Transcript www.cordeliafire.com

Triage
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC
Learning Objectives
Cognitive
1. Discuss the criteria of MCI
implementation.
2. Discuss the goals and purpose of
triage.
3. Identify appropriate patient care
activities during an MCI.
4. Define the components of the START
acronym.
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC
Learning Objectives
Cognitive
5. State how patients are categorized in
START triage.
6. Explain the role of the Triage Unit
Leader.
7. Discuss the role of the EMT in an
MCI.
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC
Learning Objectives
Psychomotor
1. Given an MCI scenario, perform
triage.
2. Demonstrate rapid patient
assessment.
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC
Key Vocabulary
 Disaster
 Multiple casualty
incident
 Scene-size up
 START Triage
System
Class # - 3.04.1




Triage
Triage
Triage officer
Triage tag
Walking
wounded
© Copyright 2006 JSL Communications LLC
Overview
Regardless of the amount of training,
will not be immune to the psychological
impact or emotional stress of disaster
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC
Overview
(continued)
Your best defense is an automatic
response, the tools and the confidence
that comes from the ongoing practice of
triage
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC
Triage
 Good triaging immediately identifies:
 Patients to be transported first
 Patients who can assist you
 Patients impossible to save without
further resources
 Scene safety and your safety are first
priority
 Do not become a victim or part of the
problem
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC
MCI vs. Disaster
 MCI: any incident in which the
number of patients places excessive
demands on personnel or equipment
 Disaster: any incident which exceeds
the capacity of a system’s resources including mutual aid
 The number of patients constituting
an MCI is locally defined
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC
MCI’s
 The EMT role in an MCI:








Recognize incident is an MCI
Request additional assistance
Establish IMS
Identify hazards
Perform triage
Treat patients according to triage priority
Transport patients according to triage priority
Document:
 Patients, conditions and care
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC
Triage
 French word means “to sort”
 To do the most good for the greatest
number of patients
 Goals:





How many patients?
Classify, label, track
Assess needs
Best utilize scene resources
Coordinate with hospitals
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC
START Triage





Simple
Triage
And
Rapid
Transport
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC
START Triage
(continued)
All Walking Wounded
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC
START Triage
(continued)
 National standard
 Developed by City of Newport Beach
(CA) Fire Department and Hoag Hospital
 Used to triage large numbers, simply and
rapidly
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC
START Triage
(continued)
 Key assessment elements:
 Respirations
 Perfusion
 Mental status
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC
30-2-Can Do
 Mnemonic
 Any patient who cannot walk but
has:
 Respiratory rate less than 30 per minute
 Capillary refill less than 2 seconds, and
 Can follow commands is a “yellow”
category patient
 All others who cannot walk are “red”
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC
Triage
 Sort multiple casualties into four
priorities for emergency care or
transportation to definitive care




Red
Yellow
Green
Black
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC
Priority 1 - Red
 Immediate
 Patients with readily correctable lifethreatening conditions




Airway and breathing difficulties
Uncontrolled or severe bleeding
Decreased mental status
Patients with severe medical problems
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC
Priority 2 - Yellow
 Delayed
 Patients with serious, but not lifethreatening conditions
 Burns without airway problems
 Major or multiple bone or joint injuries
 Back injuries with or without spinal cord
damage
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC
Priority 3 - Green
 Minor
 “Walking Wounded”
 Minor painful, swollen, deformed
extremities
 Minor soft tissue injuries
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC
Priority 4 - Black
 Deceased
 Dead or moribund patients
 Respiratory or cardiac arrest
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC
Triage
 Begins as the first unit pulls up on
scene
 Use the PA to direct all “walking
wounded” to gather in a certain area
 Walking wounded are triaged as
Green initially
 Can be re-triaged later
 Use three basic assessment criteria to
triage remaining patients
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC
Triage
(continued)
 Respirations
 Is the patient breathing?
 If no, reposition airway, re-assess
breathing
 If breathing starts, triage Red
 If no breathing, triage Black
 Is the respiratory rate greater than
30 per minute?
 If yes, triage Red
 If no, assess perfusion
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC
Triage
(continued)
 Perfusion
 Are radial pulses present and capillary
refill less than 2 seconds?
 If no, triage Red
 If yes, assess mental status
 Control any profuse bleeding
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC
Triage
(continued)
 Mental Status
 Can the patient follow simple
commands?
 If no, triage Red
 If yes, triage Yellow
 If there are injuries incompatible
with life, triage black
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC
Triage Officer
 Most knowledgeable provider, onscene first, becomes triage officer
 Request additional help
 Perform initial triage assessment
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC
Triage Officer
(continued)
 Use Triage system per protocols
 Place color-coded triage tag or tape on
patient
 Do not render any treatment more
complex than:
 Repositioning airway
 Stop major bleeding
 Use the patient or a Green patient to assist
with any bleeding control
 Move on to next patient and continue
until all receive initial triage
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC
Triage Duties
 Assign available personnel and equipment to
highest priority patients
 Re-triage patients as resources allow
 Patient transport decisions based on variety of
factors:





Patient priority
Destination facilities
Patient load and resources
Transport distance
Transportation resources
 Triage officer remains at scene to assign and
coordinate personnel, supplies and vehicles
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC
Hospital
Communications





Incident nature
Size location
Number / types of injuries
Hospital capacity
Update regularly
 Notify when incident ends
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC
Summary
 Knowing how to triage fast and
effectively is vital to saving greatest
number of lives
 Practice, drill and use a triage system
every time you have more than one
patient
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC
Applications
 Local protocols for triage
 Recent case review of MCI
 Lessons of Scenario drill
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC
24-7 EMS
888.240.4911
Visit our website for additional information
www.24-7ems.com
Class # - 3.04.1
Triage
© Copyright 2006 JSL Communications LLC