

3. Green- Minor injuries that can wait for longer period of

time for treatment

-walkingable to wait several hours for transport

4. Black- dead or still with life signs but injuries are

incompatible with survival in austere conditions.

will die during emergency care (have lethal injuries)

Mark triage priorities (tape, tag)


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Triage Category: Red

Red (Highest) Priority:

Patients who need

immediate care andtransport as soon as

possible

Airway and breathing

difficulties

Uncontrolled or severe

bleeding

Decreased level of

consciousness

Severe medical problems

Shock (hypoperfusion)

Severe burns


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Triage Category: Yellow

Yellow (Second)

Priority: Patients

whose treatment andtransportation can be

temporarily delayed

Burns without airway

problems

Major or multiplebone or joint injuries

Back injuries with or

without spinal cord

damage


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Triage Category: Green

Green (Low) Priority:

Patients whose

treatment and

transportation can be

delayed until last

Minor fractures

Minor soft-tissue

injuries


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Triage Category: Green

Green (Low) Priority:

Patients whose

treatment and

transportation can be

delayed until last

Minor fractures

Minor soft-tissue

injuries


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Triage Category: Black

Black (Lowest)

Priority: Patients who

are already dead orhave little chance for

survival. If resources

are limited, treat

salvageable patientsbefore these patients

Obvious death

Obviously

nonsurvivable injury,such as major open

brain trauma

Full cardiac arrest


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TRIAGE TOOLS

Basic Disaster Life Support

*MASS TRIAGE

M- move

A- Assess

S- Sort

S- Send


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TRIAGE TOOLS

* SALT TRIAGE

S- sort

A- Assess

L- Life saving intervention

S- Treatment/Transport


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The AVPU Scale is used to assess Level of Consciousness

during Primary Survey.

A - Alert

Able to answer questions

V - Verbal

Responds to Verbal Stimulus

P - Pain

Responds to Painful Stimulus

UUnresponsive

Types of simple triage

AVPU Scale


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TRIAGE TECHNIQUES

STARTSimpleTriage

And

Rapid

Treatment

* In initial START Assessment mark with triageribbons, but only provide minimal treatment. Only

two interventions: (1) open the airway and (2) stop

excessive bleeding. START assessments should only

last 15-30 seconds per patient


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START

*Used for PRIMARY triage

Used on scene and at hospital

Recommended for patient >100 lbs

SECONDARY TRIAGE.

*All green patients must be individually assessed in

secondary triage-assess physiology - Assess injuries

-assess probability of deterioration

-assess needs v/s resource availability

1 G d lk


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1. Get up and walk

-Have patients move to safe location outside triage area that can

-Self defined green patients

2. Respiration: check for respiratory compromise

-not breathing after reposition airway = BLACK

< 30 breaths/minute = RED

> 30 breaths/minute = CONTINUE

3. Perfusion (pulse, circulation): radial pulse check

-weak, irregular or no radial pulse = RED

-strong radial pulse = CONTINUE

4. Mental Status

-fails to follow simple commands (mental status altered) = RED

- follows simple commands = YELLOW


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Secondary Triage

1. Once resources are available and patients are transported to

treatment area, secondary triage begins.

2. In- depth reassessment

Triage tags used. Called METTAGS. Used to indicate

triage category and specific injuries or vital signs.

3. Ongoing in treatment area

4. May change categories


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Special Triage Situations

1. Injured rescuer

- Automatic Red

2. Hysterical patient or bystander

- Receives higher then usual priority

3. Child

- Receive higher category. If possible they should be transportedwith parent. Check cap-refill in children.

4. Lowered body temp in outdoor environment (hypothermia)

- Hypothermic patients change to high priority


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Triage of the Patient with multiple injuries

1. - Golden hour: average amount of time that elapses before a

patient with serious or multiple injuries starts to deteriorate rapidly.

For every 30 minute period after the Golden Hour, the patients

chances of survival are cut in half.

- be knowledgeable

- work quickly and efficiently

- establish priorities and improvise when necessary

2. Remember ABCs, then tackle blood loss

3. Long backboard to splint extremity fracture of speed transport

4. EXCEPTION Femur fracture: site should be treated seperately

with a traction splint.


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Purpose: to control, coordinate and direct emergency

responders and resources

1. Call incident command system

2. Design to be used in daily operations

3. Effective at mass casualty incidents

4. Use with >1 patient and events that stretch resources and

equipment to limits

5. Types of out door incidents that might require it

- chair lifts, ice, rock, mountain climbing, river rafting

and avalanche


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Emergency Operations Plan

1. Well designed2. Well practices

3. Coordinated with local EMS and others

Typical Plan

Command Center

Run by area manager

Extrication

Triage Area

Treatment Area

Supply Area

Transportation Area

Rehabilitation Area


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Multiple casualty exercise

exercise #1

*Patients states he cant move or feel his legs

*Respiration26*Pulse 110 (radial)

*He is awake and oriented

*WHAT TRIAGE CATEGORY


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exercise #2

*Patient is soaked with blood no obvious

killer blood

*Respiration38

*Pulse is weak, no radial

*He is awake*WHAT TRIAGE CATEGORY


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exercise #3

*Patient walk over to you and has an obvious

fracture arm

*Respiration22

*Pulse 124 (radial)

*He is awake, alert and crying*WHAT TRIAGE CATEGORY


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exercise #4

*Patient is face down in the field

* not breathing

*weak carotid pulse

*She is unresponsive

*WHAT DO YOU DO FIRST


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exercise #5

*Patient gurgles but cant maintain an opens

airway and is not breathing

*weak carotid pulse

*unresponsive

*WHAT TRIAGE CATEGORY


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TRIAGE SHOULD BE DONE WITH THE

HEAD NOT THE HEART

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