Terrorism & EMS

Download Report

Transcript Terrorism & EMS

So, How Did You Do?
NACCHO 02-2006
1
MCI Triage:
2006 Advanced Practice Centers
for Preparedness
Training Conference
v. 01282006
NACCHO 02-2006
2
Why Am I Here?
In a disaster, needs exceed resources
More patients than providers
Difficult choices must be made
Who receives care now?
Who does not?
How do I decide?
...TRIAGE
NACCHO 02-2006
3
Triage and Public Health
Competencies
CDC & CUSN-CHP (2002).
Bioterrorism & Emergency Readiness:
Competencies for All Public Health Workers, p. 12
NACCHO 02-2006
4
Objectives
Define “Triage”
Identify goals of MCI triage
Implement “MASS” Triage
Classify MCI victims by “ID-me”
categories
NACCHO 02-2006
5
In a Perfect World...
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
All “we” have to do is take care of them!
NACCHO 02-2006
6
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
NACCHO 02-2006
7
Another Awful Thought...
Hospital as “Hot Zone”
Or....
It’s your “off “day
Or…
Flu Pandemic, Bioterrorism…
NACCHO 02-2006
8
Triage: Definition
Sorting of patients
by seriousness of
condition and
likelihood of
survival
NACCHO 02-2006
9
Triage: Goals
 Primary Goal:
►Greatest good for the greatest
number of possible survivors
Secondary Goal:
►Relief of suffering
Depend on available resources
NACCHO 02-2006
10
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
NACCHO 02-2006
11
“M.A.S.S.” Triage
M – Move
A – Assess
S – Sort
S – Send
NACCHO 02-2006
12
“M.A.S.S.” Triage
Developed by the military
Tested & used by the military
Adapted for civilian disasters
It works!
►Fast
►Accurate (70%)
►Can handle large numbers of victims
NACCHO 02-2006
13
“M.A.S.S.” Triage
1. GROUP victims first...
then....
2. ...ASSESS individual victims
NACCHO 02-2006
14
Basis of
“M.A.S.S.” Triage
Ability to MOVE best predicts survival
►Head Injury patients
Glasgow Coma Scale (GCS)
NACCHO 02-2006
15
“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.”
NACCHO 02-2006
MINIMAL
16
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
Caveats:
► No individual assessment, yet
► Worsening conditions
NACCHO 02-2006
17
“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.”
NACCHO 02-2006
DELAYED
18
“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 life-
saving interventions (if medically trained)
NACCHO 02-2006
19
“M.A.S.S.” Triage
“ASSESS” IMMEDIATE patients:
Goal:
►Accurate count of IMMEDIATE patients
Action:
►Rapidly Assess ABCs
►If not EXPECTANT or already DEAD
►Correct immediate life threats…
NACCHO 02-2006
20
“M.A.S.S.” Triage
“ASSESS” IMMEDIATE patients:
www.rk19-bielefeld-mitte.de
►Open Airway
►Stop Bleeding
www.tpub.com
www.meridianmeds.com
►Give Chemical antidote
NACCHO 02-2006
21
“M.A.S.S.” Triage
“ASSESS” IMMEDIATE patients:
►Open Airway
►Stop Bleeding
►Give Chemical antidote
Pressure Points
Whatever it takes! Be creative!
Tourniquets
NACCHO 02-2006
22
“M.A.S.S.” Triage
“ASSESS” IMMEDIATE patients:
Question:
►Is transport available?
Move on!
NACCHO 02-2006
23
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
Identify who is
left
“Everyone who can
hear me, raise an arm
or leg so we can come
help you”
Delayed
Go immediately to
these patients for lifesaving interventions
Immediate
NACCHO 02-2006
ID-me
Group
Minimal
24
ONLY NOW Do We Assess
Individuals
Having grouped victims according to
their ability to move...
...The next phase entails more detailed
individual assessment.
NACCHO 02-2006
25
“M.A.S.S.” Triage
“SORT”:
Goal:
►Sort patients based upon INDIVIDUAL
assessment
Actions:
►Assign to “ID-me” Categories:
 IMMEDIATE, DELAYED, MINIMAL, EXPECTANT
►Continue treatment
NACCHO 02-2006
26
“M.A.S.S.” Triage
“SORT”:
Start with those who could MOVE
►Unless sufficient personnel for all
groups
Ideal: trained medical personnel
►May not be available
Tag immediately upon triage
►Including dead victims
NACCHO 02-2006
27
There Are Many Different
Patient Assessment Tools
www.usmc.mil/marinelink/mcn2000
CERT L.A. 2003
NACCHO 02-2006
28
START
Triage
“R”
“P”
“M”
NACCHO 02-2006
29
“ID-me” Categories
I - IMMEDIATE
D - DELAYED
M - MINIMAL
 E - EXPECTANT
NACCHO 02-2006
EXPECTANT
LETHAL INJURY
30
“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,
blue skin color, rapid or weak pulse, open
abdominal wounds, etc.
NACCHO 02-2006
31
“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.
NACCHO 02-2006
32
“M.A.S.S.” Triage
“SORT” – MINIMAL:
“Walking wounded”
Group, sort & facilitate transport from
scene
Volunteer help? Risk vs. Benefit
Examples:
►Scrapes, bruises, minor cuts, no
apparent injuries
NACCHO 02-2006
33
“M.A.S.S.” Triage
“SORT” – EXPECTANT :
Most severely injured with little chance of
survival
They are “expected” to die soon
In a perfect world, they would receive the
most care, even though chance of survival
is low
In an MCI....
NACCHO 02-2006
34
“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
NACCHO 02-2006
35
“M.A.S.S.” Triage
“SORT” – EXPECTANT :
Examples:
►Near 100 % burns
►Fatal radiation doses
►Absent pulse or breathing
 Especially if multiple injuries
►Severe open brain injury
►Death “imminent”
 “Judgment call”
NACCHO 02-2006
36
Triage Caveats
OVER-TRIAGE:
►Tendency to classify all victims as
IMMEDIATE
Defeats the purpose!
►Ruptured eardrums, chronic hearing loss,
language barrier, developmental handicaps,
etc.
Cannot respond to “MASS” commands
NACCHO 02-2006
37
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.
NACCHO 02-2006
38
“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!
NACCHO 02-2006
39
Triage Tags
Tag immediately after sorting
►Tie triage tag directly to patient
►May need to improvise tags (tape, exam
gloves, cloth)
►May need to write on patient (lipstick, marker)
NACCHO 02-2006
40
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
NACCHO 02-2006
41
“M.A.S.S.” Triage
“SEND”:
Objective:
►Transport or release ALL
living patients ASAP
Traditional sequence:
► IMMEDIATE
► DELAYED
► MINIMAL
►
EXPECTANT
NACCHO 02-2006
42
“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.
NACCHO 02-2006
43
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
NACCHO 02-2006
44
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
NACCHO 02-2006
45
When All Is Said and
Done...
MCI Triage is NOT “business as usual”
►Difficult decisions must be made
►Fatalities and suffering are likely
“Gut check” for healthcare providers
“Non-medical” people can participate
NACCHO 02-2006
46
Summary: Now you can
Define “Triage”
Identify goals of MCI triage
Implement “MASS” Triage
Classify MCI victims by “ID-me”
categories
NACCHO 02-2006
47
Thank You!
Questions?
NACCHO 02-2006
48