start & jumpstart triage joe immermann, emt-p, bba with thanks to: joy erb moser, rn bsn cen joe...
TRANSCRIPT
START & JumpSTART Triage
START & JumpSTART Triage
Joe Immermann, EMT-P, BBAWith thanks to:
Joy Erb Moser, RN BSN CEN
Aim of Triage…
Greatest Good for the Greatest Number
Aim of Triage…
Greatest Good for the Greatest Number
STARTSTART
START facilitates patient triage in 60 seconds or less
Assess Ventilation Perfusion Mental status
START facilitates patient triage in 60 seconds or less
Assess Ventilation Perfusion Mental status
STARTSTART
Correct Life Threats Correct Life Threats
Blocked airways
Severe bleeding
Blocked airways
Severe bleeding
START AssessmentsSTART Assessments
1. Ambulation
2. Respirations
3. Perfusion
4. Mental status
1. Ambulation
2. Respirations
3. Perfusion
4. Mental status
RespiratoryRespiratory
Check ventilation rate and adequacy
Check for foreign objects causing airway obstruction
Reposition to open airway
Check ventilation rate and adequacy
Check for foreign objects causing airway obstruction
Reposition to open airway
PerfusionPerfusion
Check capillary refill in nail beds or
Palpate radial pulse
Check capillary refill in nail beds or
Palpate radial pulse
Mental StatusMental Status
Ask patient to follow simple commands
Open and close eyes
Touch finger to nose
Ask patient to follow simple commands
Open and close eyes
Touch finger to nose
GreenGreen—Minor/Ambulatory
RedRed—Immediate
YellowYellow—Delayed
Black—Dead or
nonsalvageable
GreenGreen—Minor/Ambulatory
RedRed—Immediate
YellowYellow—Delayed
Black—Dead or
nonsalvageable
Triage CategoriesTriage Categories
Separate from the general group at the beginning of the triage operation. (“Walking wounded”)
Direct patients away from the scene to a designated safe area.
Consider using these patients to assist in treatment of those patients tagged as immediate.
Separate from the general group at the beginning of the triage operation. (“Walking wounded”)
Direct patients away from the scene to a designated safe area.
Consider using these patients to assist in treatment of those patients tagged as immediate.
Minor (GREEN)Minor (GREEN)
Ventilations present only after repositioning the airway.
Respiratory rate greater than 30 per minute.
Delayed capillary refill (> 2 seconds)
Unable to follow simple commands.
Ventilations present only after repositioning the airway.
Respiratory rate greater than 30 per minute.
Delayed capillary refill (> 2 seconds)
Unable to follow simple commands.
Immediate (RED)Immediate (RED)
Any patient who does not fit into either the immediate or minor categories.
Any patient who does not fit into either the immediate or minor categories.
Delayed (YELLOW)Delayed (YELLOW)
No ventilations present even after attempting to reposition the airway.
No ventilations present even after attempting to reposition the airway.
Deceased (BLACK)Deceased (BLACK)
Results in less over-triage by acknowledging differences in kids.
Addresses the emotional burden of tagging a child as “deceased” by allowing two extra steps.
Results in less over-triage by acknowledging differences in kids.
Addresses the emotional burden of tagging a child as “deceased” by allowing two extra steps.
JumpSTARTJumpSTART
If the victim looks like a child, use JumpSTART. If the victim looks like
a young adult, use START.--Dr. Lou Romig
If the victim looks like a child, use JumpSTART. If the victim looks like
a young adult, use START.--Dr. Lou Romig
Pediatric MCI PatientsPediatric MCI Patients
Not all children can walk
Respiratory rates may be normal at > 30/minute
Capillary refill influenced by environment
Obey commands? Kids??
Not all children can walk
Respiratory rates may be normal at > 30/minute
Capillary refill influenced by environment
Obey commands? Kids??
Pediatric MCI PatientsPediatric MCI Patients
If breathing spontaneously, go on to the next step: assessing respiratory rate.
If apneic or with very irregular breathing, open the airway using standard positioning technique.
If positioning results in resumption of spontaneous respirations, tag the patient REDRED and move on.
If breathing spontaneously, go on to the next step: assessing respiratory rate.
If apneic or with very irregular breathing, open the airway using standard positioning technique.
If positioning results in resumption of spontaneous respirations, tag the patient REDRED and move on.
Breathing?Breathing?
Physiological reason to believe an apneic child may still have a pulse.
Physiological reason to believe an apneic child may still have a pulse.
Pulse Check: Apneic ChildPulse Check: Apneic Child
If no breathing after airway opening, check for peripheral pulse (child may retain pulse while apnic longer than adult).
If no pulse, tag patient BLACK and BLACK and move on.move on.
If no breathing after airway opening, check for peripheral pulse (child may retain pulse while apnic longer than adult).
If no pulse, tag patient BLACK and BLACK and move on.move on.
Pulse Check: Apneic ChildPulse Check: Apneic Child
Provide 5 breaths with a mouth-to-barrier device.
If breathing returns, child is tagged as REDRED (Immediate).
If no spontaneous respirations return, the child is tagged BLACK.
Provide 5 breaths with a mouth-to-barrier device.
If breathing returns, child is tagged as REDRED (Immediate).
If no spontaneous respirations return, the child is tagged BLACK.
Pulse PresentPulse Present
Check respiratory rate:
<15 or > 45 are considered critical: tag patients as RED
Respiratory rate between 15-45: Check pulse
Check respiratory rate:
<15 or > 45 are considered critical: tag patients as RED
Respiratory rate between 15-45: Check pulse
Spontaneous RespirationsSpontaneous Respirations
Children with spontaneous respirations but no palpable pulse
(in the least injured limb) are tagged Immediate (RED).
Children with spontaneous respirations but no palpable pulse
(in the least injured limb) are tagged Immediate (RED).
Quick AVPU:
Alert (YELLOWYELLOW)
Verbal Stimuli (YELLOWYELLOW)
Physical Stimuli (YELLOWYELLOW))
Unconscious (RED)
Quick AVPU:
Alert (YELLOWYELLOW)
Verbal Stimuli (YELLOWYELLOW)
Physical Stimuli (YELLOWYELLOW))
Unconscious (RED)
Mental Status Assessment Mental Status Assessment
Infants who normally can’t walk yet
Children with developmental delay
Children with acute injuries preventing them from walking
Children with chronic disabilities
Infants who normally can’t walk yet
Children with developmental delay
Children with acute injuries preventing them from walking
Children with chronic disabilities
Non-Ambulatory Patient ModificationsNon-Ambulatory Patient Modifications
Non-Ambulatory Patient ModificationsNon-Ambulatory Patient Modifications
Evaluate with JS algorithm
If REDRED criteria, tag as RED.
If YELLOWYELLOW criteria, assess for external signs of significant injury.
If no significant external signs, tag as GREENGREEN.
If significant external sign of injury are found, tag as YELLOWYELLOW.
Evaluate with JS algorithm
If REDRED criteria, tag as RED.
If YELLOWYELLOW criteria, assess for external signs of significant injury.
If no significant external signs, tag as GREENGREEN.
If significant external sign of injury are found, tag as YELLOWYELLOW.
Unless clearly suffering from injuries incompatible with life, victims tagged in the BLACK
category should be reassessed once critical interventions have been completed for REDRED and
YELLOWYELLOW patients.
Unless clearly suffering from injuries incompatible with life, victims tagged in the BLACK
category should be reassessed once critical interventions have been completed for REDRED and
YELLOWYELLOW patients.
Deceased (BLACK) PatientsDeceased (BLACK) Patients
Apneic children are rapidly assessed for sustained circulation.
Apneic children with circulation receive a brief ventilatory trial as an additional airway opening and stimulating maneuver.
Respiratory rates are adjusted. (15-30-45)
Peripheral pulse is substituted for cap refill.
AVPU is used to assess mental status.
Apneic children are rapidly assessed for sustained circulation.
Apneic children with circulation receive a brief ventilatory trial as an additional airway opening and stimulating maneuver.
Respiratory rates are adjusted. (15-30-45)
Peripheral pulse is substituted for cap refill.
AVPU is used to assess mental status.
START/JumpSTART DifferencesSTART/JumpSTART Differences
Unresponsive
RR—36/min
No airway obstruction
CRT > 4 seconds
TRIAGE: GreenGreen//RedRed//YellowYellow/Black
Unresponsive
RR—36/min
No airway obstruction
CRT > 4 seconds
TRIAGE: GreenGreen//RedRed//YellowYellow/Black
Patient #1: Tammy TeacherPatient #1: Tammy Teacher
RR > 48/min
Weak pulse
Responds to pain
TRIAGE: GreenGreen//RedRed//YellowYellow/Black
RR > 48/min
Weak pulse
Responds to pain
TRIAGE: GreenGreen//RedRed//YellowYellow/Black
Patient #2: Pre-School PaulaPatient #2: Pre-School Paula
No Respiratory effort
Faint pulse
Unresponsive
TRIAGE: GreenGreen//RedRed//YellowYellow/Black
No Respiratory effort
Faint pulse
Unresponsive
TRIAGE: GreenGreen//RedRed//YellowYellow/Black
Patient #3: Pre-School SamPatient #3: Pre-School Sam
Patient # 4: Tom TeacherPatient # 4: Tom Teacher
Ambulated to curb, holding Jenny & Libby
RR—28/min
CRT 2 seconds
Alert; following commands
TRIAGE: GreenGreen//RedRed//YellowYellow/Black
Ambulated to curb, holding Jenny & Libby
RR—28/min
CRT 2 seconds
Alert; following commands
TRIAGE: GreenGreen//RedRed//YellowYellow/Black
Patient # 5: P.S. JennyPatient # 5: P.S. Jenny
Held by Tom Teacher
Crying for “Mommy”
RR—38/min
Pulse present
Clinging to Tom
TRIAGE: GreenGreen//RedRed//YellowYellow/Black
Held by Tom Teacher
Crying for “Mommy”
RR—38/min
Pulse present
Clinging to Tom
TRIAGE: GreenGreen//RedRed//YellowYellow/Black
Patient # 6: P.S. LibbyPatient # 6: P.S. Libby
Held by Tom Teacher
RR—32/min
Pulse present
Responds to verbal & tactile stimuli
TRIAGE: GreenGreen//RedRed//YellowYellow/Black
Held by Tom Teacher
RR—32/min
Pulse present
Responds to verbal & tactile stimuli
TRIAGE: GreenGreen//RedRed//YellowYellow/Black
Patient # 7: P.S. MikeyPatient # 7: P.S. Mikey
RR—28/min
Palpable pulse
Responds to tactile stimulation
TRIAGE: GreenGreen//RedRed//YellowYellow/Black
RR—28/min
Palpable pulse
Responds to tactile stimulation
TRIAGE: GreenGreen//RedRed//YellowYellow/Black
Patient # 8: P.S. LucasPatient # 8: P.S. Lucas
RR—8/min
Pulse weak
Unconscious
TRIAGE: GreenGreen//RedRed//YellowYellow/Black
RR—8/min
Pulse weak
Unconscious
TRIAGE: GreenGreen//RedRed//YellowYellow/Black
Patient # 9: P.S. AshleyPatient # 9: P.S. Ashley
RR—36/min
No palpable pulse
TRIAGE: GreenGreen//RedRed//YellowYellow/Black
RR—36/min
No palpable pulse
TRIAGE: GreenGreen//RedRed//YellowYellow/Black
Patient # 10: P.S. TroyPatient # 10: P.S. Troy
Crying for Teacher; walked to Tom
RR—30/min
Pulse present
Scared of EMT
TRIAGE: GreenGreen//RedRed//YellowYellow/Black
Crying for Teacher; walked to Tom
RR—30/min
Pulse present
Scared of EMT
TRIAGE: GreenGreen//RedRed//YellowYellow/Black