Transcript Slide 1

®
MASS Triage
Chapter 1
Part B
V 2.6 03/06
® BDLS is a registered trademark of the American Medical Association
Objectives
• Define disaster triage
• List components of MASS triage
• Discuss importance and utilization
of triage tags
• Identify victim triage categories for
simulated triage scenario
2
Triage System Types
Triage systems “sort” patients
for a variety of purposes and
situations:
• Military Triage
• Emergency Department Triage
• Disaster Triage
3
Disaster Triage
• Sorting patients by the
seriousness of their condition and
the likelihood of their survival
• To achieve the greatest good for
the greatest number possible
• Dependent on resources available
4
Disaster Triage
Factors impacting available resources:
• Volume and severity of patients
• Limited providers
• Infrastructure limitations
• Inadequate hazard preparation
(HAZMAT, etc.)
• Limited transport capabilities
• Multiple agencies responding
• Hospital Resources Overwhelmed
5
Disaster Triage
Methods used must be:
• Simple
• Effective
• Easily remembered
• Able to sort large numbers of
patients quickly
6
Disaster Triage
Key Principles:
• Life, Limb or Vision Threat
• Medical Intervention Needed
• Transportation Access
7
Disaster Triage
• How do I identify the most
injured victims quickly?
• How do I get ambulatory or
least injured victims out of the
dangerous scene quickly?
8
D-I-S-A-S-T-E-R Paradigm
Triage
Triage Categories:
• “ID-me”!
“Identify Me”
– A mnemonic for sorting patients during triage
I – Immediate
D – Delayed
M – Minimal
E – Expectant
D - DEAD
V 2.6 03/06
9
D-I-S-A-S-T-E-R Paradigm
Triage
M.A.S.S. Triage System
M – Move
A – Assess
S – Sort
S – Send
V 2.6 03/06
10
MASS Flow Chart
V 2.6 03/06
11
M.A.S.S Triage
• Move
• Anyone who can walk is told to MOVE to a collection area
• Remaining victims are told to MOVE an arm or leg
• Assess
• Remaining patients who didn’t move (help these people first)
• Sort
• Categorize patients by “ID-me”
• Immediate, Delayed, Minimal, Expectant, Dead
• Send
• Transport IMMEDIATE patients first
• Send to Hospitals and Secondary Treatment Facilities
12
M.A.S.S Triage
Key Principle of MASS Triage:
• Group, then Sort!
…then Transport!
13
D-I-S-A-S-T-E-R Paradigm
MASS Triage Model
“MOVE” Step 1:
• Goal
• Group - Ambulatory Patients
• Action:
• “Everyone who can hear me and needs medical
attention, please move to the area with the
green flag”
• “ID-me” Category
• Minimal initial group
14
D-I-S-A-S-T-E-R Paradigm
MASS Triage Model
“MOVE”
• Minimal group, initial screening
– Airway, breathing, and circulation intact
– Mental status: able to follow commands
– Not likely low blood pressure or breathing trouble
– Some conditions worsen, more urgent triage
category
– Must be reassessed and monitored
– Limitations: not based upon individual
assessment yet
• Actively managing this group will reduce selftransports and perhaps unnecessary overburdening
of nearest hospital ER’s
• Assess last, after Immediate and Delayed groups
15
D-I-S-A-S-T-E-R Paradigm
MASS Triage Model
“MOVE” Step 2:
• Goal
– Group – can’t walk, but awake and able to follow
commands to MOVE an arm or leg
• Action:
– Ask the remaining victims “everyone who can hear
me please raise an arm or leg so we can come help
you”
• “ID-me” Category
– Delayed initial group
16
D-I-S-A-S-T-E-R Paradigm
MASS Triage Model
“MOVE”
• Delayed group
– Airway, breathing, and circulation adequate to
follow simple commands
– Mental status: Conscious & able to follow simple
commands
• May have low blood pressure or low oxygen level
• Likely significant injuries present
• Limitations: not based upon individual
assessment yet
• Assess second, after Immediate group
17
D-I-S-A-S-T-E-R Paradigm
MASS Triage Model
“ASSESS”
• Goal
– Group – Identify location of who is left,
unable to ambulate and unable to follow
simple commands
• Action:
– Proceed immediately to these patients and
deliver immediate life-saving interventions
• “ID-me” Category
– Immediate initial group
18
D-I-S-A-S-T-E-R Paradigm
MASS Triage Model
“ASSESS”
• Immediate group
–
–
–
–
–
–
ABC status unknown, immediate assessment
Mental status: Unresponsive to verbal commands
Likely low blood pressure or low oxygen level
Life-threatening injuries present
Expectant and dead patients may be in this group
Minor injuries may be present due to:
• Ruptured ear drums, hearing impaired, chronically disabled
– Limitations: not based upon individual assessment
• Assess these people FIRST!
19
D-I-S-A-S-T-E-R Paradigm
MASS Triage Model
“ASSESS” IMMEDIATE patients
• Rapidly Assess ABC’s :
– Is airway open? Open it manually
– Is patient breathing? If not, EXPECTANT and go on
– Is uncontrolled bleeding present? Assign direct
pressure (do not hesitate to use tourniquet!)
– Is likely fatal injury present? If yes, EXPECTANT
• Correct immediate life threats
• Accurate count of immediate patients
• Is transport available for anyone now? …Move
on!
20
D-I-S-A-S-T-E-R Paradigm
MASS Triage Model
“SORT”
• Everyone should be able to complete the
“Move” and “Assess” steps of Triage
• “Sort” requires a level of patient assessment
skills beyond basic first aid / buddy aid
• If you are unable to “Sort”, then assure that
appropriate emergency medical services are
enroute and continue to “move and assess”
21
D-I-S-A-S-T-E-R Paradigm
MASS Triage Model
“SORT” - “ID-me”:
I – Immediate
D – Delayed
M- Minimal
E – Expectant
D - DEAD
“SORT” them based upon individual
assessment, …continue lifesaving treatment
22
D-I-S-A-S-T-E-R Paradigm
MASS Triage Model
“SORT” Immediate
• Life or limb threatening injury
• Usually persistent ABC problem
• Examples:
– Unresponsive, altered mental status, severe
breathing trouble, uncontrollable bleeding,
proximal amputations, turning blue, rapid and
weak pulse…
23
D-I-S-A-S-T-E-R Paradigm
MASS Triage Model
“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 good pulses;
finger amputations; abdominal injuries
with stable vital signs…
24
D-I-S-A-S-T-E-R Paradigm
MASS Triage Model
“SORT” Minimal:
• “Walking Wounded”
• Treated and released (preferably
without transport)
• Source of “volunteer” help
• Examples:
– Abrasions, contusions, minor lacerations,
no apparent injury
25
D-I-S-A-S-T-E-R Paradigm
MASS Triage Model
“SORT” Expectant
• Severely injured with little
or no chance of survival
• Care resources not utilized initially
• Comfort resources used as available
• Remember death could be hours or days away!
• Require reassessment and transport:
– If alive after all immediate patients transported,
resuscitate per available resources!
26
D-I-S-A-S-T-E-R Paradigm
MASS Triage Model
• How to handle the dead patients:
– Dead patients should not be moved
– May aid in identification of the deceased
• Evidence is important!
– Finding and convicting
perpetrators....and possibly...
PREVENTING future attacks!
– Excessive manipulation of human
remains may destroy vital evidence
27
D-I-S-A-S-T-E-R Paradigm
MASS Triage Model
“SORT” is dynamic! Reassess!
• Who is left?
• Expectant group could become new
Immediate group
• “Most serious” injury present requires
your immediate attention!
28
D-I-S-A-S-T-E-R Paradigm
MASS Triage Model
• When all patients have been triaged
and immediate life saving procedures
complete:
– Accurate count in each category
– Advise incident commander/triage officer
– Move all immediate to collection point
– Prepare for immediate transport
– Often marked with red flag/tarp
29
D-I-S-A-S-T-E-R Paradigm
MASS Triage Model
“SEND”
• Traditional syntax
• Immediate →Delayed →Minimal →Expectant
• Objective
• Transport or release ALL living patients ASAP
• Mission Focused
• Send Minimal(s) with each Immediate (if
unused space available in vehicle), etc…
• Resourceful
• Secondary treatment facilities for minimal pts
(or on-scene treatment and release)
• Utilize buses, taxis, trains, boats, etc..
30
M.A.S.S Triage
Key Principle of MASS Triage:
• Group, then Sort!
…then Transport!
31
Medical Record
• Triage Tags
• Communication
– History & Physical
– Treatment
– Contact information
– Personal message
Front
Back
32
Summary
Now you can:
• Define disaster triage
• List components of MASS
triage
• Discuss importance and
utilization of triage tags
33
Questions?
34
Triage “Tabletop”
35
Triage Scenario
• Shooting incident at a Local
Sporting Event
– Multiple gunshots were fired
– You are first at the scene
– 10 victims
• What do you do?
36
Is Need > Resources?
• D- Detect
– Is this a disaster / MCI? (need>resources)
• I- Incident Command
– Who is in charge? (incident commander) Who will you contact?
• S- Scene Safety/Security
– Is it safe enough to enter?
• A- Assess Hazards
– Active shooter? Secondary device? Further penetrating trauma
• S- Support
– Law enforcement, EMS, Medical Control, Trauma Center, etc..
• T- Triage/Treatment
– 10 victims
• E- Evacuation
– What vehicles are available? What route is safe?
• R- Recovery
37
MASS Triage
• Move
– Two walk
– Three move
• Assess
– Five do not move
• Sort
– IDME categories
• Send
38
MASS Triage
• Move
– Two walk (Minimal Group)
– Three move (Delayed Group)
• Assess
– Five do not move (Immediate Group)
• Sort
– IDME categories
• Send
39
MASS: Immediate Group
Unable to “MOVE”
• 29 yr male Immediate
– GSW to left chest, awake in severe respiratory distress
• 8 yr female
Expectant
– GSW to head (through and through) RR=4, HR=101
• 50 yr male
Dead
– GSW to abdomen & chest, RR=0, HR=0, not moving
• 40 yr female
Immediate
– GSW to neck with gurgling respirations, marked
respiratory distress
• 16 yr male
Immediate Vs Expectant
– GSW right chest, No respiratory effort, HR=130 thready40
MASS: Delayed Group
Able to MOVE, not walk
• 14 year male Immediate -Delayed**
– GSW to R upper arm, active massive
hemorrhage, good
pulses
**after
pressure dressing
• 65 year male
Immediate
– No obvious GSW, c/o severe chest pain,
diaphoretic, and SOB
• 22 year female Delayed
– GSW to R leg, good pulses, no active
bleeding, normal VS
41
MASS: Minimal Group
Able to “MOVE” out
• 29 yr male Minimal
–Superficial “scratch” wound to L
arm, no deeper penetration
• 37 yr male Delayed
–GSW to left hand, exposed muscle,
tendon and bone fragments,
capillary refill < 2 sec
42
Triage Status
Category
SORT
Immediate
Delayed
Minimal
Expectant
DEAD
4-5*
2
1
1-2*
1
43
SORT: Immediate
• 29 yr male
Delayed
– GSW to left chest, awake in severe respiratory distress:
Needle decompression of L chest successful, VSS
• 40 yr female
Dead
– GSW to neck with gurgling respirations, marked
respiratory distress: Airway management unsuccessful,
profuse bleeding occurred, pt now apneic and pulseless
• 14 year male
Delayed
– GSW to R upper arm, active massive hemorrhage, good
pulses: Now well controlled, no active bleeding, VSS
• 65 year male
Immediate
– No obvious GSW, c/o severe chest pain, diaphoretic,
and SOB: Symptoms continue
44
SORT: Delayed
• 22 year female
Delayed
– GSW to R leg, good pulses, no active
bleeding, normal VS: Splinted leg, VSS
• 37 yr male
Immediate
– GSW to left hand, exposed muscle,
tendon and bone fragments, initial
capillary refill < 2 sec: Now L hand is
pulseless and cyanotic
45
SORT: Minimal
• 29 yr male Minimal
–Superficial “scratch” wound to L
arm, no deeper penetration: No
clinical change, desires to leave and
go home
46
SORT: Expectant
• 16 yr male Dead
–GSW right chest, No respiratory
effort, HR=130 thready: Now no
palpable pulse, no respiratory effort
• 8 yr female IMMEDIATE?
–GSW to head (through and through)
RR=4, HR=101: RR=6-8, HR=100
47
Triage Status
Category
SORT
SORT
Immediate
Delayed
Minimal
Expectant
DEAD
4-5*
2
1
1-2*
3
3
1
0
1
3
48
Summary
Now you can:
• Define disaster triage
• List components of MASS triage
• Discuss importance and utilization
of triage tags
• Identify victim triage categories for
simulated triage scenario
49
Questions?
50