Triage

1. Triage Triage

2. Learning Objectives Cognitive • Discuss the criteria of MCI implementation. • Discuss the goals and purpose of triage. • Identify appropriate patient care activities during an MCI. • Define the components of the START acronym. Triage

3. Learning Objectives Cognitive • State how patients are categorized in START triage. • Explain the role of the Triage Unit Leader. • Discuss the role of the EMT in an MCI. Triage

4. Learning Objectives Psychomotor • Given an MCI scenario, perform triage. • Demonstrate rapid patient assessment. Triage

5. Disaster Multiple casualty incident Scene-size up START Triage System Triage Triage officer Triage tag Walking wounded Key Vocabulary Triage

6. Overview Regardless of the amount of training, will not be immune to the psychological impact or emotional stress of disaster Triage

7. Overview (continued) Your best defense is an automatic response, the tools and the confidence that comes from the ongoing practice of triage Triage

8. 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 Triage

9. 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 Triage

10. 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 Triage

11. 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 Triage

12. START Triage • Simple • Triage • And • Rapid • Transport Triage

13. START Triage (continued) All Walking Wounded Triage

14. 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 Triage

15. START Triage (continued) • Key assessment elements: • Respirations • Perfusion • Mental status Triage

16. 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” Triage

17. Triage • Sort multiple casualties into four priorities for emergency care or transportation to definitive care • Red • Yellow • Green • Black Triage

18. Priority 1 - Red • Immediate • Patients with readily correctable life-threatening conditions • Airway and breathing difficulties • Uncontrolled or severe bleeding • Decreased mental status • Patients with severe medical problems Triage

19. Priority 2 - Yellow • Delayed • Patients with serious, but not life-threatening conditions • Burns without airway problems • Major or multiple bone or joint injuries • Back injuries with or without spinal cord damage Triage

20. Priority 3 - Green • Minor • “Walking Wounded” • Minor painful, swollen, deformed extremities • Minor soft tissue injuries Triage

21. Priority 4 - Black • Deceased • Dead or moribund patients • Respiratory or cardiac arrest Triage

22. 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 Triage

23. 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 Triage

24. 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 Triage

25. 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 Triage

26. Triage Officer • Most knowledgeable provider, on-scene first, becomes triage officer • Request additional help • Perform initial triage assessment Triage

27. 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 Triage

28. 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 Triage

29. Hospital Communications • Incident nature • Size location • Number / types of injuries • Hospital capacity • Update regularly • Notify when incident ends Triage

30. 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 Triage

31. Applications • Local protocols for triage • Recent case review of MCI • Lessons of Scenario drill Triage

32. 24-7 EMS 888.240.4911 Visit our website for additional information www.24-7ems.com Triage