Triage

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Triage Jamileh Mokhtari nori, MSN, PhD candidate
Nursing Faculty, Nursing Management Dept.,
Baqiyatallah Medical Sciences University.
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• ????? ?????
• ????? ?????
• ????? ?? ????????? ?? ????? ????
• ????? ?? ????? ????? ?? ?????????
• ????? ?? ????? ????? ??? ?? ?????? ?? ?????????
• ????? ????? START
• ????? ????? MASS
• ??????? ?????? ?????

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?????

• ?? ???? ??????? Trier ?? ????? ?????????
• ?? ???? ???????? Larrey ??? ????? ?? ???? ?????
  ?????? ???? ?? ??????? ????? ???.
• ??? ????? ??????? ????? ?? ??????? ?????
  ??????? ?? ????? ?????

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???? ??? ???????

• ????? ??????? ??? ????? ?????
• Lifesaving Interventions
• (LSIs)

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Lifesaving Interventions(LSIs)

• ??? ???? ??? ????? ?? ?????? ????
• ????? ??????? ???? ?? ??????? ?? ???? ??????
• ???? ???? ?????????? ?? needle

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Triage

• A method of quickly identifying victims who have
  immediately life-threatening injuries AND who
  have the best chance of surviving.

????????? ??????? ? ??????? ? ????? ????? ?????
???? ?? ????? ?? ??????? ?? tagging
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Tagging

• Complements Triage
• Rapid Identification of patient
• Color Coded System
• Plastic bands can substitute tags

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• ???) ?? ????????? ?? ????? ????
• ?) ?? ????? ?????
• ?? ?????????
• ??? ?? ?????????

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????????? ????? ?? ????????? ?? ????? ????
????? ????????? ?????
???????? ????? ??? ?????????? ???? ??? ?????? ???? ????????? Resuscitation /Exigent ???????? ????? (????) ?????? ????
????????? ?????????? ???? ?? ???????? ?? ???? ?? ??????? ?? ????? ????? ??? ??????? ???? Emergent ???????? ???? (???) 5 ?? 60 ????? ????
????????? ?????????? ???? ?? ???????? ?? ???? ?? ??????? ?? ????? ??? ??? ?????? ??? ?????? ??? Urgent ???????? ?????? (???) 4 ?? 6 ???? ????
????????? ?????????? ???? ?? ???????? ?? ???? ?? ????? ?? ????? ??? ??? ??? ????? ??? ?????? ?????? Semi-Urgen ??? ???
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Managing Multiple Casualty Incidents(MCI) The
Hospital/Pre-hospital
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Definition of MCI

• MCI Multiple Casualty Incident Any incident
  where the number/severity of patients exceeds the
  capacity of local resources.

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????? ?? ????? ?????

• ????? ?? ????? ????? ???? ????? ? ??? ?? ????
  ???? ??????? ?? ??? ?????????.
• CPR ????? ????? ???.

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Types of Multiple Casualty Incidents

• Trauma
• Acute Medical
• Biological

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???? ???????? ???? ? ???? ?? ???? ?????????? ??? ????? ??? ??? ??????? ? ???????? ?? ????? ????????? ?????? ??? ??? ???? ????? ????? ? ???? ????? ?? ????? ??????? ??? ????? ?? ??? ???? ??????? ?????? ??. ?????? ??? ???? ????? ??????? ???? ??? ?????????? ???? 45-60 ????? ???? ?????? ??? ???? ???? ??? ????? ????? ???? ?? ??????? ??? ??? ???? ?????? ??? ???????? ???? ???????.
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????? ??? ????? ?? ????? ????? ?? ??? ?? ?????????

• ????? ?????????? ???????? ?? ??? ????? ??????
  ????? ? ?????
• Triage Treatment Transport Zone
• TTTZ
• START
• Simple Triage And Rapid Treatment
• 2. MASS
• Move Assess Sort Send

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START Triage

• 1983 ????? ??.
• ????? ?????? ?? ?? ??? ?? ???? ???? ?? ??? ??
  ???.
• ????? ?? ????? ????? ????? ???? ??? ? ??? ????.
  (RPM)
• Respiratory R
• Perfusion P
• Mental status evaluation M

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S.T.A.R.T. Triage System

• S.T.A.R.T. (Simple Triage Rapid Transport)
• It should not take more than 15 sec/ Pt

• Little or no care needed,
• Delay care, injuries not life-threatening
• Immediate care for life-threatening situation
• No care, mortal injuries, cannot be saved

MINOR
DELAYED
IMMEDIATE
MORGUE
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S.T.A.R.T. Patient Tag

• notes on injuries and vital signs
• decision flow chart (algorithm)
• Note the four color-coded categories at the
  bottom

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START Protocol
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START First Step
Can the Patient Walk?
YES
NO
Evaluate Ventilation (Step-2)
Green (Minor)
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START Step-2
Ventilation Present?
NO
YES
Open Airway
Ventilation Present?
gt 30/Min
lt 30/min
NO
YES
Red/ Immediate
Black
Evaluate Circulation (Step-3)
Red/ Immediate
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START Step-3
Circulation
Absent Radial Pulse
Present Radial Pulse
Control Hemorrhage
Evaluate Level of Consciousness
Red/ Immediate
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START Step-4
Level of Consciousness
Can Follow Simple Commands
Cant Follow Simple Commands
Yellow/ Delayed
Red/ Immediate
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START Protocol
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ActivityTriage Practice Case 1

• A woman runs up to you, supporting her left arm,
  and says, I think its broken.
• Respiratory rate is 24/minute
• Radial pulse rate is 120/minute
• How would you label her?

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ActivityTriage Practice Case 2

• You approach a man who is lying on the ground
• He is taking 36 breaths per minute
• You cannot find a radial pulse
• Capillary refill takes almost 5 seconds
• He moans when you use a painful pinch
• How would you label him?

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ActivityTriage Practice Case 3

• A woman is sitting slumped over, not breathing
• You open her airway still not breathing
• There is no radial pulse
• Her carotid pulse is 30 beats/minute
• She does not respond to noise, touch, or painful
  stimuli
• How would you label her?

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Conclusions

• Triage is a method of quickly identifying victims
  who have immediately life-threatening injuries
  AND who have the best chance of surviving.
• Key elements of the START Triage System are
  Respiration, Perfusion and Mentation.

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MASS Triage

• ????? ?? ??? ??? ???? ????
• Coule Schwartz
• ?? ???? ??????? ???? ??? ???? ? ????? ?? ???????
  ?? ???? ???? ????? ??????? ?????? ? ?????? ?????
  ?? ????.
• ??? ????? ????? ????? ???? ??????? ?? ?? ?????
  ????? ?? ????? ????? ????? ???? ?? ????.

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MASS Triage
?? ????? ??????? ???? ???.
???
???

• ????? ???

?? ????? ??????? ??? ?? ??????? ?? ???? ???.
???
???
????? ?? ????? ???? ? ???????? ???? ????? ???.
????? ???
????? ????
????? ????
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MASS Move Phase

• ?? ??? ??????? ?? ????????? ??? ????? ?????? ??
  ??? ?? ?? ??? ????? ???????.
• ?? ???? ??????? ?????? ?? ??? ?? ?? ??????? ????
  ????? ???? ????? ???? ?? ???? ?? ?? ??
• ????? ?? ??? ??????? ????? ??????? ???? ???
• ?? ???? ?????? ???? ?? ????? ? ????? ?????????
  ?? ???? ???? ?? ??????.

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MASS Assess Phase

• ???????? ?? ???? ??? ???? ????? ? ???? LSIs ?????
  ?? ???.
• ???????? ???? ????? ?? ??? ????? ??? ???? ???
  ????? ? ????? ???????.

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MASS Sort Phase

• ???? ???? ?? ???? IDME
• Immediate Delayed Minimal - Expectant

????? ????????? IDME
???? ???? ?? ?? ?????? ??? ?????. ?????? ?? ?? ??? ??? ???? ????? ?? ???? ?? ????? ??????. Minimal
???? ???? ?? ?????? ????? ??? ??? ?????? ?? ????? ?????? ???? ????? ???. Delayed
???? ?? ???? ???? ????? Immediate
????? ???? ????? ???? ?????? ?? ???? ??? ????? Expectant
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MASS Sort Phase
???? ????????? IDME
????? ???? ????? ????????? ??????? V/S ?????. Minimal
???????? ??? ????? ??????? ????? ??? ? ???? ??? ???????? ?????? ?????? ??? ???? ????? ???? ?? V/S ?????. Delayed
?????? ?????? ??????? ????? ????? ??? ????? ??????? ??? ??? ???? ???. Immediate
?? ???? ????? ????? ????? ???? ???? ?????. Expectant
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MASS Send Phase

• ?????? ??????? ?? ???? ?? ???? (Hot Zone).

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??????? ?????? ?? ??? ???? ???????SAVE

• ?? ????? ????????? ?? ??? ???? ??????? ? ???????
  ????? ?????? ????????? ??????? ?? ??? ??? ?? ????
  ????? ???? ????.
• ?? ?????? SAVE ??????? ??????.
• Secondary Assessment of Victim Endpoint
• ?? ???? 1. ????? ?? ???????? ?? ??? ?????? ? ??
  ??? ??????.
• ??? ???????? ?????? ??????? ??????? ????? ????
  ???.
• 2. ????? ?? ???? ???????? ?? ??? ?????? ? ?? ???
  ??????.
• ????? ????? ?? ???? ??????? ? ?? ?????? ???? ????
  ??????? ???? ???????.
• 3. ????? ?? ?? ???? ?? ??????? ?????? ?? ????
  ????? ??? ???????.
• ??? ???? ??? ??? ????? ???? ????????.

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• ??? ??? ??????? ???? ????? ?? 30 ????? ?? ??
  ???? ????? ?? ????? ?????? ?? ???? (8-50
  ???????)
• ??? ??? ???? ????? 1 ???? ??? ?? ???? ??????
  ???????? ??????(20-50 ???????)? ???? ????? ??
  ????? ???????
• ??????? ?? ???? ???? ??? ??? ????? ?????????.

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• ??????? ?? ???? ????? ?????
• ????? ??? ??? ?????

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• ???? ?????? ?? ??????
• ????? ?? ??? ??? ??????
• ????? ?? ??? ????? ??? ?? ?????? ???? ? 6 ???
  ??? ?? ??? ???????
• ????? 4 ???? ?????? ??? ????? ? ?? ???? ??
  ????? ?????? ????? ?????
• ????? ???? ?????? ??????? ?? ??????

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• ??????? ???????? ??? ?????? ?? ????? ?
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• ??????? ???? ?????? ?? ??????? ??? ? ????
• ??????? ???? ??? ?????? ?? ???? ????? ? ????
  (???? 60 ?????)

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??????? ?????? ??? ????? ?????

• ?????? ??????? ???? ???? ?? ??
• ????? ??? ? ??????? ??? ?? ????? ??????? ? ????
  ?? ????? ? ????????? ????? ????
• ?? ????? ????
• ??????? ?????? ?????? ????
• (??????? ???? ????? 3 ?????)
• (??????? ?? ?? 1 ?????)

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1.Check ABC

• Check ABC
• Continue spinal immobilization
• Assess mental status
• Assess the head

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2.Assess the neck

• Crepitus
• subcutaneous emphysema
• broken bone rub (1 2)
• Deformity, Tenderness, Bleeding

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3.Apply a cervical collar
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4.Assess the chest

• Injury or signs of trauma
• Tenderness
• Swelling
• Retractions
• Breath sounds (front)

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5.Assess the abdomen

• Obvious injuries
• Bruising
• Bleeding
• Tenderness
• Do not palpate obvious soft-tissue

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6.Assess the pelvis

• Obvious injury, bleeding, deformity
• Tenderness
• Do not rock

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7.Assess the extremities

• Check pulse and circulation
• Check motor function
• Check sensory function

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8.Assess the back

• Tenderness
• Deformity
• Open wounds
• Bleeding

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9.Assess Baseline Vitals

• Reassess V/S every 15min
• If unstable every 5 min

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