Transcript Terrorism & EMS

MCI Triage:
A “Cure”
For A MASSive
Headache
Texas EMS Conference 2008
Ronna G. Miller, MD
EMS/Disaster Medicine/Homeland Security Section
UT Southwestern Department of Surgery
[email protected]
TX EMS 2008
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The Fine Print
 Successful completion of this activity is based upon your
attendance for the entire presentation.
 The presenter has no commercial support, or other affiliations
relating to a possible conflict of interest to disclose.
 There will be no discussion of off-label usage or product
endorsement during this course.
 The content of this presentation is designed for educational
purposes only.
 The author has made every effort to verify the information
presented, but neither the accuracy nor the completeness of this
information can be guaranteed.
 The participant assumes all risks in using the information.
 The author shall not be held responsible for errors or omissions
or held liable for any damages incurred as a result of use or
reliance upon the material presented.
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Objectives
Define “MCI” and “Triage”
Discuss goals of MCI triage
Perform simulated “MASS” Triage
Classify simulated MCI victims by “ID-me”
categories
Describe life-saving interventions during MCI
victim triage
Identify specific all-hazards triage concerns
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The Plan
Brief questionnaire
Interactive mass cal simulation: Part 1
Didactic presentation
Interactive mass cal simulation: Part 2
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Question 1
 Which of the following best describes you?
A.
B.
C.
D.
E.
F.
G.
ECA
EMT-B
EMT-I
EMT-P
Physician
RN
Other
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Question 2
 Which best describes the geographical
area where you work?
A.
B.
C.
D.
E.
Rural
Suburban
Urban (city < 100,000)
Urban (city ≥ 100,000)
None of the above
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Question 3
 Which one of the following is your primary
type of EMS/healthcare service?
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
Rural EMS (non-transporting)
Rural EMS (transporting)
Urban-Fire/EMS
Urban-”Third Service” EMS
Aeromedical
Interfacility Transport Only
Hospital-Based
Student
Retired
Other
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Question 4
 How long have you worked in
EMS/healthcare?
A.
B.
C.
D.
E.
Less than 2 years
2 to 5 years
5 to 10 years
10 to 15 years
More than 15 years
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Question 5
 Have you ever had formal classroom
training in mass casualty triage?
A. Yes
B. No
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Question 6
 Have you ever participated in a handson mass casualty simulation or drill in
which you triaged “victims”?
A. Yes
B. No
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Question 7
 Have you ever had to triage patients in
an actual mass casualty incident?
A. Yes
B. No
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Question 8
 If yes, what triage method or system did
you use during that incident?
A. I answered “No” to Question 7
B. MASS
C. START
D. SAVE
E. Sacco®
F. Military
G. Other
H. Don’t Know
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Question 9
 If yes, did you feel confident in your
triage decisions during that incident?
A. I answered “No” to Question 7
B. Yes
C. No
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Question 10
 Did you participate in relief efforts to
provide medical care to evacuees after
Hurricanes Katrina or Rita?
A. Yes
B. No
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Question 11
 Is knowing how to perform mass
casualty triage part of your
professional responsibilities?
A. Yes
B. No
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Question 12
 What is the likelihood, in your opinion, that
you would ever be called upon to perform
mass casualty triage in the future?
A. Very likely
B. Likely
C. Neutral
D. Unlikely
E. Very unlikely
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Question 13
 If there were an explosion at this location
right now, how confident are you that you
would be able to rapidly and accurately
triage victims?
A. Very confident
B. Somewhat confident
C. Neutral
D. Somewhat unsure
E. Very unsure
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Let’s Begin!
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Victim 1
 Into which category would you triage
this patient?
C.
IMMEDIATE
DELAYED
MINIMAL
D.
EXPECTANT
A.
B.
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Victim 2
 Into which category would you triage
this patient?
C.
IMMEDIATE
DELAYED
MINIMAL
D.
EXPECTANT
A.
B.
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Victim 3
 Into which category would you triage
this patient?
C.
IMMEDIATE
DELAYED
MINIMAL
D.
EXPECTANT
A.
B.
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Victim 4
 Into which category would you triage
this patient?
C.
IMMEDIATE
DELAYED
MINIMAL
D.
EXPECTANT
A.
B.
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Victim 5
 Into which category would you triage
this patient?
C.
IMMEDIATE
DELAYED
MINIMAL
D.
EXPECTANT
A.
B.
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Victim 6
 Into which category would you triage
this patient?
C.
IMMEDIATE
DELAYED
MINIMAL
D.
EXPECTANT
A.
B.
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Victim 7
 Into which category would you triage
this patient?
C.
IMMEDIATE
DELAYED
MINIMAL
D.
EXPECTANT
A.
B.
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Victim 8
 Into which category would you triage
this patient?
C.
IMMEDIATE
DELAYED
MINIMAL
D.
EXPECTANT
A.
B.
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Victim 9
 Into which category would you triage
this patient?
C.
IMMEDIATE
DELAYED
MINIMAL
D.
EXPECTANT
A.
B.
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Victim 10
 Into which category would you triage
this patient?
C.
IMMEDIATE
DELAYED
MINIMAL
D.
EXPECTANT
A.
B.
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Victim 11
 Into which category would you triage
this patient?
C.
IMMEDIATE
DELAYED
MINIMAL
D.
EXPECTANT
A.
B.
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Victim 12
 Into which category would you triage
this patient?
C.
IMMEDIATE
DELAYED
MINIMAL
D.
EXPECTANT
A.
B.
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MCI Triage:
A “Cure”
For A MASSive
Headache
Texas EMS Conference 2008
Ronna G. Miller, MD
EMS/Disaster Medicine/Homeland Security Section
UT Southwestern Department of Surgery
[email protected]
TX EMS 2008
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This is NOT a good thing!
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“Why Am I Here?”
How do I decide who receives care
now and who does not?
In a disaster, needs exceed resources
More patients than providers
Difficult choices must be made
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1942, Boston, MA
492 dead
2003, Warwick, RI
100 dead
IS TRIAGE NEEDED HERE?
Boston Globe
AP Photo
AP Photo
Boston Globe
AP photo: Matt Slocum
www.masada2000.org
September 23, 2005
Wilmer, TX
“Triage Typically Means “Trauma””
August 2, 1985
Dallas, TX
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Add Photos
London?
Madrid?
LA train?
NYC crane?
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What About Medical Triage?
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Triage:
“It’s not in my job description!”
http://www.ahrq.gov/prep/cbrne/
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Business As Usual
Resources exceed demand
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The “Perfect World” of MCI
Response
First responders respond to scene
Patients are triaged in the field
HazMat handles decon in the field
Sickest patients arrive with EMS:
 Already sorted and tagged
 Already decontaminated
 Already partially treated
Hospitals “only” need to care for them...
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What REALLY Happens...
 “Chaotic” phase: 15-25 min
 No EMS, no scene leader
 80% of minimally injured selftransport
 They arrive at closest
hospitals:
 NO TRIAGE
 NO DECONTAMINATION
 NO MEDICAL
INTERVENTION
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Mass Casualty Predictor
http://www.bt.cdc.gov/masscasualties/predictor.asp
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Another Awful Thought...
Hospital as “Hot Zone”
Or....
It’s your “off” day
Or…
Flu Pandemic, Bioterrorism…
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Definitions
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MCI: Definition
Mass Casualty Incident
Major Casualty Incident
Multiple Casualty Incident
Healthcare needs exceed resources!
Resources must be rationed!
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Adapted from Heightman AJ (2006). JEMS 31(4):16.
Your Own Safety Comes First!
We all want to help
Triage is an important part
However, your first priority is to
PROTECT YOURSELF!
You don’t need to die!
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Before Any Casualty Care...
“Scene Size-Up” – “Scene Safety”
Incident Survey BEFORE Casualty Survey
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“RED Survey”
“Rapid Evaluation of Disaster”
 Incident
Survey
 BEFORE
patient care!
 Casualty
Survey
 Life-saving Interventions
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All-Hazards: Definition
Man-made or natural events with destructive
capability for multiple casualties
Graniteville, SC – January 2005
La Conchita, CA – January 2005
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“All-Hazards” Examples
Natural
Man-made
Earthquakes
Landslides & Avalanches
Volcanoes
Tornadoes
Hurricanes
Floods & Flash Floods
Tsunamis
Wildfires
Emerging Infectious Diseases
Structure Fires
Structure Collapses
Explosive Devices
Transportation Events:
Air, Rail, Roadway, Water
Industrial HazMat Events
Terrorism Incidents:
CBRNE events, Firearms
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Triage: Definition
Sorting of patients
by seriousness of
condition and
likelihood of
survival
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www.learnovation.com
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Triage Levels
 Primary (scene & hospital)

Physiology:


Can patient use his own resources to deal w/injuries?
Which conditions will benefit from use of scarce resources?
 Secondary (scene & hospital)

Match patients’ current & anticipated needs with available
resources

Physiology, Physical Assessment, Initial Treatment &
Reassessment, Knowledge of Resource Availability
 Tertiary (hospital)

Optimize individual outcome

Higher-level Treatment & Reassessment, Further Resource
Assessment, Determination of Best Venue for Definitive Care
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Triage: History
“Trier”: French for “to sort”
18th century European battlefields
Original military goal:

Return to combat as many soldiers as possible
http://nmhm.washingtondc.museum/
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Triage: Goals
 Primary Goal:
 Greatest
good for the greatest
number of possible survivors:
maximize survival
Secondary Goals:
 Relief
of suffering
 Efficient resource allocation
Depend on available resources
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Factors That Impact Resource
Availability
Volume and severity of patients
Limited numbers of providers
Infrastructure limitations
Inadequate hazard preparation (HAZMAT,
etc.)
Limited transport capabilities
Multiple-jurisdictional response
Lack of hospital surge capacity
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Triage Systems
Multiple triage systems in use
Various methods using tags, categories,
colors, symbols
Familiarize yourself with your agency’s
system and PRACTICE it
IDEAL = one uniform system used by all
agencies in the field & at hospitals
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Why Triage?
System tool to bring order from chaos
Get care for those who need it most and
are most likely to benefit
Aids resource allocation
Objective framework for stressful &
emotional decisions
Increases provider efficiency &
effectiveness
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The “Ideal” Triage System?
Simplicity
Easy to remember
 Easy to use

Objectivity
Accuracy
Ability to process large numbers of
victims
(Evidence-based)
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Underlying Parameters
Life, limb or vision threat
Level of medical intervention needed
(Access to transportation)
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Triage Process
GROUP
SORT
TRANSPORT
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“M.A.S.S.” Triage
M – Move
A – Assess
S – Sort
S – Send
www.triagetags.com
www.triagetags.com
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“M.A.S.S.” Triage
M – Move
A – Assess
S – Sort
S – Send
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“ID-me” Categories
I - IMMEDIATE
D - DELAYED
M - MINIMAL
E
EXPECTANT

EXPECTANT
LETHAL INJURY
D - DEAD
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“M.A.S.S.” Triage
Tested & used by the military
Adapted for civilian disasters
It works!
Fast
 Accurate
 Large numbers of victims

You needn’t be an “expert” to help!
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“M.A.S.S.” Triage
1. GROUP victims first...
2.
then....
SORT individual victims
then...
3. TRANSPORT
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Basis of “M.A.S.S.” Triage
Ability to move best predicts outcome
 Glasgow Coma Scale
 Motor
component
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“M.A.S.S.” Triage
“MOVE”: STEP 1
Goal:

Group - Victims who can WALK
Action:

“Everyone who can hear me and who
can walk, please move to the area
with the green flag.”
MINIMAL
Identifies:

MINIMAL group
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Why Bother with Them FIRST?
MINIMAL group: major vital functions intact
 Assess last, after more critical groups
However, actively managing this group may:



Facilitate scene management
Conserve scene resources
Reduce self-transports & overburdening of
nearest hospital ERs
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“M.A.S.S.” Triage
“MOVE”: STEP 2
Goal:

Group – Victims who can’t walk, but who can
MOVE
Action:

Ask the remaining victims “Everyone who
can hear me and needs help, please raise
an arm or leg so we can come help you.”
DELAYED
Identifies:

DELAYED Group
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“M.A.S.S.” Triage
“ASSESS”:
Goal:
Group – Identify who is left, victims unable
to walk & unable to follow simple
commands to move
Action:
Go immediately to these patients for lifesaving interventions (if medically trained)
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“M.A.S.S.” Triage
“ASSESS” IMMEDIATE patients:

Open Airway

Stop Bleeding
www.rk19-bielefeld-mitte.de
www.tpub.com

Give Chemical antidote
www.meridianmeds.com

Decompress TPtx
www.trauma.org
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“M.A.S.S.” Triage
“ASSESS” IMMEDIATE patients:

Open Airway
 Stop

Bleeding
Give Chemical antidote
Pressure Points
Whatever it takes! Be creative!
Tourniquets
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“M.A.S.S.” Triage
“ASSESS” IMMEDIATE patients:
Question:
Is transport available?
Move on!
www.usmc.mil/marinelink/mcn2000
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Victim Group Summary
Goal
Action
Group
ambulatory
patients
“Everyone who can
hear me and needs
medical attention, move
to the area with the
green flag”
Group awake, can
follow commands
“Everyone who can
hear me, raise an arm
or leg so we can come
help you”
Delayed
Identify who is left
Go immediately to
these patients for lifesaving interventions
Immediate
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ID-me
Group
Minimal
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In Other Words...
GREEN: “First Aid”, “DIY”
YELLOW: Get thee to a doctor soon
RED: Gonna’ die without immediate
care
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“ID-me” and NATO Categories
COLOR
“ID-me”
NATO
Priority
RED
Immediat
e
1
YELLOW
Delayed
2
GREEN
Minimal
3
BLACK
Expectant
DEAD
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Adapted from Heightman AJ (2006). JEMS 31(4):16.
ONLY NOW Do We Assess
Individuals
Having grouped victims according to
their ability to move...
...The next phase entails more detailed
individual assessment.
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“M.A.S.S.” Triage
“SORT”:
Goal:

Sort patients via INDIVIDUAL assessment
Actions:

Assign to “ID-me” Categories:


EXPECTANT
IMMEDIATE, DELAYED, MINIMAL,
Continue treatment
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“M.A.S.S.” Triage
“SORT”:
Ideally: trained medical personnel

May not be available
Begin with those who didn’t move
Tag immediately upon triage

Including dead victims
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There Are Many Different
Patient Assessment Tools
www.usmc.mil/marinelink/mcn2000
CERT L.A. 2003
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START
Triage
“R”
“P”
“M”
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START Mnemonic
R
P
M
30
2
Can Do
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START Limitations?
Do you have time to count RR for full
minute?
Can you measure CRT in the dark, in
the cold, or in a contaminated patient?
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Sacco Triage Method (STM)
http://www.sharpthinkers.com/abc/ts_approach_triss.htm
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Non-ambulatory
Non-moving
Simplified
Triage
Too fast?
Too slow?
Pulse (radial)
Palpable?
YES
(Already identified
&
grouped separately)
Respirations
Breathing?
YES
>6 & <30
MINIMAL
NO
Mental Status
Follows commands?
As needed:
Bleeding control
Chemical antidotes
Decompress chest
NO
Position airway
YES
IMMEDIATE
NO
EXPECTANT
NO
DELAYED
YES
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ATLS®
“Sift” and “Sieve”
Advanced Trauma Life Support for
Doctors – Student Course Manual
7th Edition
American College of Surgeons,
Chicago, IL, 2004
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BTLS/ITLS
BTLS, 5th Edition
Campbell JE
Brady – Prentice Hall,
New Jersey, 2004
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“M.A.S.S.” Triage
“SORT”:
Goal:
 Sort
patients based upon
INDIVIDUAL assessment
Actions:
 “ID-me”:

EXPECTANT
IMMEDIATE, DELAYED, MINIMAL,
DEAD
 Continue
,
treatment
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“M.A.S.S.” Triage
“SORT”:
Ideally: trained medical personnel

May not be available
Begin with those who didn’t move
Tag immediately upon triage

Including dead victims
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“ID-me” Categories
I - IMMEDIATE
D - DELAYED
M - MINIMAL
E
EXPECTANT

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EXPECTANT
LETHAL INJURY
93
“M.A.S.S.” Triage
“SORT” – IMMEDIATE:
 Life- or Limb-threatening injury
 Airway, Breathing or Circulation Problem
 Unconscious
 Examples:
 Unresponsive, altered level of consciousness,
severe breathing difficulty, uncontrollable
bleeding, amputations above elbow or knee,
cyanosis, rapid or weak pulse, open abdominal
wounds, etc.
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“M.A.S.S.” Triage
“SORT” – DELAYED:
Need definitive medical care, but should
not worsen rapidly, if initial care is delayed
Examples:
 Deep cuts or open fractures with
controlled bleeding and strong pulses,
finger amputations, abdominal injuries
with stable vital signs, closed head
injuries without altered LOC, etc.
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“M.A.S.S.” Triage
“SORT” – MINIMAL:
“Walking wounded”
Group, sort & facilitate transport from
scene
Volunteer help? Risk vs. Benefit
Examples:
 Abrasions, contusions, minor lacerations,
no apparent injuries
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“M.A.S.S.” Triage
“SORT” – EXPECTANT :
Most severely injured
Little chance of survival
“Expected” to die soon
In a perfect world, they would receive the
most care, even though chance of survival is
low
In an MCI....
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“M.A.S.S.” Triage
“SORT”
EXPECTANT
–
:
Care resources NOT utilized initially
Comfort care as available
 Death
could be hours or days away!
Reassessment & transport
 Transport
those still alive after all
IMMEDIATE victims evacuated
 Resuscitate & treat as resources allow
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“M.A.S.S.” Triage
“SORT” – EXPECTANT :
Examples:
Near 100 % TBSA burns
 Fatal radiation doses
 Apnea or pulselessness

 Especially
if multiple injuries
Severe open brain injury
 Death “imminent”

 “Judgment
call”
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Triage Category Summary
RED: life-threatening but treatable
YELLOW: potentially serious, but can
wait a while
GREEN: minor injuries can wait longer
BLACK: life signs present, but
“expected” to die under disaster
conditions
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Triage Caveats
OVER-TRIAGE:
Urge to classify all victims as IMMEDIATE
 Defeats the purpose!
 Ruptured eardrums, chronic hearing loss,
language barrier, developmental handicaps,
etc.
 Cannot respond to “MASS” commands

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Other Triage Caveats
UNDER-TRIAGE:
Initial grouping ≠ individual assessment
 Worsening patient conditions:

 Internal
or external bleeding, shock
 Closed head injury
 Blast injury to lung, gut, brain
 Airway swelling
 Delayed chemical exposure symptom onset
 Etc.
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“M.A.S.S.” Triage
“SORT” process is dynamic:
Resources change
 Patient conditions change

 Frequent


reassessment
 All categories
EXPECTANT may become IMMEDIATE
“Most serious” injury present demands
“immediate” attention!
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Triage Tags
Tag immediately after sorting
Tie triage tag directly to patient
 May need to improvise tags (tape, latex
gloves)
 May need to write on patient (lipstick,
marker)

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Wrapping up the SORT...
When all patients have been triaged
and tagged:
Count all IMMEDIATES
 Advise incident commander or transport
officer of number

Take all IMMEDIATES to collection
point for urgent transport
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“M.A.S.S.” Triage
“SEND”:
Objective:
 Transport or release
ALL living patients
ASAP
Traditional sequence:



IMMEDIATE
DELAYED
MINIMAL
EXPECTANT

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“M.A.S.S.” Triage
“SEND”:
Be mission-focused:

Send MINIMALS or DELAYEDS with each
IMMEDIATE, if space allows
Be resourceful:

Secondary treatment facilities for
MINIMALS
Be creative:

Buses, taxis, trains, boats, etc.
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The Need To Drill
Regardless of which triage
system your agency favors...
...Practice, practice, practice!

“TRIAGE TAG TUESDAY”
Preparation will promote
more efficient triage in an
actual MCI
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What About The DEAD?
Should NOT be moved or sent
 1 EXCEPTION?
Medical examiner / coroner:
Identification of remains
 Disposition of remains

Crime scene investigation:
Evidence must be preserved
 Apprehend perpetrators and prevent
future attacks

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Specific All-Hazards
Considerations
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Chemical Incidents
Issues:
Minute quantities can be rapidly fatal
 Risk of “off-gassing” and 2° contamination
 Delayed symptom onset for some

Implications:
PPE for healthcare providers
 ~ Simultaneous decon, triage and treatment

 Dry

decontamination removes 80-90%
If you think it might be, safest bet is to decon
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Capnography as Triage Tool
“... the only direct, non-invasive measure of
ventilatory status available to EMS crews...”
Rapid (15 seconds) indication of:



Hypoventilation, respiratory depression or failure
Laryngospasm, upper airway obstruction
Bronchospasm
 Krauss B (2005) Pediatric Emerg Care 21(8): 493
 Krauss B, Heightman AJ (2006) JEMS 31(6):
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Biological Incidents
Issues:
Person-to-person spread for some agents
 Non-specific “flu-like” symptoms
 Lengthy incubation periods

Implications:
Delayed detection likely
 “Triage” only once outbreak underway
 Healthcare providers may become victims

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Radiological Incidents
Issues:
 Covert
release likely
 Detection requires special equipment
 Symptom onset typically delayed
HOWEVER.....
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Radiation Risks for Healthcare
Providers
“A living patient cannot be so
radiologically contaminated as to
present an acute hazard to medical
personnel.”
Medical Management of Radiological Casualties, 2nd
edition. AFRRI, Bethesda, 2003, p. 94.
Download at: http://www.afrri.usuhs.mil
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Patient Care Implications
Limb- and life-saving
medical attention
should never be
delayed because of the
presence of
radioactive material
or contamination!
After 1st 24 hours,
radiation does matter
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Nuclear Incidents
Issues:
Most immediate fatalities 2° trauma, burns
 Massive dose needed for early symptoms

Implications:

Onset < 1-3 hr. post-exposure:
 Nausea/vomiting,
EXPECTANT
altered LOC, CNS symptoms
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Natural Disasters
Issues:
More common than terrorism
 Scene size may be enormous
 Massive infrastructure destruction:
hospitals
 Healthcare providers as victims

Implications:

Severely limited resources
 Equipment,
personnel, supplies, utilities
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Explosive & Bombing Incidents
Issues:
Still #1 terrorist modality
 4 Modes of Blast Injury
 1°blast injury (PBI): delayed onset
 Ruptured TMs in blast survivors

Implications:
Basic ABCs
 Frequent reassessment & re-triage

 Lung,
GI and brain
 Otoscope as triage tool
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When All Is Said and Done...
MCI Triage is NOT “business as usual”
“Standard of Care” vs. “Best Choices”
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“Gut Check” for
Healthcare Providers
Difficult decisions must be made
Fatalities and suffering are likely
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It’s NOT “Rocket Science”, either!
One need not be a “specialist”
 Identify,
collect and control
MINIMALS
& DELAYEDS
 Focus
first on those who most
need care and are most likely to
benefit from it!
IMMEDIATES
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Adapted from Heightman AJ (2006). JEMS 31(4):16.
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More Work Is Needed
National Standards
WMD & “All-Hazards” Incidents
“Medical” MCI Triage
Special Patients
Patient Tracking Systems
More Effective Hands-on Training
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Thank You!
Questions??
Let’s try it again!!
 Copyright © 2007 by Ronna G. Miller, MD
 All rights reserved. No part may be modified or distributed in any format without
written permission of the author.
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Victim 1
 Into which category would you triage
this patient?
A.
B.
C.
D.
IMMEDIATE
DELAYED
MINIMAL
EXPECTANT
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Victim 2
 Into which category would you triage
this patient?
A.
B.
C.
D.
IMMEDIATE
DELAYED
MINIMAL
EXPECTANT
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Victim 3
 Into which category would you triage
this patient?
A.
B.
C.
D.
IMMEDIATE
DELAYED
MINIMAL
EXPECTANT
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Victim 4
 Into which category would you triage
this patient?
A.
B.
C.
D.
IMMEDIATE
DELAYED
MINIMAL
EXPECTANT
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Victim 5
 Into which category would you triage
this patient?
A.
B.
C.
D.
IMMEDIATE
DELAYED
MINIMAL
EXPECTANT
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Victim 6
 Into which category would you triage
this patient?
A.
B.
C.
D.
IMMEDIATE
DELAYED
MINIMAL
EXPECTANT
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Victim 7
 Into which category would you triage
this patient?
A.
B.
C.
D.
IMMEDIATE
DELAYED
MINIMAL
EXPECTANT
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Victim 8
 Into which category would you triage
this patient?
A.
B.
C.
D.
IMMEDIATE
DELAYED
MINIMAL
EXPECTANT
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Victim 9
 Into which category would you triage
this patient?
A.
B.
C.
D.
IMMEDIATE
DELAYED
MINIMAL
EXPECTANT
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Victim 10
 Into which category would you triage
this patient?
A.
B.
C.
D.
IMMEDIATE
DELAYED
MINIMAL
EXPECTANT
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Victim 11
 Into which category would you triage
this patient?
A.
B.
C.
D.
IMMEDIATE
DELAYED
MINIMAL
EXPECTANT
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Victim 12
 Into which category would you triage
this patient?
A.
B.
C.
D.
IMMEDIATE
DELAYED
MINIMAL
EXPECTANT
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Now what do you think?
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Question 14
 Is knowing how to perform mass
casualty triage part of your
professional responsibilities?
A. Yes
B. No
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Question 15
 What is the likelihood, in your opinion, that
you would ever be called upon to perform
mass casualty triage in the future?
A. Very likely
B. Likely
C. Neutral
D. Unlikely
E. Very unlikely
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Question 16
 If there were an explosion at this location
right now, how confident are you that you
would be able to rapidly and accurately
triage victims?
A. Very confident
B. Somewhat confident
C. Neutral
D. Somewhat unsure
E. Very unsure
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The Newest Triage Method
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Contact Information
Ronna G. Miller, MD
Assistant Professor
EMS/Disaster Medicine/Homeland Security Section
Division of Emergency Medicine
Department of Surgery
UT Southwestern Medical Center at Dallas
5323 Harry Hines Blvd.
Dallas, Texas 75390-8890
Email: [email protected]
Voicemail: (214) 648-6881
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There must be a cookie here
somewhere!
Journal References
 Armstrong JH et al (2008). Toward a National Standard in
Primary Mass Casualty Triage. Disaster Med Public Health
Prep 2 Suppl 1:S8.
 Briggs S (2007). Triage in Mass Casualty Incidents:
Challenges and Controversies. Am J Disaster Med 2(2):57.
 Donohue D (2008). Medical Triage for WMD Incidents. JEMS
33(5):60.
 Goodloe JM, et al (2008). Big-Top Incident: Tulsa EMS
responds to tent collapse. JEMS 33(9):42.
 Heightman AJ (2006). Neutralize MCI Chaos. JEMS 31(4):16.
 Kraus B (2005). Capnography as a Rapid Assessment and Triage
Tool for Chemical Terrorism. Pediatric Emergency Care
21(8):493-7.
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Journal References – Cont’d.
 Robertson-Steel I (2006) Evolution of Triage Systems. Emerg
Med J 23:154-5. doi:10.1136/emj.2005.030270
 Sacco WJ, et al (2005) Precise Formulation and EvidenceBased Application of Resource-Constrained Triage. Academic
Emergency Medicine 12: 759-770.
 Zorster R (2006). Disaster Triage: Is It Time to Stop START?
Am J Disaster Med 1(1):7.
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“RED Survey”
“Rapid Evaluation of Disaster”
 Incident
Survey
 BEFORE
patient care!
 Casualty
Survey
 Life-saving Interventions
You don’t need to die!
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“RED Survey”
“Rapid Evaluation of Disaster”
 Incident
Survey
 BEFORE
patient care!
 Casualty
Survey
 Life-saving Interventions
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“RED Survey”
 “Rapid Evaluation of Disaster”
 Casualty Survey - Triage:
1.
Rapid grouping by:


2.
Severity of injury AND
Likelihood of survival, THEN
Individual assessment
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