1. Chapter 28 Triage

2. Chapter 28: Triage 2 Explain the purpose, use, and benefits of the triage process. Describe the four-colored categories used in primary triage. Summarize the four steps of the START system for triage. Describe methods of identifying triage categories. Objectives (1 of 2)

3. Chapter 28: Triage 3 Describe the sequence of emergency care for a single patient with multiple injuries. Given a scenario of a mass-casualty incident, perform triage correctly using the START algorithm. Objectives (2 of 2)

4. Chapter 28: Triage 4 Triage Assessment of multiple injured patients Multiple-casualty/mass-casualty incident (MCI) refers to a situation with more than one patient. Incidents may overtax resources. Safety is your primary concern! Situations could include avalanche, lift accident, vehicle crash, earthquake, terrorist attack, etc.

5. Chapter 28: Triage 5 The Triage Process Sorting two or more patients to provide the best outcome for the greatest number –Patients ranked by severity –Patients marked to reflect ranking Triage officer assigns rescuers and equipment to priority patients.

6. Chapter 28: Triage 6 Remote Locations In remote locations, triage may require modification due to: –Manpower –Weather –Equipment –Communications –Terrain, including distance from definitive care

7. Chapter 28: Triage 7 5 S’s of Triage 1.Safety assessment—scene safety 2.Scene size-up—MOI, patients, injuries, access 3.Send—information to dispatcher and request resources 4.Setting up scene—establish triage points and obtain tags or ribbon 5.START—a type of triage process

8. Chapter 28: Triage 8 Triage Priorities: Red (Four-Color System) Highest or first priority, usually injuries to the circulatory or respiratory system Probable survival with immediate care and transport. Usually includes: –Hypoxia or shock, present or imminent –Major external or internal hemorrhage

9. Chapter 28: Triage 9 Triage Priorities: Red (Four-Color System) Respiratory distress due to flail chest, sucking chest wound, pneumothorax, upper airway obstruction, or burns Pericardial tamponade Head injuries with progressive deterioration, altered mental status Medical emergencies such as AMI, poisoning, diabetic hypoglycemia

10. Chapter 28: Triage 10 Triage Priorities: Yellow (Four-Color System) Second or delayed priority, usually with musculoskeletal or nervous system injuries Able to survive a wait of 45 minutes or longer Lesser chance of survival than RED Greater need of resources than RED

11. Chapter 28: Triage 11 Triage Priorities: Yellow (Four-Color System) Usually includes: –Severe burns without respiratory distress –Spinal injuries –Multiple fractures –Pelvic or femur fractures without shock

12. Chapter 28: Triage 12 Triage Priorities: Yellow (Four-Color System) Usually includes: –Open fractures –Stable abdominal injuries, including open injuries without shock –Eye injuries –Stable head or chest injuries

13. Chapter 28: Triage 13 Triage Priorities: Green (Four-Color System) Third or lowest priority, usually “walking wounded” or with no life- threatening injuries Uninjured and present at an MCI scene Usually includes patients with minor burns

14. Chapter 28: Triage 14 Triage Priorities: Green (Four-Color System) Usually includes: –Single, closed fractures –Localized soft-tissue injuries –Psychological problems

15. Chapter 28: Triage 15 Triage Priorities: Black (Four-Color System) Nonsalvageable patients, dead patients, patients who will die even with care Usually includes: –Cardiac arrest –Respiratory arrest with an open airway –Massive head, chest, or abdomen injuries –Total body burns (>90%)

16. Chapter 28: Triage 16 Triage Tags Rolls of red, yellow, green, and black surveyor’s ribbon Preprinted tags with tear-off sections Tape with color initial affixed to forehead

17. Chapter 28: Triage 17 The START System Simple Triage And Rapid Treatment Begins by having all “walking wounded” move outside triage area to safety Based on a 15- to 30-second assessment of each remaining patient Assesses “RPM” — respirations, pulse, and mental status. Tracks the total numbers of patients.

18. Chapter 28: Triage 18 The START system Step 1 –Get up and walk GREEN Step 2 –Open airway and assess respirations 0/min = BLACK > 30/min = RED < 30/min = Step 3 Step 3 –Radial pulse check –Absent = RED –Control bleeding –Present = Step 4 Step 4 –Assess mental status –Altered = RED –Appropriate = YELLOW/GREEN

19. Chapter 28: Triage 19 Secondary Triage Move patients from a triage area to treatment area for care and transport. Reassess all RED patients to allocate limited resources and personnel. Recategorize patients as status changes (ie, YELLOW to RED or RED to BLACK). Triage tags can be used to record patient information.

20. Chapter 28: Triage 20 Triage Tags

21. Chapter 28: Triage 21 Special Triage Situations Injured rescuer Injured relative Injured child Disruptive patient or witness Lightning Hypothermia

22. Chapter 28: Triage 22 Patients with Multiple Injuries Golden Hour—the time from injury to definitive care during which treatment should occur to maximize survival Use assessment to prioritize treatment. Maintain airway, support ventilations with O 2, control hemorrhage, place on backboard, treat shock, and arrange timely transport. Seamless interface with local ALS is essential.