Triage

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Chapter 28

• Triage

2
Objectives (1 of 2)

• Explain the purpose, use, and benefits of the
  triage process.
• Describe the four-colored categories used in
  primary triage.
• Summarize the four steps of the START system for
  triage.
• Describe methods of identifying triage categories.

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Objectives (2 of 2)

• Describe the sequence of emergency care for a
  single patient with multiple injuries.
• Given a scenario of a mass-casualty incident,
  perform triage correctly using the START
  algorithm.

4
Triage

• Assessment of multiple injured patients
• Multiple-casualty/mass-casualty incident (MCI)
  refers to a situation with more than one patient.
  
• Incidents may overtax resources.
• Safety is your primary concern!
• Situations could include avalanche, lift
  accident, vehicle crash, earthquake, terrorist
  attack, etc.

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The Triage Process

• Sorting two or more patients to provide the best
  outcome for the greatest number
• Patients ranked by severity
• Patients marked to reflect ranking
• Triage officer assigns rescuers and equipment to
  priority patients.

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Remote Locations

• In remote locations, triage may require
  modification due to
• Manpower
• Weather
• Equipment
• Communications
• Terrain, including distance from definitive care

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5 Ss of Triage

• Safety assessmentscene safety
• Scene size-upMOI, patients, injuries, access
• Sendinformation to dispatcher and request
  resources
• Setting up sceneestablish triage points and
  obtain tags or ribbon
• STARTa type of triage process

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Triage Priorities Red(Four-Color System)

• Highest or first priority, usually injuries to
  the circulatory or respiratory system
• Probable survival with immediate care and
  transport.
• Usually includes
• Hypoxia or shock, present or imminent
• Major external or internal hemorrhage

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Triage Priorities Red(Four-Color System)

• Respiratory distress due to flail chest, sucking
  chest wound, pneumothorax, upper airway
  obstruction, or burns
• Pericardial tamponade
• Head injuries with progressive deterioration,
  altered mental status
• Medical emergencies such as AMI, poisoning,
  diabetic hypoglycemia

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Triage Priorities Yellow(Four-Color System)

• Second or delayed priority, usually with
  musculoskeletal or nervous system injuries
• Able to survive a wait of 45 minutes or longer
• Lesser chance of survival than RED
• Greater need of resources than RED

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Triage Priorities Yellow(Four-Color System)

• Usually includes
• Severe burns without respiratory distress
• Spinal injuries
• Multiple fractures
• Pelvic or femur fractures without shock

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Triage Priorities Yellow(Four-Color System)

• Usually includes
• Open fractures
• Stable abdominal injuries, including open
  injuries without shock
• Eye injuries
• Stable head or chest injuries

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Triage Priorities Green(Four-Color System)

• Third or lowest priority, usually walking
  wounded or with no life-threatening injuries
• Uninjured and present at an MCI scene
• Usually includes patients with minor burns

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Triage Priorities Green(Four-Color System)

• Usually includes
• Single, closed fractures
• Localized soft-tissue injuries
• Psychological problems

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Triage Priorities Black(Four-Color System)

• Nonsalvageable patients, dead patients, patients
  who will die even with care
• Usually includes
• Cardiac arrest
• Respiratory arrest with an open airway
• Massive head, chest, or abdomen injuries
• Total body burns (gt90)

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Triage Tags

• Rolls of red, yellow, green, and black surveyors
  ribbon
• Preprinted tags with tear-off sections
• Tape with color initial affixed to forehead

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The START System

• Simple Triage And Rapid Treatment
• Begins by having all walking wounded move
  outside triage area to safety
• Based on a 15- to 30-second assessment of each
  remaining patient
• Assesses RPMrespirations, pulse, and mental
  status.
• Tracks the total numbers of patients.

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The START system

• Step 1
• Get up and walk GREEN
• Step 2
• Open airway and assess respirations
• 0/min BLACK
• gt 30/min RED
• lt 30/min Step 3

• Step 3
• Radial pulse check
• Absent RED
• Control bleeding
• Present Step 4
• Step 4
• Assess mental status
• Altered RED
• Appropriate YELLOW/GREEN

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Secondary Triage

• Move patients from a triage area to treatment
  area for care and transport.
• Reassess all RED patients to allocate limited
  resources and personnel.
• Recategorize patients as status changes (ie,
  YELLOW to RED or RED to BLACK).
• Triage tags can be used to record patient
  information.

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Triage Tags
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Special Triage Situations

• Injured rescuer
• Injured relative
• Injured child
• Disruptive patient or witness
• Lightning
• Hypothermia

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Patients with Multiple Injuries

• Golden Hourthe time from injury to definitive
  care during which treatment should occur to
  maximize survival
• Use assessment to prioritize treatment.
• Maintain airway, support ventilations with O2,
  control hemorrhage, place on backboard, treat
  shock, and arrange timely transport.
• Seamless interface with local ALS is essential.