Centre for Trauma, Conflict & Catastrophe Jim Ryan

Triage – Principles & Pressures Conflict & Catastrophe Course Society of Apothecaries 6 October 2018 Triage – Principles & Pressures

To see where triage fits into the care pathway of the trauma victim Learning Objectives To define triage To see where triage fits into the care pathway of the trauma victim To differentiate between the 3 triage systems in use To understand triage in action To recognise the danger of under and over triage

Chapter 29 – Course Handbook, Part B Trauma & Triage 418-420 Associated Reading Chapter 29 – Course Handbook, Part B Trauma & Triage 418-420 Triage – Principles & Pressures – JM Ryan Eur J Trauma & Dis Med, 2008;34:427-432

Triage, derived from the French verb trier, and is the process by which treatment and transport priorities are allocated to patients

Jean Dominique Larrey Surgeon to Napolean’s Imperial Guard

The aim of triage is to get the right patients to the right care in the right way at the right time

Principles of care – conflict & catastrophe Shared care – Time & place Triage – for resus, surgery & evac Forward surgery – cannot wait! The wound operation is staged First - wound excision – then DPS (C) Ist op at 2nd or 3rd Role

Pressures Time factor Early access Minimalist approach at scene Accurate triage Rapid transport Stop the bleeding – changing role of IV fluids

Triage Systems Physiological Anatomical Both

Triage - Variants Resuscitation Triage Surgical Triage Transfer (Evacuation) Triage

Priority Colour Label Immediate Red P1 T1 Urgent Yellow P2 T2 Delayed Triage Systems Priority Colour Label Immediate Red P1 T1 Urgent Yellow P2 T2 Delayed Green P3 T3 Expectant Black/green T4 Dead White/black T0

Multiple casualties Mass casualties

P Table Cannot wait Urgent but can be stabilised for a time (30-60 mins) Can tolerate long delay P1 Immediate priority P2 Second priority P3 Delayed treatment

T Table T1 Immediate T2 Urgent T3 Non urgent T4 Expectant Rapid treatment possible & good prognosis for survival Severe injuries but can wait (30/60 mins) Minor injury & can tolerate indefinite wait Severe multisystem injury, time consuming, prognosis?

Triage – Time & Place Different Environments

Majax - Environment Primary triage outside Circuits Avoid ‘contamination’ Flexibility

Triage & Documentation

Triage in UK – Method in Outline Sieve Sort Manage Move Hospital triage Management by priority Evacuation triage

Triage WALKING BREATHING RESPIRATORY RATE CAPILLARY REFILL Y PRIORITY 3 (delayed) N N BREATHING DEAD After airway opening Y < 10 > 30 RESPIRATORY RATE PRIORITY 1 (immediate) 10 to 29  2 sec < 2 sec CAPILLARY REFILL PRIORITY 2 (urgent)

Triage Undertriage Overtriage

Training & Exercises

Summary The most for the most Multi-system injury Combined injury Resuscitative surgery Didactic approach Shared care