1. 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

2. 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

3. Triage “Tabletop”

4. 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?

5. 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

6. 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

7. MASS Flow Chart

8. 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>>

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

10. 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

11. 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

12. 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

13. 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

14. 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

15. Triage Status Immediate 5 4-5* Delayed 3 2 Minimal 2 1 Expectant 1-2*
Category Group SORT
Immediate *
Delayed
Minimal
Expectant *
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

16. 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

17. 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

18. 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

19. 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?

20. Triage Status Immediate 5 4-5* 3 Delayed 3 2 3 Minimal 2 1 1
Category Group SORT SORT
Immediate * 3
Delayed
Minimal
Expectant * 0
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

21. 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

22. Questions?