1. Centre for Trauma, Conflict & Catastrophe Jim Ryan

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

3. 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

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

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

6. Jean Dominique Larrey
Surgeon to Napolean’s Imperial Guard

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

8. 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

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

10. Triage Systems
Physiological
Anatomical
Both

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

12. 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

13. Multiple casualties
Mass casualties

14. 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

15. 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?

16. Triage – Time & Place Different Environments

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

24. Triage & Documentation

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

28. 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)

29. Triage
Undertriage
Overtriage

30. Training & Exercises

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