1 Triage Pakistan ICITAP. Learning Objectives Define triage Know the principles of triage Know the categories of triage Know what is mass casualties (MASCAL)

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Triage

Pakistan

ICITAP

Learning Objectives Define triage

Know the principles of triage

Know the categories of triage

Know what is mass casualties (MASCAL)

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Introduction As Police Officers, you will be need to

know how to triage victims from injuries resulting from accidents, combat and blast injuries

These victim must be treated at a medical facility as soon as possible

A knowledge of first aid can often mean the difference between life and death

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Triage

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French: “to sort”

The sorting of casualties by order of priority

Triage applications

Terrorist attacks Urban Mass Casualty Incidents Natural disasters

Principles of Triage

Greatest good for the greatest number of casualties

Employ the most efficient use of available

resources

Return personnel to duty as quickly as

possible6

Plan Ahead

Secure a plan or Standard Operating Procedure (SOP) to mitigate Triage and MASCAL's

Identify areas of responsibility, evacuation and treatment procedures, communications, and other essential procedures

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Let the Most Experienced Lead

The Operator with the greatest medical training and experience should be Triage leader, regardless of rank or position

Do not allow petty power concerns get in the way of good casualty care

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Triage Categories

Immediate (Category I)

Delayed (Category II)

Minimal (Category III)

Expectant (Category 0) (Dead or Dying)

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Immediate/Category I/Category I

The highest priority, referring to the urgent nature of the casualty

Implies the need (within minutes to an hour) intervention to save life, limb, or eyesight

Not all critically ill or injured casualties are Immediate

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Triage Examples of immediate victims who need immediate

care:

Bleeding that is not controllable except with a tourniquet

Airway or Respiratory problems not easily fixable or maintainable for a long period of time

Weak, thready pulse (signs of shock)

ALOC (altered level of consciousness)

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Delayed/Category II

Second priority referring to the need for treatment (usually surgery) that is required but can wait for a few hours

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TriageExamples of victims that may have delayed treatment:

Airway or Respiratory problems that have been fixed and are maintainable for a period of several hours

Bleeding that has been controlled Amputees with bleeding controlled with tourniquet

Pulse rate has returned to normal after short IV therapy

Brief period of unconscious or ALOC, now following commands

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Minimal/Category III

Those casualties with minor problems requiring medical attention, but whose condition is unlikely to deteriorate over the next several hours to days

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TriageExamples of victims that may need minimal treatment:

Victims with no CBA or mental status problems

Lacerations with controlled bleeding

Strains, sprains, abrasions

Simple extremity bone fractures

Femur, pelvis, spinal, facial fractures are NOT

included in this category15

Expectant/Category 0

Last category, where casualties are so gravely ill or injured that survival is unlikely

These casualties are expected to die

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Triage

Examples of victims that are expectant:

Separation of pt from any vital organ

Respiratory arrest No breathing after opening airway

Cardiac arrest

Massive head injury17

Do Not Second-Guess

Trust your medical instincts

Do not go back to re-triage until all casualties have been triaged

Remember the goal, the greatest good for the greatest number of casualties

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Triage

Mass casualty (MASCAL) situations occur when the number of casualties exceeds the available medical capability to rapidly treat and evacuate them

MASCAL’s overwhelm the available medical resources and require the use of Triage to set casualty priorities

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Triage

The actual number of victims required before a MASCAL situation is declared changes from situation to situation depending upon the availability of medical resources

Technically, a MASCAL situation occurs if a medic has more than one seriously injured victim to be cared for at one time

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Start Triage

If patient is in the Immediate (Category I) upon your initial assessment:

Treat only for uncontrolled bleeding or to correct airway blockage before moving on to next patient

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Start triaging wherever you happen to be at the time:

First - clear the walking wounded using verbal instructions

Direct them to the treatment areas for detailed assessment and treatment

These Patients are triaged MINOR

Starting Triage

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Triage for RPM (Respiration/Pulse/Mental Status)

Respiration's :

If none - open the Airway Still none present? - Deceased Restored?- Immediate care (triage)

Respiration present? Above 30 – Immediate care (triage) Below 30 - Check pulse

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Pulse:

Is Radial Pulse Absent ? Immediate care (triage)

Is Radial Pulse Present?

Check Mental Status


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Mental Status:

Can Not Follow Simple Commands (Unconscious or Altered LOC)

Immediate care (Triage)

Can Follow Simple Commands Delayed care (Triage)


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Patients are systematically moved to treatment areas where more detailed assessment and treatment are conducted

Triage

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Summary

Triage is a method of sorting casualties by order of priority

The overriding principle of Triage is the “greatest good for the greatest number of victims”

Requires training and experience to perform well

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Questions?

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Class Practical Exercise

Practice some of the skills shared in this presentation

Documents

1 Triage Pakistan ICITAP. Learning Objectives Define triage Know the principles of triage Know the categories of triage Know what is mass casualties (MASCAL)