TRIAGE

• mass- casualty or multi- casualty incident• Involves >1 patient or situation that places great demand

on resources (stretched to limit)• Triage is the sorting of two or more patients based on the

severity of their conditions to establish priorities for care based on available resources

• Scene Safety1. Size of hazard area2. Safe and sheltered location to move patients3. Self- protective measures

THE TRIAGE PROCESS

A. Sort patients to provide the best outcome for the GREATEST 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

C. The 5 S’s1. 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

D. Triage Priorities

1. Red- highest priority patients

need immediate care (usually circulatory or respiratory)

2. Yellow- second highest priority

able to wait longer before transport (45 minutes)

3. Green- walking

able to wait several hours for transport

4. Black- dead

will die during emergency care (have lethal injuries)

*** mark triage priorities (tape, tag)

Triage Category: Red

• Red (Highest) Priority: Patients who need immediate care and transport as soon as possible

• Airway and breathing difficulties

• Uncontrolled or severe bleeding

• Decreased level of consciousness

• Severe medical problems

• Shock (hypoperfusion)

• Severe burns

Triage Category: Yellow

• Yellow (Second) Priority: Patients whose treatment and transportation can be temporarily delayed

• Burns without airway problems

• Major or multiple bone or joint injuries

• Back injuries with or without spinal cord damage

Triage Category: Green

• Green (Low) Priority: Patients whose treatment and transportation can be delayed until last

• Minor fractures• Minor soft-tissue

injuries

Triage Category: Black

• Black (Lowest) Priority: Patients who are already dead or have little chance for survival. If resources are limited, treat salvageable patients before these patients

• Obvious death• Obviously

nonsurvivable injury, such as major open brain trauma

• Full cardiac arrest

TRIAGE TECHNIQUESSTARTSimple

Triage

And

Rapid

Treatment

* In initial START Assessment mark with triage ribbons, 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

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

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

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 transported with parent. Check cap-refill in children.

4. Lowered body temp in outdoor environment (hypothermia)

- Hypothermic patients change to high priority

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 patient’s 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.

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

Emergency Operations Plan

1. Well designed

2. 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