curso triage
DESCRIPTION
presentación en ingles par explicar los fundamentos del triageTRANSCRIPT
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Maryland MarylandTriageTriageSystemSystem
MIEMSS 1999
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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
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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
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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
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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.
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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
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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
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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
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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
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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
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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
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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
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Vital Signs Section
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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
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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
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Treatment Record Layout
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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.
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Establishing the System
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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
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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
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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
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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
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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
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During Initial TriageUse Ribbons Only
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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
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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
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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
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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
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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
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Tracking Patient Flow
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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
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Treatment UnitCoordinator
ll Attach Tag To RibbonAttach Tag To Ribbon & Circle Priority at & Circle Priority at Initial Assessment Initial Assessment
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Treatment UnitCoordinator
ll Remove Remove TreatmentTreatmentPeel-off LabelPeel-off Label
ll Place on Place on Treatment Treatment LogLog
ll Note TimeNote Time
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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
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Treatment Area Managersll Log Patient Into Area &Log Patient Into Area &
Take Take Other Other Label Label
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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
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Transportation GroupSupervisor
Is Responsible For. . .
ll LoadingLoading
ll Assigning Disposition &Assigning Disposition &CommunicationCommunicationCoordinatorsCoordinators
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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
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Loading
ll Tear Off Transportation Tickets and Hand toTear Off Transportation Tickets and Hand toDriverDriver
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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
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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
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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
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Disposition Coordinator
ll Discuss Next Available Hospital, AppropriateDiscuss Next Available Hospital, Appropriatefor Patients, With Communication Coordinatorfor Patients, With Communication Coordinator
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Funding Provided By
Maryland Department ofTransportation
State Highway Administration
Maryland Institute forEmergency Medical Services
Systems
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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
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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
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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