1. Module 3: Triage Unit Leader Triage Crews Porters and Morgue Manager
This module covers the Triage Unit Leader, Triage Crews, Porters, and the Morgue Manager.

2. (1st arriving Engine OIC)
EMS Branch Director
(EMS BC or 3rd arriving EMS Supervisor)
Medical Group Supervisor
(1st arriving EMS Supervisor)
Triage Unit
Leader
(1st arriving Engine OIC)
Treatment Unit
(1st arriving Medic OIC)
Medical Supply
Coordinator
(MCSU OIC)
Patient Transportation
Group Supervisor
(2nd arriving EMS Supervisor)
The Triage Unit Leader is generally the first arriving engine OIC. This position falls under the supervision of the Medical Group Supervisor.

3. First arriving suppression unit after hazards are addressed
The Triage Unit Leader does not have to be an engine company officer.
They could be the first arriving rescue or truck company officer if they arrive after the first engine which is mitigating life saving hazards.

4. 1st arriving Engine Company must assign triage function to another arriving suppression company if they need to engage in suppression related duties and/or have to retain command
If the first arriving engine decides to mitigate hazards or retain command in a fashion which does not allow him to serve as the triage unit leader, this person must assign the task to another arriving suppression company.

5. Identifies Staging Area, stages all units
Identifies Casualty Collection Point (Treatment Area)
Implements Triage
Only essential life saving BLS interventions occur in triage area
Care performed in treatment areas
No EMS Transport Units to Impact Area
Report to Casualty Collection Point (Treatment Area)
Once you have been assigned as the Triage Unit Leader – you must identify a casualty collection point. It is the area where all the walking wounded/green will be directed to by one of your crew members.
You must implement triage.
Only essential, life saving BLS intervention occurs in the triage area. If they can survive, then they are taken to the casualty collection point. Care is performed in the treatment area. No EMS transport units to the impact area.
Your job is to sort and move patients to the casualty collection point. Organization is the key. It is the discipline of these initial arriving units that make an MCI run smoothly.

6. Generally is crew from 1st arriving engine company
Triages patients with triage ribbon
Provides essential life-saving BLS treatment to patients prior to movement as incident conditions dictate
Chaos is the norm in an MCI.
You must maintain discipline. People will be yelling and screaming at you begging for help.
You must provide only essential life-saving BLS treatment and move on to the next patient.
Your job is to sort and move patients safely out of the impact area. This job is done quickly or more slowly depending on the danger to you and the victims – such as secondary devices or an active shooter.

7. Suppression Unit OIC Bring Triage Board Radio Nextel Traffic Vest
Clipboard
Pens
Markers
You need to bring a triage board, radio, Nextel, traffic vest, clipboard, pens, and markers.
Your job is to organize and sort.
It not a glory job, yet it is essential. You help to make sure that this incident runs smoothly.

8. The MCI command boards are placed on all tactical units in the region.
Board #1 is the Triage Unit Leader.
This will be your best friend. Using a very fine point permanent marker works well. You can erase with alcohol prep. Do not use a wide marker. It will make a too much of a mess.
The board is organized with task and objectives to the right.
Write down your triage units. Who are your porter units.
The key is organization and this board will help immensely.

9. Triage Crews – what do we do and how do we do it.

10. Triage Crew Wear Traffic Vest Radio Triage Ribbons Extra Gloves
Hand Lights if needed
Part of the triage crew – you need a calm, cool head.
You need wear a traffic vest, carry a radio, triage ribbons, extra gloves and a hand light if needed.

11. Tie appropriate ribbon around a wrist
Triage ribbons are red, yellow, green and black. Many units in Northern Virginia carry them like the picture. Tie the appropriate ribbon around the wrist or somewhere easily visible.
Ribbons are for Triage areas
Tags are for Treatment areas
Tie appropriate ribbon around a wrist

12. START Triage System.
This is what we use in the Northern Virginia Region.
Respirations, Perfusion, Mental status – RPM.
Your goal is to move the patient population rapidly, get a ribbon on them, and get them out of the impact area.
The ones who will die quickly are “red.” The ones who may die later are “yellow.” Your goal is to organize. If you make the wrong decision, it will be sorted out in the Treatment Area.

13. If they can get up, are walking and talking they are initially Green
If they lying on ground, crying, bleeding, rolling around and cannot get up they are Yellow
If they are lying on ground, unconscious/semi-conscious, SOB, heavy bleeding, shock-like s/s they are RED
No Pulse or Respirations they are Black (DOA)
If you have trouble remembering START – we have START triage for Dummies:
If they can get up and walk and talk – they are initially green. You walk them out of the impact area with a crew member.
If they are lying on the ground, bleeding, and can’t get up, they are “yellow.”
If they are lying on the ground unconscious or semi-conscious, extremely short of breath, heavy bleeding, shock like signs and symptoms – they’re “red.”
If they have no pulse or respiration – they’re “black.”

14. Porters - these are the work horses of triage.
These are the crews moving the patients out of the impact area.
They will move them to the casualty collection point or treatment area.
It may be as simple as walking a group of green patients or carrying heaving, bleeding, screaming patients from the impact area.
It is a very important job and must be done well.

15. If they are Minor
Assign FRD member to them and remove from impact area
Consider moving them out of view of Yellow/Red Treatment areas
Place green ribbon on their wrist
Communicate to Triage Unit Leader number of green tags
Consider transport by bus to various hospitals
Coordinate with RHCC
Re-triage once you have gained control over group
Re-Triage every 15 minutes
The green tags – they are people who can move themselves out of the impact area.
Place a green ribbon on each of them and escort them to a safe area – the casualty collection area.
Escort them, calm them down, gain control of them, reassure of them and keep your eye on them.
Re-triage them every 15 minutes. Adrenaline may be hiding significant injuries.
Green tags don’t always stay green tags.
Communicate your findings to the Triage Unit Leader. Organization and communication is important.

16. Move them from Impact Area to Treatment Areas
Immediate-First
Delayed-Second
Limited Patient Care
Airway Positioning
Bleeding Control
Do not waste time splinting extremity fractures
Use Engine, Truck and Rescue Personnel
Use whatever you can to move patients
Yellow & red – immediate goes first and delayed goes second.
Control their airways and bleeding.
Don’t waste time with splinting fractures.
Do what you need to do to move them quickly and safely out of the impact area.

17. C-Spine Immobilization is nice but goal is to quickly remove viable injured out of Impact Area (Bombing Event, Active Shooter)
C-spine is nice, but the goal is to quickly move the patient out of the impact area.
If there is any threat – bombing, secondary device, active shooter, etc. you move them as quickly as you can.
Try to keep in mind what is going to do them extra harm, but you must move them quickly.

18. Establish temporary morgue away from viable patients
Morgue Manager – you will need to establish a temporary morgue that is not visible to the viable patients.
Make sure it is in a discreet location.

19. Ensure identity of deceased persons is kept confidential
Be ready to accept deceased patients from treatment area
Once police department arrives on scene, turn temporary morgue over
Morgue Manager must ensure the identity of deceased remain confidential.
Make the morgue large enough to receive the initial triage patients, but also for those who may perish on the scene later.
Once the police arrive on the scene, turn the management of the morgue over to them.

20. Temporary morgue may be small.
This is in the back of a truck.
It is a discreet location and not many people can view it.

21. Morgue may be very large.
On this incident, the entire arena is used. There are hundreds of dead.
Whether it is large or small, your job is the same.
You need to organize the deceased and respect their dignity and keep the area in a discreet location.

22. Either way - should be established in secluded area
Keep area off limits to all but authorized personnel
Use place that can be easily secured to limit access
It must be established in a secluded area.
Keep the area off limits to all but authorized personnel.
There should be limited access – the fewer ways in – the better.

23. So be respectful of the dead
At some point during the event, the deceased may be needed to be identified.
Keep areas private and quiet. Be respectful of the dead.
There may be grieving family members and friends going from body to body searching for their loved ones.