Module 5: Triage 1 st. Responder’s Guide 6-15

Medical Triage focuses on “symptoms, not aspect”

Triage Unit Triage Means “To Sort” –A process for sorting injured people into groups based on their need for immediate medical treatment and transport Clear and assemble the walking wounded using verbal instructions Primary triage assesses respiration, perfusion, and mental status RPM Secondary triage is a more in-depth assessment usually conducted in the Treatment Unit

Triage Unit Determine location of triage areas Conduct Primary triage, ensure all patients are assessed and sorted using appropriate triage protocol Communicate resource requirements

Simple Triage and Rapid Treatment S.T.A.R.T

Triage Ribbon

S.T.A.R.T Triage Method AMBULATORY PATIENT Breathing Open Airway Breathing IMMEDIATE Perfusion IMMEDIATEEXPECTANT IMMEDIATE Mental Status Inappropriate IMMEDIATE NOYES 30/min NOYES UNDEROVER NOYES NO YES Appropriate DELAYED CONTROL BLEEDING MINIMUM

Triage Tag Functions: Alert care providers to patient priority Prevent re-triage of the same patient Serve as a tracking system

“All Risk” or “All Hazards” Tag

The New Generation of “All Risk” Triage

Disaster Management Systems All Risk TRIAGE TAG

Features of the All Risk Tag Adopted By MMRS & CalChiefs/Standardization All Risk- Contaminated/Non- Contaminated Tracking Capabilities Waterproof Synthetic Paper Evidence Identification Personal Property Accountability Primary/Secondary Decon

Risk Management Features Reliability Tag Construction Increased shelf life/Mold and Mildew proof Impervious to fluid application Dependability Produced by Field Personnel for Field Personnel Field Tested Accountability Improved patient tracking Evidence tagging Personal property identification/tracking

The “Contaminated” strip has three main 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 Third to aid rescuers with identifying clothing (evidence) belonging to victims

HazMat First Responder Operational Considerations Contamination Hazard YES Initiate Primary Decon Strip & Bag Evidence Tag Patients Treatment of Symptomatic Patients as Needed Initiate Secondary Decon Triage Move to Treatment Track Transport NO Remove Contaminated Strip Initiate START Triage Treatment Tracking Transportation

HazMat First Responder Operational Considerations Contamination Hazard NO Remove Contaminated Strip Initiate START Triage Treatment Tracking Transportation

HazMat First Responder Operational Considerations Contamination Hazard YES Initiate Primary/Gross Decon Treatment of Symptomatic Patients as Needed Initiate Secondary/Tech Decon Triage Move to treatment Track Transport Strip & Bag Evidence Tag Patients

APPARATUS PLACEMENT Medical Treatment Area Medical Triage SRA Exclusion Zone Safe Refuge Area Support Zone Primary/Gross Decon Strip, Bag & Tag Area Mass Decon Corridor

Personal Property Accountability 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..) 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 Front Back

Evidence Collection/Identification After a victim's clothing has been removed and placed into an airtight CLEAR plastic bag, the CONTAMINATED tear off strip is placed inside the bag face out

Patient Triage

Patient Accountability

Patient Treatment XX XX XX XX Peds/Burns/Neuro/etc…

Patient Documentation Standard documentation format Addresses Patient Treatment

Transport & Tracking Front Back Accurate Patient accountability with or without Technology Designed to utilize latest in software and hardware applications Scanner is a multi-purpose device Electronic Pt tracking Equipment inventorying capable Gray scale digital camera Take photos of special inventory caches Mechanism of Injury Versatility: can be used by field and hospital providers and law enforcement

Hospital Identification & Tracking Hospitals have difficulty tracking by the Triage Tag number Utilize hospital ID bracelet and appropriate remaining category receipt Reduces risk of losing patient assigned field triage number for continued accountability Special Note***

The New Generation of All Risk Designed For Today's Emergency Service Needs By Today's Emergency Service Leaders

Staging Area Location designated to collect available resources near incident area Several staging areas may be required Should be easy for arriving resources to locate Staging area may need to be relocated as the situation dictates

Level II Staging

Mass Casualty Triage Exercise 1

Mass Casualty Trauma Exercise 1 Its 7:45 am on a Thursday in August the weather is clear, temperature is 90 degrees. At a local airport a commuter plane with 40 passengers on board begins speeding down the runway. As the plane lifts off and the landing gear retracts, a catastrophic equipment failure causes the aircraft to crash in a field just north of the airport. Upon impact the plane is torn apart, the debris field is 100 yards long.

Mass Casualty Exercise 1 What resources do you have available to respond? What are the priorities at this phase of the response? How will the services of the responding agencies and jurisdictions be coordinated? What agency will assume Incident Command? How will you deal with the public? for Discussion STOP

Mass Casualty Exercise 1 7:49 Emergency dispatchers advise that multiple calls are coming in from witnesses who state there are people everywhere. 7:54 Your unit is the first on scene. You see great devastation but there are survivors in the field. 7:55 People are walking toward your unit. STOP What is your plan of action?

Mass Casualty Exercise 1 Your partner assumes Incident Command while you begin triage operations. Triage the next 5 patients Remember - RPM

Patient states he can’t move or feel his legs Respirations are 26 Pulse is 110 (Radial) He is awake and oriented What Triage Category?

Patient states he can’t move or feel his legs Respirations are 26 Pulse is 110 (Radial) He is awake and oriented Delayed

Patient is soaked with blood no obvious killer bleed Respirations are 38 Pulse is weak, no radial He is awake What Triage Category?

Patient is soaked with blood no obvious killer bleed Respirations are 38 Pulse is weak, no radial He is awake IMMEDIATE

Patient walks over to you and has an obvious broken arm Respirations are 22 Pulse is 124 (Radial) He is awake, alert, and crying What Triage Category?

Patient walks over to you and has an obvious broken arm Respirations are 22 Pulse is 124 (Radial) He is awake, alert, and crying Minor

Patient is face down in the field Not Breathing Weak Carotid Pulse She is unresponsive Open The Airway

Patient gurgles but can’t maintain an open airway and Is not breathing Weak Carotid Pulse She is unresponsive What Triage Category?

Patient gurgles but can’t maintain an open airway and Is not breathing Weak Carotid Pulse She is unresponsive Morgue

Patient has an open head Wound, bleeding controlled Respirations are 16 Pulse is 88 (Radial) He is unconscious What Triage Category?

Patient has an open head Wound, bleeding controlled Respirations are 16 Pulse is 88 (Radial) He is unconscious IMMEDIATE

Chemical Triage

CHEMICAL AGENTS PERSONAL SAFETY IS STILL THE NUMBER ONE PRIORITY

MEDICAL TREATMENT MARK I kit consists of a: 2 mg. Atropine Injector and a 600 mg. 2-PAM Injector (Pralidoxime) 600 MG PRALIDOXIME 2 MG ATROPINE

SIGNS AND SYMPTOMS OF CHEMICAL NERVE AGENT EXPOSURE SLUDGEM + Respiratory Distress and Agitation

S = Salivation L = Lacrimation (tearing) U = Urination D = Defecation / Diarrhea G = Gastrointestinal Distress E = Emesis (vomiting) M = Muscle Twitching S L U D G E M

Respiratory Distress = shortness of breath wheezing pulmonary secretions Agitation = confusion combativeness seizures

TRIAGE OF CHEMICAL NERVE AGENT CASUALTIES NON-VIABLE Black CRITICAL EXPOSURE Red MODERATE EXPOSURE Yellow ASYMPTOMATIC Green

NON-VIABLE: After Noxious Stimulus Triage (NST) If there is no movement, then the patient is black tagged. No care is provided. Black tagged in the HOT ZONE by trained personnel in Level A Haz Mat suits

CRITICAL - SEVERE EXPOSURE: These are non-ambulatory victims who are exhibiting signs and symptoms of SLUDGEM: severe respiratory distress, altered mental state or seizures. Red tagged in the HOT ZONE by trained personnel in Level A Haz Mat suits

MODERATE EXPOSURE: These are ambulatory victims that are exhibiting signs and symptoms of SLUDGEM and respiratory distress to a limited degree Yellow tagged in the COLD ZONE by field personnel after being decontaminated by trained personnel

ASYMPTOMATIC: Patient is not exhibiting any signs or symptoms of exposure. Patient must be observed. No treatment is provided initially. Green tagged in the COLD ZONE by field personnel

Mass Casualty Triage Exercise 2 Triage these patients Remember! SLUDGEM Respirations Mental Status

Patient is exhibiting shortness of breath, SLUDGEM and has an altered mental status What Triage Category?

CRITICAL - SEVERE EXPOSURE Red tagged in the HOT ZONE by trained personnel in Level A Haz Mat suits

After Noxious Stimulus Triage (NST), there is no movement from the patient What Triage Category?

NON-VIABLE The patient is black tagged. No care is provided Black tagged in the HOT ZONE by trained personnel in Level A Haz Mat suits

What Triage Category? Victim is exhibiting signs and symptoms of SLUDGEM and respiratory distress to a limited degree

MODERATE EXPOSURE Yellow tagged in the COLD ZONE by field personnel after being decontaminated by trained personnel

What Triage Category? Patient is not exhibiting any signs or symptoms of exposure.

ASYMPTOMATIC: Patient must be observed. No treatment is provided initially. Green tagged in the COLD ZONE by field personnel

What Triage Category? Patient is having seizures, wheezing, and exhibiting signs of SLUDGEM

CRITICAL - SEVERE EXPOSURE: Red tagged in the HOT ZONE by trained personnel in Level A Haz Mat suits