Transcript Triage - Hatzalah of Miami-Dade

Triage
Triage?
Triage is the sorting of patients by
the severity of injury or illness so
that resources can be more
efficiently utilized to do the most
good for the most people…
Mass Casualty Incident?
• A Mass Casualty Incident (MCI) is when
there are more patients than there are
resources immediately available.
• A Multi-victim Accident is when there is a
large number of victims, but there ARE
adequate resources.
Triage is a Dynamic Process…
• Regardless of whether patients are moved from point of
injury/illness to another location for treatment, or if they
are treated in place…triage is repeated before treatment
begins. Triage is conducted at least four times: During
the initial contact with Healthcare Providers, When the
patient is moved to the treatment sector, When the
patient is moved to the transportation sector, and When
the patient is presented to the Emergency Department.
Triage, responsibilities
The Triage Sector has four responsibilities.
* Implement the triage system and tag patients according
to the severity of their injuries or illness.
* Report progress and needs to the EMS Command Officer.
* Treat ONLY immediate threats to life, i.e. blocked
airways and severe arterial bleeding.
* Move patients by priority to treatment sector.
Triage Tags
• Triage tags are often used to document the patient
condition and treatment received. Tags come in a
variety of different designs.
• Different colors are used to represent priority of
injury.
Red: Immediate
Yellow: Delayed
Green: Walking Wounded, Minor
Black: Expectant, deceased
What do the colors mean???
• Green: Minimal/Walking wounded- These are patients
that are ambulatory, and have only minimal injuries
and are capable of making their own way to the
casualty collection point/treatment sector.
• Yellow: Delayed- These are patients that have wounds
that require attention, but are not immediately life
threatening. These patients usually need assistance
making their way to the treatment sector.
What do the colors mean?
• Red: Immediate- critically-injured patients
with treatable life-threatening injuries or
illnesses. This might include airway and
breathing difficulties, decreased mental
status, and uncontrolled bleeding. These
patients will be treated and transported
from the scene first.
What do the colors mean?
• Black: Expectant (morgue)- is used for
dead and unsalvageable patients such as
someone in cardiac arrest. These victims
will be removed from the scene, but only
after all of the living/salvageable patients.
DMS Triage Tag, Instructions
The Contaminated strip running the length of the
triage tag has three functions. First to prevent the
tag from being used until patient contamination has
been considered. Second, to identify victims who
have been exposed to a hazardous material, and
third to aid rescuers with identifying clothing
(evidence) belonging to victims.
Triage Tag Instructions, Cont.
After a victim's clothing has been removed and
placed into an airtight clear plastic bag, the long
CONTAMINATED tear off strip is placed inside the
bag face out. The numbered tag allows for clear
identification of items for retrieval by the owner or
for investigative purposes.
Triage Tag Instructions, Cont.
If contamination is not an issue, the
strip may be removed and standard
triage procedures may be initiated.
Triage Tag Instructions, Cont.
The Personal Property
Receipt/Evidence tag found at
the top of the tag is to be used
for identifying valuables
removed from victims. (Jewelry,
wallets, watches, cash etc..).
Triage Tag Instructions, Cont.
These items should be collected and
placed in a smaller one-gallon clear
plastic bag. The back of the
Personal Property Receipt tag may
be used to record property of
unusual value. The property tag is
than placed with the valuables and
sealed.
Triage Tag Instructions, Cont.
At this point both the clothing bag and the
property bag are placed into a second large
plastic bag and sealed using duct tape or
other air tight measures. At this point the
remainder of the tag is placed over the
victims head and becomes identification for
the victim and a claim ticket for personal
property after the incident.
Triage Tag Instructions, Cont.
The Gross Decon and Secondary Decon
check boxes are to be used after victims
have
undergone
Decontamination
procedures. The Solution used during
decontamination will be recorded on the
tag. It should be noted that no patient
should be allowed to leave the exclusion
zone without undergoing decontamination
procedures.
Triage Tag Instructions, Cont.
Once contamination has been ruled out or
decon procedures completed, the next step
will be to follow START triage guidelines. On
the back of the tag the R.P.M. pneumonic will
be used while referring to the flow chart
located directly above. Once the patients have
been categorized they are ready to be moved
to the treatment area.
Triage Tag Instructions, Cont.
The front of the tag is than used to
record injuries and their anatomical
locations, as well as vital signs and
medications.
(Atropine, 2-Pam, 1V solutions etc..)
Triage Tag Instructions, Cont.
The second tear off tag from the top is
to be used for recording patient
destination. The tag may be removed
just prior to the patient leaving the
scene. Both the destination and how
the
patient
was
transported
(ambulance number, helicopter, bus,
etc.) shall be recorded on the tag.
Ok, now we know what triage
is, and how to use the tags….
LET’S GET TO WORK!!!
How do we determine what
color a patient gets?
• RPM
• Respirations?
• Perfusion?
• Mentation?
Respirations
• Is the patient breathing?
!-If the patient is not breathing, open
the airway and reassess. If the patient is
still not breathing tag as expectant and
move on.
!- C-Spine control may have to be
sacrificed in this situation. Do the best
you can…as quickly as you can…
Respirations
• Assess the rate of respirations.
!- If >30 or <8, tag as red and move on
to the next patient.
!- As the triage officer, you do not stop
to ventilate the patient.
Respirations
• If the patient requires simple airway maintenance
you will need to assign someone to this task. If no
EMS personnel are available, remember that you
have a pool of human resources in the green tag
area. If no one there is available, you will need to
improvise by placing something under the patient’s
head/neck to keep the airway open. You may also
consider placing a simple airway adjunct.
Perfusion
• Check for the presence of radial pulses.
However, note that we are not concerned
with a pulse rate at this time. If the patient
has no radial pulses, he is critical and in
immediate need of care. You apply a red
tag to the patient and move on to the next
patient.
Perfusion
• If there are no radial pulses, there is no
need to check for carotid pulses
!- If the patient is breathing, the heart
is beating…if the radial pulses are absent,
the BP is <80-90mmHG and requires
attention from the treatment sector.
Perfusion
• Is there any immediately life threatening
bleeding?
!- Quickly address only life threatening
bleeding. Use the cleanest dressing
material available, and use green tagged
patients to provide pressure.
Mentation (Mental Status)
• Unconscious patients, or patients that can
not follow simple instructions require
immediate attention from the treatment
sector. Tag these patients with a red tag
and move on.
• Patients that can follow instructions may
be tagged yellow.
Putting it all together
• As soon as a patient meets any one of the
criteria for triage as critical/immediate,
you should apply a red tag, delegate
someone to provide rapid treatment (e.g.
maintain an airway or control bleeding),
stop any further assessment and move on
to the next victim.
Putting it all together
• Any patient who makes it through all three
assessments, without any findings that
would result in triaging as
critical/immediate, is given a yellow tag.
Putting it all together
• No triage system is 100% fail safe. It is, however,
reasonable to assume, that a patient who cannot
walk, but is maintaining his own airway, breathing
at a rate less than 30 breaths-per-minute, perfusing
radial pulses, has no sign of uncontrolled bleeding
and follows commands, is in need of medical
attention at the hospital, but can wait until all of
the critical/immediate (red tags) are removed from
the scene.
Summary
• Anyone who gets up and walks to the
designated area is given a green tag
• Anyone who is not breathing is given a
black tag
• Anyone who fails one of the RPM
assessments is given a red tag
• Anyone who cannot walk but passes all of
the assessments is given a yellow tag
A note about MCIs
• Mass Casualty Incidents are stressful
events, that are often overwhelming.
• As an emergency medical care provider,
your are encouraged to seek CISD after
event.
• As an Incident Commander, you are
encouraged to hold after action
debriefings, and make CISD resources
available.