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8/12/2019 Triage Lecture
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8/12/2019 Triage Lecture
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TRIAGE
What is triage?
Triage means to sort
Looks at medical needs and urgency of each individualpatient.
Sorting based on limited data acquisition
Also must consider resource availability
THE NEEDS OF THE MANY OUTWEIGH THE
NEEDS OF THE FEW OR THE ONE
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TRIAGE
mass- casualty or multi- casualty incident
Involves >1 patient or situation that places great demandon resources (stretched to limit)
Triage is the sorting of two or more patients based on theseverity of their conditions to establish priorities for care
based on available resources
Scene Safety
1. Size of hazard area2. Safe and sheltered location to move patients
3. Self- protective measures
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TRIAGE
DAILY EMERGENCIES
DO THE BEST FOR EACH INDIVIDUAL
DISATER SETTINGSDO THE GREATEST GOOD FOR THE GREATEST NUMBER.
MAXIMIZE SURVIVAL
TRIAGE IS A DYNAMIC PROCESS AND IS USUALLYDONE MORE THAN ONCE.
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THE TRIAGE PROCESS
A. Sort patients to provide the best outcome for theGREATEST number of patients
1. Rank in order of severity
2. Mark patients for visual identification
B. May need to modify triage process because of environment
1. Weather
2. Equipment
3. Manpower
4. Communication
5. Distance from definitive care
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CONTINUOUS INTEGRATED TRIAGE
A. PRIMARY TRIAGEB. SECONDARY TRIAGE
C. TERTIARY TRIAGE
PRIMARY DISASTER TRIAGE
-Goals: to sort patient based on probable needs for immediate care.
-Triage based on physiology
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CONTINUOUS INTEGRATED TRIAGE
B. SECONDARY DISASTER TRIAGEIncorporates:
-A reassessment of physiology
-An assessment of physical injuriesInitial Treatment and assessment of patient responses
Further knowledge of resource availability
-
SECONDARY TRIAGE TOOLS
Goals is to distinguish between:
Victims needing life saving treatment that can only be provided in
a hospital setting.
Victims needing life saving treatment initially available on scene.
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CONTINUOUS INTEGRATED TRIAGE
B. SECONDARY TRIAGE TOOLSVictims with moderate non life-threatening injuries, at risk for
delayed complications
Victims with minor injuries
TERTIARY DISASTER TRIAGE
Goals: To optimize individual outcomes
Incorporates:
-Sophisticated assessment and treatment
-Further assessment of available medical resources
-Determination of best venue for definitive care.
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C. The 5 Ss1. Safety Assessment
Assess scene for safety
2. Simultaneous scene size up
Size and severity
Type of incident
Approximate number of patients
Severity of injuries
Area involved, access
3. Send information Contact dispatch with your scene size-up
Request assistance and additional resources
4. Setting up scene
Obtain triage ribbon
Identify triage areas
Consider scene access and egress
5. START triage process
Begin where you are
Relocate green-tagged patients
Move in an orderly pattern
Maintain a patient count of casualties
Provide minimal treatment
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D. Triage Priorities
1. Red-
- highest priority patients need immediate care (usuallycirculatory or respiratory)
2.Yellow- second highest priority
able to wait longer before transport (45 minutes)
3. Green- Minor injuries that can wait for longer period of
time for treatment
-walkingable to wait several hours for transport
4. Black- dead or still with life signs but injuries are
incompatible with survival in austere conditions.
will die during emergency care (have lethal injuries)
Mark triage priorities (tape, tag)
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Triage Category: Red
Red (Highest) Priority:
Patients who need
immediate care andtransport as soon as
possible
Airway and breathing
difficulties
Uncontrolled or severe
bleeding
Decreased level of
consciousness
Severe medical problems
Shock (hypoperfusion)
Severe burns
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Triage Category: Yellow
Yellow (Second)
Priority: Patients
whose treatment andtransportation can be
temporarily delayed
Burns without airway
problems
Major or multiplebone or joint injuries
Back injuries with or
without spinal cord
damage
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Triage Category: Green
Green (Low) Priority:
Patients whose
treatment and
transportation can be
delayed until last
Minor fractures
Minor soft-tissue
injuries
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Triage Category: Green
Green (Low) Priority:
Patients whose
treatment and
transportation can be
delayed until last
Minor fractures
Minor soft-tissue
injuries
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Triage Category: Black
Black (Lowest)
Priority: Patients who
are already dead orhave little chance for
survival. If resources
are limited, treat
salvageable patientsbefore these patients
Obvious death
Obviously
nonsurvivable injury,such as major open
brain trauma
Full cardiac arrest
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TRIAGE TOOLS
Basic Disaster Life Support
*MASS TRIAGE
M- move
A- Assess
S- Sort
S- Send
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TRIAGE TOOLS
* SALT TRIAGE
S- sort
A- Assess
L- Life saving intervention
S- Treatment/Transport
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The AVPU Scale is used to assess Level of Consciousness
during Primary Survey.
A - Alert
Able to answer questions
V - Verbal
Responds to Verbal Stimulus
P - Pain
Responds to Painful Stimulus
UUnresponsive
Types of simple triage
AVPU Scale
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TRIAGE TECHNIQUES
STARTSimpleTriage
And
Rapid
Treatment
* In initial START Assessment mark with triageribbons, but only provide minimal treatment. Only
two interventions: (1) open the airway and (2) stop
excessive bleeding. START assessments should only
last 15-30 seconds per patient
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START
*Used for PRIMARY triage
Used on scene and at hospital
Recommended for patient >100 lbs
SECONDARY TRIAGE.
*All green patients must be individually assessed in
secondary triage-assess physiology - Assess injuries
-assess probability of deterioration
-assess needs v/s resource availability
1 G d lk
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1. Get up and walk
-Have patients move to safe location outside triage area that can
-Self defined green patients
2. Respiration: check for respiratory compromise
-not breathing after reposition airway = BLACK
< 30 breaths/minute = RED
> 30 breaths/minute = CONTINUE
3. Perfusion (pulse, circulation): radial pulse check
-weak, irregular or no radial pulse = RED
-strong radial pulse = CONTINUE
4. Mental Status
-fails to follow simple commands (mental status altered) = RED
- follows simple commands = YELLOW
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Secondary Triage
1. Once resources are available and patients are transported to
treatment area, secondary triage begins.
2. In- depth reassessment
Triage tags used. Called METTAGS. Used to indicate
triage category and specific injuries or vital signs.
3. Ongoing in treatment area
4. May change categories
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Special Triage Situations
1. Injured rescuer
- Automatic Red
2. Hysterical patient or bystander
- Receives higher then usual priority
3. Child
- Receive higher category. If possible they should be transportedwith parent. Check cap-refill in children.
4. Lowered body temp in outdoor environment (hypothermia)
- Hypothermic patients change to high priority
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Triage of the Patient with multiple injuries
1. - Golden hour: average amount of time that elapses before a
patient with serious or multiple injuries starts to deteriorate rapidly.
For every 30 minute period after the Golden Hour, the patients
chances of survival are cut in half.
- be knowledgeable
- work quickly and efficiently
- establish priorities and improvise when necessary
2. Remember ABCs, then tackle blood loss
3. Long backboard to splint extremity fracture of speed transport
4. EXCEPTION Femur fracture: site should be treated seperately
with a traction splint.
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Purpose: to control, coordinate and direct emergency
responders and resources
1. Call incident command system
2. Design to be used in daily operations
3. Effective at mass casualty incidents
4. Use with >1 patient and events that stretch resources and
equipment to limits
5. Types of out door incidents that might require it
- chair lifts, ice, rock, mountain climbing, river rafting
and avalanche
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Emergency Operations Plan
1. Well designed2. Well practices
3. Coordinated with local EMS and others
Typical Plan
Command Center
Run by area manager
Extrication
Triage Area
Treatment Area
Supply Area
Transportation Area
Rehabilitation Area
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Multiple casualty exercise
exercise #1
*Patients states he cant move or feel his legs
*Respiration26*Pulse 110 (radial)
*He is awake and oriented
*WHAT TRIAGE CATEGORY
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Multiple casualty exercise
exercise #2
*Patient is soaked with blood no obvious
killer blood
*Respiration38
*Pulse is weak, no radial
*He is awake*WHAT TRIAGE CATEGORY
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Multiple casualty exercise
exercise #3
*Patient walk over to you and has an obvious
fracture arm
*Respiration22
*Pulse 124 (radial)
*He is awake, alert and crying*WHAT TRIAGE CATEGORY
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Multiple casualty exercise
exercise #4
*Patient is face down in the field
* not breathing
*weak carotid pulse
*She is unresponsive
*WHAT DO YOU DO FIRST
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Multiple casualty exercise
exercise #5
*Patient gurgles but cant maintain an opens
airway and is not breathing
*weak carotid pulse
*unresponsive
*WHAT TRIAGE CATEGORY
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TRIAGE SHOULD BE DONE WITH THE
HEAD NOT THE HEART