1. 1 Triage Pakistan ICITAP

2. Learning Objectives Define triage Know the principles of triage Know the categories of triage Know what is mass casualties (MASCAL) 2

3. Introduction As Police Officers, you will be need to know how to triage victims from injuries resulting from accidents, combat and blast injuries These victim must be treated at a medical facility as soon as possible A knowledge of first aid can often mean the difference between life and death 3

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5. Triage 5 French: “to sort” The sorting of casualties by order of priority Triage applications  Terrorist attacks  Urban Mass Casualty Incidents  Natural disasters

6. Principles of Triage Greatest good for the greatest number of casualties Employ the most efficient use of available resources Return personnel to duty as quickly as possible 6

7. Plan Ahead Secure a plan or Standard Operating Procedure (SOP) to mitigate Triage and MASCAL's Identify areas of responsibility, evacuation and treatment procedures, communications, and other essential procedures 7

8. Let the Most Experienced Lead The Operator with the greatest medical training and experience should be Triage leader, regardless of rank or position Do not allow petty power concerns get in the way of good casualty care 8

9. Triage Categories Immediate (Category I) Delayed (Category II) Minimal (Category III) Expectant (Category 0) (Dead or Dying) 9

10. /Category I Immediate/Category I The highest priority, referring to the urgent nature of the casualty Implies the need (within minutes to an hour) intervention to save life, limb, or eyesight Not all critically ill or injured casualties are Immediate 10

11. Triage Examples of immediate victims who need immediate care:  Bleeding that is not controllable except with a tourniquet  Airway or Respiratory problems not easily fixable or maintainable for a long period of time  Weak, thready pulse (signs of shock)  ALOC (altered level of consciousness) 11

12. Delayed/Category II Second priority referring to the need for treatment (usually surgery) that is required but can wait for a few hours 12

13. Triage Examples of victims that may have delayed treatment:  Airway or Respiratory problems that have been fixed and are maintainable for a period of several hours  Bleeding that has been controlled  Amputees with bleeding controlled with tourniquet  Pulse rate has returned to normal after short IV therapy  Brief period of unconscious or ALOC, now following commands 13

14. Minimal/Category III Those casualties with minor problems requiring medical attention, but whose condition is unlikely to deteriorate over the next several hours to days 14

15. Triage Examples of victims that may need minimal treatment:  Victims with no CBA or mental status problems  Lacerations with controlled bleeding  Strains, sprains, abrasions  Simple extremity bone fractures  Femur, pelvis, spinal, facial fractures are NOT included in this category 15

16. Expectant/Category 0 Last category, where casualties are so gravely ill or injured that survival is unlikely These casualties are expected to die 16

17. Triage Examples of victims that are expectant:  Separation of pt from any vital organ  Respiratory arrest  No breathing after opening airway  Cardiac arrest  Massive head injury 17

18. Do Not Second-Guess Trust your medical instincts Do not go back to re-triage until all casualties have been triaged Remember the goal, the greatest good for the greatest number of casualties 18

19. Triage Mass casualty (MASCAL) situations occur when the number of casualties exceeds the available medical capability to rapidly treat and evacuate them MASCAL’s overwhelm the available medical resources and require the use of Triage to set casualty priorities 19

20. Triage The actual number of victims required before a MASCAL situation is declared changes from situation to situation depending upon the availability of medical resources Technically, a MASCAL situation occurs if a medic has more than one seriously injured victim to be cared for at one time 20

21. Start Triage If patient is in the Immediate (Category I) upon your initial assessment:  Treat only for uncontrolled bleeding or to correct airway blockage before moving on to next patient 21

22.  Start triaging wherever you happen to be at the time:  First - clear the walking wounded using verbal instructions  Direct them to the treatment areas for detailed assessment and treatment  These Patients are triaged MINOR Starting Triage 22

23. Triage for RPM (Respiration/Pulse/Mental Status) Respiration's : If none - open the Airway Still none present? - Deceased Restored?- Immediate care (triage) Respiration present? Above 30 – Immediate care (triage) Below 30 - Check pulse 23

24. Pulse: Is Radial Pulse Absent ? Immediate care (triage) Is Radial Pulse Present? Check Mental Status Triage for RPM (Respiration/Pulse/Mental Status) 24

25. Mental Status: Can Not Follow Simple Commands (Unconscious or Altered LOC) Immediate care (Triage) Can Follow Simple Commands Delayed care (Triage) Triage for RPM (Respiration/Pulse/Mental Status) 25

26.  Patients are systematically moved to treatment areas where more detailed assessment and treatment are conducted Triage 26

27. Summary Triage is a method of sorting casualties by order of priority The overriding principle of Triage is the “greatest good for the greatest number of victims” Requires training and experience to perform well 27

28. Questions? 28

29. 29 Class Practical Exercise Practice some of the skills shared in this presentation