Transcript START

Simple Triage and Rapid Treatment
Immediate
Patients
Delayed
Deceased
John P. Frey, LP
Objectives
 Define START and MCI
 Identify the need for START
 Learn the START Algorithm
 Learn how to effectively use START
Immediate
Patients
Delayed
Deceased
What Problems Might We Find?
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What is an MCI
 An event that produces more patients
than you have medics
 Produces minimal casualties but has
unusual events surrounding the
incident
 HazMat, Rail, Aircraft, Marine
 Effects local hospitals ability to
adequately treat patients
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Elements of an Command System
 Unified command
 Limited span of control
 Clear chain of command
 Line and staff functions
 Intelligence gathering
 Flexibility
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Incident Command System (ICS)
ICS is a system of establishing command
and control of an emergency incident
Command
Treatment
Triage
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Transport
Staging
Qualities of a Great Commander
 All knowing
 Forceful, yet sensitive
 Totally calm under fire
 Likes dogs and small children
 Free of impure thoughts
 Brave, clean, honest, trustworthy
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So..Who’s In Charge?
 First Responder
 EMS
 Supervisor
 Line Officer
 Chief
 Governmental Official
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First Responders Responsibility
 One member becomes
“Command”
 Other members starts the
Triage process
 Start calling for any additional
resources that you think you
will need
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Triage
 French for “sorting” or “to sort”
 A process for determining who to
treat and transport first in the case
of a multi casualty incident (MCI)
 Refined during the Vietnam
conflict by military medics
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What is START?
START is an acronym for Simple Triage
And Rapid Treatment
It is a simple step-by-step triage and
treatment method to be used by the first
rescuers responding to a multi casualty
incident. It allows these rescuers to
identify victims at greatest risk for early
death and to provide basic stabilization
maneuvers
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Why START?
 Medically responsible
 Easily learned
 Easily remembered
 Clear-cut decision process
 Relies only on BLS skills
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3rd Law of the House of God
In cases of cardiac arrest (or triage), the first
thing you do is check your own pulse!
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Your First Action
If you can walk, go stand over there!
All of Ya’ll, go over there! (Texas version )
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The Next Step
 Take a DEEP breath
 Ensure that your scene is safe
 Start to triage all patients that
were unable to move
 Spend about 60 seconds/patient
 Put triage tag on and note group
 Move to the next patient
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START Algorithm (Airway/Breathing)
RESPIRATIONS/VENTILATIONS
NONE
YES
REPOSITION AIRWAY
ASSESS RESPIRATIONS/VENTILATIONS
NONE
YES
> 30/MINUTE
DECEASED
IMMEDIATE
IMMEDIATE
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<30/MINUTE
ASSESS
PERFUSION
START Algorithm (Circulation)
PERFUSION
<2 SECONDS
ASSESS
MENTAL STATUS
> 2 SECONDS
CONTROL
BLEEDING
IMMEDIATE
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START Algorithm (Disability)
MENTAL STATUS
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FOLLOWS
SIMPLE
COMMANDS
FAILS TO FOLLOW
SIMPLE
COMMANDS
DELAYED
IMMEDIATE
Triage Tags (front)
TRANSPORTATION OFFICER
NAME______________________
AMBULANCE _______________
HOSPITAL __________________
PRIORITY-1
2
10945
NAME
AGE
MALE
FEMALE
MEDICATION/TIME:
________________________________
________________________________
________________________________
________________________________
________________________________
10945
Immediate
Patients
IMMEDIATE
10945
DELAY
10945
Delayed
Deceased
Triage Tag (back)
Immediate
IMMEDIATE
Patients
Delayed
DELAY
Deceased
Other Triage ID Methods
 Different tags
 Bracelets
 Duct tape
 Survey tape
 Marker on forehead
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After Primary Triage
 Move to secondary triage
 Provide primary treatment
 Complete triage tags
 Call for necessary transport
 Continue to reassess patients
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Field Triage
 Primary Triage (Triage)
 Implement START
 Immediate, life saving care
 Secondary Triage (Treatment)
 Document information on triage tags
 Provide medical treatment
 Tertiary Triage (Transport)
Immediate
Patients
 Transport patients
Delayed
Deceased
Example 1
 57 year old female complaining of
chest pain. Respirations 24,
capillary refill 3 seconds,
responds to all verbal commands
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Triage Tags
TRANSPORTATION OFFICER
NAME______________________
AMBULANCE _______________
HOSPITAL __________________
PRIORITY-1
2
10945
NAME
AGE 57
MALE
FEMALE X
MEDICATION/TIME:
________________________________
________________________________
________________________________
________________________________
________________________________
10945
Immediate
IMMEDIATE
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Delayed
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10945
Example 2
 24 Year old male, with a 3’ pole
impaled through his abdomen,
respirations 28, capillary refill <2
seconds, responds to all
commands
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Example 2 Tag
TRANSPORTATION OFFICER
NAME______________________
AMBULANCE _______________
HOSPITAL __________________
PRIORITY-1
2
10945
NAME
AGE 24
MALE X
FEMALE
MEDICATION/TIME:
________________________________
________________________________
________________________________
________________________________
________________________________
10945
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Patients
IMMEDIATE
10945
DELAY
10945
Delayed
Deceased
Example 2 Tag (back)
Immediate
IMMEDIATE
Patients
Delayed
DELAY
Deceased
Example 3
 3 year old child with no obvious
injury. No respirations, capillary
refill 6 seconds, unconscious
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Example 3 Tag
TRANSPORTATION OFFICER
NAME______________________
AMBULANCE _______________
HOSPITAL __________________
PRIORITY-1
2
10945
NAME
AGE 3
MALE X
FEMALE
MEDICATION/TIME:
________________________________
________________________________
________________________________
________________________________
________________________________
10945
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Other MCI Concerns
 What caused (or is causing) the
problem?
 Medical Supplies
 Communications
 Transportation
 Media Coverage
 Crowd Control
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What’s Causing the Problem?
 Was it an acute event?
 Is it still occurring?
 Are we in a safe area?
 Is a chemical involved?
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Texas A&M Bonfire Collapse
 November 18, 1999
 2:30 AM bonfire stack collapsed
 150 people believed to be on bonfire site
at time of collapse
 As stack collapsed, all lighting was
pulled down leaving the area in total
darkness
 First Responders reported hearing
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screaming in the darkness
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First Responder Actions
 Immediate call for additional help
with description of bonfire collapse
 Dispatch issued a MCI and paged all
personnel as well as CSFD and BFD
and Texas Fire Training Center
resources. MCHD ambulances
requested as well.
 Fire Department and TxDot light
trucks were immediately called for
 Triage started by flashlight
Triage Actions
 START was used immediately
 Separate Triage areas established
early to isolate patients needing triage
 All site resources used the ICS system
for unified incident command.
Command was ultimately run by DPS.
 Texas Task Force 1 (FEMA) was
mobilized for specialty rescue
 Mobile morgue was sent to site
As the Sun Came Up
Final Outcome
 All recoverable patients triaged and
transported in less than 1 hour
 Last bodies recovered about 20 hours
after the collapse
 27 patients injured, 12 killed
 Investigative committees universally
credited first responders with saving
many lives
So....How does this apply to me?
 Major incidents can occur
 First responders are generally involved in
these incidents
 Most responders face few large incidents
in their career
 Preparation is the key to successful
handling of these incidents
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START Card
WALKING WOUNDED - Walks
and follows commands
IMMEDIATE - Respirations
greater than 30; capillary refill 2
sec's or longer; mental
confusion or no response
START Triage Steps:
1. “If you can get up and walk,
follow me”
2. Respiration
Perfusion
DELAYED - Cannot walk;
respirations less than 30; Cap
refill less than 2 sec's; responds
to questions
Mental Status
3. “Thirty and two, can do”
DECEASED - Patient with no
respirations after one attempt to
manually establish an airway
Front
Back
Additional Resources
 The EMS Incident
Management System,
Christen/Maniscalco (Brady)
 START Training Manual Texas
Department of Health
 http://www.tdh.state.tx.us/hcqs/
ems/startman.exe
Questions