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Triage Tags

Triage Tags . Patients brought by EMS Tag will be applied to patient by EMS Patients directed to appropriate treatment area in the hospital based on color of triage tag MCI/Disaster patients presenting to ED by own transportation Triage tags in disaster cage in basement

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Triage Tags

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  1. Triage Tags • Patients brought by EMS • Tag will be applied to patient by EMS • Patients directed to appropriate treatment area in the hospital based on color of triage tag • MCI/Disaster patients presenting to ED by own transportation • Triage tags in disaster cage in basement • Triage tags will be available in the ED • Decon room • At Triage • Should be used and applied to patients as they enter the hospital via the triage area where-ever this has been established

  2. Triage • Primary triage- START and JumpStart • Segregates casualties into groups • Walkers move to another area • The more critically injured, but still a smaller crowd, left to sort through to determine reds and yellows • Secondary triage • Refines our clinical picture • Uses a physiological scoring system & anatomical examination

  3. Primary vs Secondary Triage (The 1st vs Subsequent Triage) • JumpSTART triage will be performed in the field – IF the patient is brought by EMS • If the patient accesses the ED on their own, triage will need to be set up and performed at the ED • If the patient comes to ED via EMS, ED should use the secondary triage (RTS) as their reassessment process

  4. Secondary Triage • Glasgow coma scale (GCS) – 3-15 points • Best eye opening • Best verbal response • Best motor response • Respiratory rate • Systolic B/P • Secondary triage scores calculate RR and B/P based on adult norms • Secondary triage scores have not been modified for pediatric normal RR and B/P

  5. Glasgow Coma Scale (GCS) • Best eye opening 1 - 4 points • Eyes spontaneously open, looking around; does not have to focus (4 points) • Eyes open (or eyelids flutter) to verbal stimuli prior to tactile stimulation(3 points) • Eyes open (or eyelids flutter) to painful or tactile stimuli (2 points) • There is absolutely no eye movement, including no eyelid flutter or flicker (1 point)

  6. Best verbal response • Patient oriented (5 points) • Patient confused, can carry on a conversation but not always appropriate; infant has irritable cry (4 points) • Patient using inappropriate words for the situation and you can understand what the words are; this is beyond confusion (ie: “the sky is blue”); infant cries to pain (3 points) • Patient has incomprehensible words (ie: moans and groans and noises made but cannot be understood for any words); child responds to pain (2 points) • There are no sounds, no moans, no groans, nothing heard from the patient (1 point)

  7. Best motor response • Patient obeys commands (6 points) • Patient is purposeful & localizes; this is the obnoxious patient who pulls at the equipment and tries to remove the equipment; they try to hit your hand away; infant withdraws to touch (5 points) • Patient responds to pain by withdrawal (the brain can no longer discern where the obnoxious stimuli is felt so just withdraws); infant withdraws to pain (4 points) • Patient flexes extremities (decorticate) (3 points) • Patient extends extremities (decerebrate) (2 points) • Patient is flaccid with no response (1 point)

  8. Converting GCS Points to RTS • Conversion score ranges from 0 – 4 points • Total GCS 13 – 15 (4 points) • Total GCS 9 – 12 (3 points) • Total GCS 6 – 8 (2 points) • Total GCS 4 - 5 (1 point) • Total GCS 3 (0 points) • Add converted points (0 - 4) to respiratory rate score and systolic B/P score • RTS score range 0 – 12 points

  9. Respiratory rate – 0 – 4 points • 10 – 29 breaths per minute (4 points) • 30 or more breaths per minute (3 points) • 6 - 9 breaths per minute (2 points) • 1 – 5 breaths per minute (1 point) • 0 breaths (0 points) • Points added to GCS conversion points (0 - 4) and to systolic B/P score (0 – 4) • RTS score ranges 0 - 12

  10. Systolic blood pressure (0 – 4 points) • 90 or more (4 points) • 76 – 89 (3 points) • 50 - 75 (2 points) • 1 – 49 (1 point) • 0 (0 points) • Points added to GCS conversion points (0 - 4) and to respiratory rate score (0 – 4) • RTS score ranges 0 - 12

  11. Secondary Triage - RTS • RTS score ranges from 0 to 12 • Score of 12 (highest) – patient is GREEN • Score of 11 – patient is YELLOW • Score 10 or less – patient is RED

  12. Scenario Practice • Use worksheet at end of power point as resource for START & JumpSTART triage and the secondary triage process • Place patients in the appropriate categories • Check answers at the end of the practice scenarios • Some scenarios are based in the field – does not matter as triage is performed the same in all settings (and you might be dispatched to help in the field if requested)

  13. Scenario 1: Bus Crash It’s 7pm on a summer night when a bus returning from a day camp collides with a train on a remote road. There are 20 + kids either still in the bus and some are lying about the road. There are 3 adults.

  14. JumpSTART Triage – Scenario #1 (Initial Triage) Patient #1 Unresponsive; RR 30 and pale Patient #2 5 y/o looking around; RR 35 and open femur fracture Patient #3 Unresponsive; labored respirations 52 and open chest wound What color are you triaging these patients?

  15. Initial JumpSTART Triage Scenario #1 • Patient #1 – RED • RR okay at 30 (between 15 and 45) • Patient is unresponsive • Patient #2 – YELLOW • Not able to walk so initially made yellow until retriaged – then may stay yellow or be triaged as green or red • Even though RR okay at 35 (between 15 and 45) • Even though looking around (awake) • Patient #3 – RED • Labored RR of 52 (> 45) • Unresponsive

  16. Scenario #2

  17. Scenario #2 Adult and Pediatric Mixed Triage • 9 y/o – RED (RR<15) • 50 y/o – GREEN (RR, cap refill & neuro okay) • 10 y/o – GREEN (walking, neuro okay) • 8 y/o – RED (faint distal pulse, unresponsive) • 11 y/o – YELLOW (can’t walk so initially can’t be green; minimally will be yellow when you make it through the triage process and all other parameters are okay. D • Distal pulses and obeys commands okay so left yellow for now • 25 y/o – RED (cap refill >2 sec; not responding to commands given (only to painful/tactile)

  18. Scenario #2: F5 Tornado An F5 tornado has struck within your city/town. It occurred at 3pm while school was letting out. It touched down near 3 schools and a mall.

  19. Triage This Patient: School age girl lying on roadway • Breathing 10/min. • Good distal Pulse • Groans to verbal stimuli • JumpSTART triage category?

  20. Patient is categorized as a RED • Respiratory rate (RR) is 10 (<15) • Do not even need to get to the type of AVPU response patient has • This patient is categorized influenced by respiratory rate and then rescuer must move onto next patient for triage • Patient care not delivered during triage • Patient care delivered in treatment

  21. Triage This Patient: School age girl found; refuses to walk • Open arm fracture visible • RR 26, radial pulse present • Alert and talking • JumpSTART triage category?

  22. Open arm fracture could be a distracting injury – so don’t get distracted • Stay with physiological parameters • Not able to walk so automatically at minimum a YELLOW • Respiratory rate 26 (okay 15 - 45) • Neurologically okay (alert and talking) • Patient remains triaged as YELLOW • In secondary triage may be upgraded to GREEN (RTS most likely a 12)

  23. Infants/Non-walkers • Evaluate this group of patients starting triage with the breathing assessment

  24. Scenario Practice #2 –Patients From Tornado

  25. Scenario #2 Patient Triage • 8 y/o – RED (unresponsive) • 3 y/o – YELLOW (not walking; RR 15 – 45; “P” on AVPU) • 9 mo – GREEN (pulse +; “V” on AVPU, minor external wounds) • 10 y/o – RED (pulse+; not focusing, screaming, running around – distracting others so remove to control the scene) • 50 y/o – RED (cap refill >2 sec; not following commands) • 7 y/o – BLACK (apnea not corrected with 5 rescue breaths)

  26. Fire reported on 15th floor Smoke to the 16th and 17th floors. The building Day Care Center is on the 17th floor Scenario #3: High-Rise Fire

  27. Reported 30 kids in the day care and 6 employees • Fire Crews carry 5 kids all being given CPR. • The day care is next to the hospital and triage is set up in the ED • How would you triage these patients?

  28. Scenario #3 – High rise fire

  29. Scenario #3 Patient Triage • 6 y/o – GREEN (walks; RR 15-45; awake/alert) • 53 y/o – RED (cap refill >2 sec) • 3 y/o – RED (weak pulse, unresponsive) • 4 y/o – GREEN (walks; RR 15- 45; pulse present) • 2 y/o – GREEN (walks; RR 15-45; pulse present • 5 y/o – YELLOW (can’t walk; RR 15-45; strong pulse)

  30. Scenario #3 • The patients made GREEN (1st, 4th and 5th) have evidence of airway involvement from the fire (facial burns and soot to face) • The patient, regardless of how initially triaged, may deteriorate and need upgrading • Remember secondary triage should occur rapidly and repeat assessments should occur frequently to determine if a patient needs to move up to a higher level of triage

  31. Disaster Triage Decisions • Remember the point of primary triage • To sort patients to determine who is the most critical and who is less critical • Need to do the greatest good for the greatest number • Disaster triage is not routine daily triage where you do the best for each individual

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