MASS Triage Scenario -Introduction of instructor -Can everyone hear me? (adjust microphone/close doors) -Can everyone see the screen? (adjust focus/lighting) -Announcement of first lecture topic -students may follow along in their textbooks....Chapter 1

Objectives During a facilitator led mass casualty scenario-based discussion you will: Discuss DISASTER paradigm List components of MASS triage Identify victim triage categories At an MCI, all patients cannot be treated at once……… thus the need for a systematic method to quickly determine which patients need treatment most urgently the goal is to help as many patients as possible with the available resources the amount of help that can be given is of course dependent upon available resources………fewer resources will equate to treatment delays/omissions for more victims

Triage “Tabletop”

Triage Scenario Shooting incident at a local shopping center Multiple gunshots were fired You are first at the scene 10 victims What do you do?

Is Need > Resources? D- Detect I- Incident Command Is this a disaster / MCI? (need>resources) I- Incident Command Who is in charge? (incident commander) Who will you contact? S- Scene Safety/Security Is it safe enough to enter? A- Assess Hazards Active shooter? Secondary device? Further penetrating trauma S- Support Law enforcement, EMS, Medical Control, Trauma Center, etc.. T- Triage/Treatment 10 victims E- Evacuation What vehicles are available? What route is safe? R- Recovery

D-I-S-A-S-T-E-R Paradigm Triage M.A.S.S. Triage System M – Move A – Assess S – Sort S – Send MASS is an easy-to-remember acronym for; MOVE ASSESS SORT SEND “MASS” may be thought of as also referring to MASS casualty incident

MASS Flow Chart

Step 2: M.A.S.S Triage Move Assess Sort Send What are the two action steps? Assess Who are you going to approach first? Sort How will you categorize your patients? Name the three variables impacting decision making? Send When and what transportation methods are available? This is a summary of the MASS triage method it is basically this simple…….just do what it says on this slide and you have accomplished MASS triage this can be done reasonably well even by non-medical personnel (ie. Police, firefighters, etc…) this exact same method is used in CDLS as well as ADLS…….everyone should be able to easily accomplish the triage (alone or working together) if they have been trained in one of these classes MASS Triage is based on research which shows that the motor component of the Glasgow Coma Scale is the best predictor of mortality for trauma patients. Of importance is the distinction between the intial triage group and the patients final triage category that has been assigned. Although a patient may have been grouped into the minimal intial triage group, upon individual assessment they may be foind to have a life threatening condition that requires immediate attention. This patient would therefore be triaged as an immediate patient, despite their initial grouping as a minimal patient. <<THIS IS A VERY IMPORTANT POINT TO MAKE>>

MASS Triage Move Assess Sort Send Two walk Three move Five do not move IDME categories Send

MASS Triage Move Assess Sort Send Two walk (Minimal Group) Three move (Delayed Group) Assess Five do not move (Immediate Group) Sort IDME categories Send

Triage Status Immediate 5 Delayed 3 Minimal 2 Expectant DEAD Category Group Immediate 5 Delayed 3 Minimal 2 Expectant DEAD  These are the 4 triage categories that are used in MASS triage “ID-me” is the acronym used to teach these categories each category is associated with the color it is printed in here this color coding can be helpful in organizing/sorting patients and the scene

MASS: Immediate Group Unable to “MOVE” 29 yr male GSW to left chest, awake in severe respiratory distress 8 yr female GSW to head (through and through) RR=4, HR=101 50 yr male GSW to abdomen & chest, RR=0, HR=0, not moving 40 yr female GSW to neck with gurgling respirations, marked respiratory distress 16 yr male GSW right chest, No respiratory effort, HR=130 thready Immediate Expectant Dead Immediate Immediate Vs Expectant

MASS: Delayed Group Able to “MOVE”, not walk 14 year male GSW to R upper arm, active massive hemorrhage, good pulses 65 year male No obvious GSW, c/o severe chest pain, diaphoretic, and SOB 22 year female GSW to R leg, good pulses, no active bleeding, normal VS Immediate Delayed **after pressure dressing Immediate Delayed

MASS: Minimal Group Able to “MOVE”, can walk 29 yr male Superficial “scratch” wound to L arm, no deeper penetration 37 yr male GSW to left hand, exposed muscle, tendon and bone fragments, capillary refill < 2 sec Minimal Delayed

Triage Status Immediate 5 4-5* Delayed 3 2 Minimal 2 1 Expectant 1-2* Category Group SORT Immediate 5 4-5* Delayed 3 2 Minimal 2 1 Expectant 1-2* DEAD  1 These are the 4 triage categories that are used in MASS triage “ID-me” is the acronym used to teach these categories each category is associated with the color it is printed in here this color coding can be helpful in organizing/sorting patients and the scene

SORT: Immediate Delayed 29 yr male 40 yr female Dead 14 year male GSW to left chest, awake in severe respiratory distress: Needle decompression of L chest successful, VSS 40 yr female GSW to neck with gurgling respirations, marked respiratory distress: Airway management unsuccessful, profuse bleeding occurred, pt now apneic and pulseless 14 year male GSW to R upper arm, active massive hemorrhage, good pulses: Now well controlled, no active bleeding, VSS 65 year male No obvious GSW, c/o severe chest pain, diaphoretic, and SOB: Symptoms continue Dead Delayed Immediate

SORT: Delayed 22 year female 37 yr male Delayed Immediate GSW to R leg, good pulses, no active bleeding, normal VS: Splinted leg, VSS 37 yr male GSW to left hand, exposed muscle, tendon and bone fragments, initial capillary refill < 2 sec: Now L hand is pulseless and cyanotic Delayed Immediate

SORT: Minimal 29 yr male Minimal Superficial “scratch” wound to L arm, no deeper penetration: No clinical change, desires to leave and go home Minimal

SORT: Expectant 16 yr male 8 yr female Dead GSW right chest, No respiratory effort, HR=130 thready: Now no palpable pulse, no respiratory effort 8 yr female GSW to head (through and through) RR=4, HR=101: RR=6-8, HR=100 Dead Immediate?

Triage Status Immediate 5 4-5* 3 Delayed 3 2 3 Minimal 2 1 1 Category Group SORT SORT Immediate 5 4-5* 3 Delayed 3 2 3 Minimal 2 1 1 Expectant 1-2* 0 DEAD  1 3 These are the 4 triage categories that are used in MASS triage “ID-me” is the acronym used to teach these categories each category is associated with the color it is printed in here this color coding can be helpful in organizing/sorting patients and the scene

Summary Now you can: During a facilitator led mass casualty scenario-based discussion you can Discuss DISASTER paradigm List components of MASS triage Identify victim triage categories At an MCI, all patients cannot be treated at once……… thus the need for a systematic method to quickly determine which patients need treatment most urgently the goal is to help as many patients as possible with the available resources the amount of help that can be given is of course dependent upon available resources………fewer resources will equate to treatment delays/omissions for more victims

Questions?