Unit #3-Triage Objectives 1. Identify the “killers.” 2. Apply techniques for opening airways, controlling bleeding, and treating for shock. 3. Conduct triage under simulated disaster conditions.

Safety / Health Considerations Remember Rule # 1! Assess the situation…. Avoid contact with body fluids…. Wash hands frequently using soap and water Wear medical gloves; change after each patient. Wear a mask and goggles. Keep bandages/dressings sterile. Discard infectious materials properly.

THE GOOD OF THE MANY OUTWEIGHS …. What is Triage? Triage (n, v) from the French ~~~ means = to Sort (circa 1918) CERT goal in a disaster situation – where victims overwhelm 1st responders – is to treat as many as possible; as efficiently as possible THE GOOD OF THE MANY OUTWEIGHS ….

Treatment of Life-Threatening Conditions The “Killers”: Airway obstruction- Lack of oxygen intake can lead to brain damage or death in a very few minutes. Bleeding, excessive- Life cannot continue without an adequate volume of blood to carry oxygen to body tissues. Shock- Unless shock is prevented or treated, death may result even though the injury would not otherwise be fatal.

Opening The Airway A patient with suspected air way obstruction must be treated immediately. Common obstruction is the tongue. Steps in Opening Airway: (Spinal Damage ? - Head - Tilt/Chin Lift Method) 1. Shake the patient by touching the shoulder and shout “ Can you hear me”. 2. No response, place fingers on each side of jawbone and lift up. 3. Look for chest rising. 4. Listen for air exchange. 5. Feel for abdominal movement. NO 2nd Response - MOVE ON

Controlling Bleeding - Types ARTERIAL bleeding is bright ,oxygen-rich red blood, under pressure, which spurts from the wound. VENOUS bleeding is dark, oxygen poor blood flows from a wound in a steady stream. CAPILLARY bleeding is dark red blood which tends to ooze from a wound. Arterial Venous Capillary

Controlling External Bleeding Wear disposable gloves to protect against disease Direct pressure stops most bleeding. Place a sterile gauze pad or a clean cloth over the wound. If bleeding does not stop in 10 minutes, press harder over a larger area. If bleeding persists, use elevation combined with direct pressure over the wound.

Controlling With Bleeding Using Pressure Points Form the arm, Compress the Brachial artery. For the leg, compress the Femoral artery

Recognizing & Treating For Shock Shock is the results of insufficient oxygenated blood being delivered to every part of the body. This creates irreversible damage to the body. Systems of Shock: 1. Rapid, shallow breathing ( rate greater than 30 per minute). 2. Cold, pale skin ( capillary refill greater than 2 sec. 3. Extreme thirst 4. Anxiety 5. Failure to respond to simple commands, <===== such as “Squeeze my Hand.” Cont. next slide

Recognizing & Treating For Shock Treatment for Shock: 1. Lay patient on his/her back. 2. Elevate the feet 6 - 12 inches. ( No signs of head or back injury). 3. Maintain body temperature ( e.g., cover the ground and patient with a blanket). 4. Maintain airway. 5. Control Bleeding. DO NOT give a patient anything to eat or drink. (Patient in shock often vomit)

S.T.A.R.T. System of Triage START – Simple Triage and Rapid treatment Provides an rapid approach to triage a large number of patients. 60 Second assessment of patient based on: 1. Respiration “A” 2. Circulation “B” 3. Mental Status “S” Uses plastic stripes or ribbons (placed on wrist). 1. Red - Immediate Care 2. Yellow - Delayed Care 3. Green - Ambulatory ( minor) 4. Black – Dead Video===PC

Professional Responders use Tags

START STEPS Call out for ‘walking wounded’ [GREEN] Triage the nearest victim [60 seconds] Treat life-threatening situations [ABS] Move on to next victim Report findings to ICS ICS – assign transport teams to Medical treatment area

AMBULITORY( Green -Minor ) S.T.A.R.T. - Simple Triage& Rapid Treatment START Where You Stand Assess the Scene Callout to patient for Assistance Determine Safety Call Out Walking Wounded & Uninjured Non - Walking Adult Respiration's Rate (12 – 20 Breaths/Min.) RESPIRATIONS AMBULITORY( Green -Minor ) YES NO Hold in a Specific Location Position Airway Look, Listen & Feel Over 30/Min. or Under 10/Min. Under 30/Min. or Over 10/Min. Remember to Fully TRIAGE ASAP Blood flow through organs and tissues of the body IMMEDIATE (Red) PERFUSION NO Blanch Test: Pinch nail Bed; Color should return In less than 2 seconds Reposition Airway Adult Pulse 60 – 100/ min. Radial Pulse Capillary Refill NO Absent Present Under 2/Sec. Over 2/Sec. DEAD ? IMMEDIATE (Red) IMMEDIATE (Red) MENTAL STATUS IMMEDIATE (Red) Follows Simple Commands Can’t Follow Simple Commands DELAYED (Yellow) IMMEDIATE (Red)

If Respirations <30, Capillary refill <2, Alert = Yellow TRIAGE Simplified Rule # 5: Thirty, two, How are you? Walking wounded – GREEN Respirations Greater 30 – RED No Respirations? Airway reposition. Now Breathing? RED No result- BLACK 4. Capillary refill > 2 seconds; excessive bleeding? RED 5. No Simple commands (squeeze hand)? RED If Respirations <30, Capillary refill <2, Alert = Yellow

Triage Practice examples Exercise Questions

Triage Pitfalls No team plan, organization, or goal Indecisive leadership Too much time/focus on one injury/victim Treatment (rather than triage) performed

Review: Triage Three killers: A, B, S Use START technique – 30,2,How are you? Call out for “Walking wounded” A – Reposition airway B – Direct pressure C – Simple command Report to ICS for victim transport