1. TRIAGE (the basics) Mass Casualty Incidents Presenter: Dan Dempsey

2. Key concepts (in order) Ambulance National Incident Plan (AMPLANZ) joint agency Establish a clear command structure – STICK TO IT! Establish clear communications through one single point (Incident commander) Triage patients Treat patients

3. Incident Roles Scene commander (incident officer) – Assigns resources on the ground and communicates with central communications Triage officer/s – Triage patients according to the START or traffic light method – Never treats patients Treatment providers (medics) – Provides actual medical treatment – Treat per skill level

4. The Triage System Buy some pegs!! M ajor incident declaration E xact location of incident T ype of incident H azards (significant) A ccess and egress N umber (estimated) of pts E xtra resources required? An American!

5. Initial Triage (Scene size up) Done on arrival at scene (in order to establish METHANE!) Start by asking all patients to walk to a specified area. Why? Only interventions provided are opening airways and life threatening external bleeding. Why? Where possible use bystanders or other crew for this

6. Initial Triage

7. Secondary Triage Perform a primary and secondary survey on all patients in order of triage priority If the triage status changes as a result, change the tag but note what status they were before. Why?

8. Treatment (Back a winning pony!) Treat by TRIAGE priority not by tactical “plans” Treatment decisions should be made by an experience person who tasks others to provide that treatment QUICK WINS! Patients that have the greatest chance of survival with the least use of time, equipment and personnel should be treated first Treatments that are highly unlikely to be successful (eg. CPR) should not be provided unless there is a very good reason Treatments that take significant time should be avoided. Examples? The greater number of patients, the greater the importance of restricting the treatments to those that are immediately life saving

9. Transport Transport patients in order of triage priority Transport options? St John will establish the same structure for receiving patients from you or work within your established structure

10. The Morality Bit! (Stick to the plan) In the setting of a major incident some patients have injuries so severe that death is highly likely. Some examples are: – Respitory arrest – Severe shock with a falling heart rate – GCS of 3 (unconscious, unresponsive) with bilateral dilated unreactive pupils – Severe life threatening injuries in the elderly If the numbers of severely injured patients are high, it is appropriate for patients considered unsalvageable to have treatment withheld