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Triage

Triage. “To Save as Many Lives as Possible”. Objectives. Define Triage Identify the Goals of Triage Understand the Triage Process Understand the Triage Tag Understand Police MCI Triage Understand Victim Assessment Understand Special Situations

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Triage

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  1. Triage “To Save as Many Lives as Possible”

  2. Objectives • Define Triage • Identify the Goals of Triage • Understand the Triage Process • Understand the Triage Tag • Understand Police MCI Triage • Understand Victim Assessment • Understand Special Situations • Demonstrate Triage process proficiency (Video’s)

  3. What is Triage? • Triage means to “SORT” • Systematic process of “sorting” injured persons into categories based on wound severity • Sorting the injured allows for the most severely injured to be removed and treated first.

  4. Goals of Triage ONE “To Save as Many Lives as Possible” TWO To sort the victims by wound severity THREE Evacuate victims the most severely wounded first

  5. Triage Process • Many different models • START, SALT, GEOGRAPHICAL, etc. • Who conducts Triage? • Assessment Time Line • Triage person only provides life saving intervention • Use as many persons as possible to minimize the amount of time required (victim count) • Start at the closest victim • All victims receive a “TAG”

  6. Triage Tags

  7. Color Indicators • RedTag – Immediate Transport • Surgeon within 1 hour • YellowTag – Delayed Transport • ER in 1 – 2 hours • GreenTag – Minimal Transport • ER within 8 hours • BlackTag – Leave body in place • CID issue

  8. Triage for Police • Simplified process • Multi-tasking process • Establishes security • Sorts “Triages” victims • Establishes Driving Force for the room

  9. Triage for Police GEOGRAPHICAL TRIAGE Breaks Triage Down into Two Categories Does not follow Commands Follows Commands Not Ambulatory (Walking) Ambulatory (usually) Heavy Bleeding Minor/ Mod Wounds Airway Problems Dead DELAYED IMMEDIATE Provide Overwatch First Priority SECURITY THREAT

  10. Geographical Triage

  11. Geographical Triage Delays Immediates

  12. Victim Assessment • Time Is Important • Unconscious/Altered • Must be cleared of weapons • Handcuffed as needed

  13. Key Fundamental of Triage • All victims must have equal importance at the time of triage • No individual can receive more or less “attention” than another • This includes: • Children • Actors/Suspects • Bystanders • Public Safety Personnel *

  14. Continuous Process The triage process will be repeated several times as time and resources allow

  15. ALL IN ON ME ----

  16. HANDS ON YOUR FACES! IF YOU CAN MOVE, MOVE AWAY FROM ME TO THAT FAR WALL

  17. SECURITY, IMMEDIATE ACTION, MEDICAL COVERING DOOR/HALL I GOT COVER I GOT HANDS

  18. STILL GOT COVER STILL GOT HANDS NO PULSE, NO BREATHING, GSW TO HEAD TOURNIQUET APPLIED TO RIGHT LEG. BLEEDING STOPPED. TIMECHECK. LISTEN UP! IF THERE’S MORE SHOOTING WE ALL GO. DISPATCH, WE ARE IN ROOM 102 IN EAST WING. FOUR OFFICERS IN UNIFORM. WE HAVE 3 CRITICAL WOUNDED VICTIMS, 1 DEAD AND 5 WITNESSES. NO SUSPECT AT THIS TIME. I NEED MORE OFFICERS TO CLEAR THIS WING ON THEIR WAY TO ME, ADVISE THEM TO MAKE VERBAL AND VISUAL CONFIRMATION BEFORE THEY ENTER MY HALL.

  19. STILL GOT COVER I GOT COVER ON WALL

  20. GSW TO CHEST WITH EXIT, No Medical yet I GOT HANDS STILL GOT COVER

  21. GSW TO LEFT ARM, TOURNIQUET APPLIED. BLEEDING STOPPED, TIMECHECK. ALL INJURED HAVE BEEN TREATED, GET THEM INTO RECOVERY POSITION OVER HERE

  22. CONTACTING UNKNOWNS, I GOT HANDS I GOT COVER

  23. IS THERE ANYONE IN HERE THAT WAS TRYING TO HURT YOU? MAN IN BLUE SHIRT, HANDS ON YOUR FACE, MOVE TO MY VOICE AND STOP

  24. BAD GUY LEFT ALREADY? OK, MOVE AWAY FROM ME TO THE OTHER WALL DOWN ON YOUR KNEES, FACE THE WALL AND PUT YOUR HANDS ON THE BACK OF YOUR HEAD

  25. MAN IN BLUE SHIRT, HANDS ON YOUR FACE, MOVE TO MY VOICE AND STOP NEXT MAN IN BLUE SHIRT, HANDS ON YOUR FACE, MOVE TO MY VOICE AND STOP IS THERE ANYONE IN HERE THAT WAS TRYING TO HURT YOU?

  26. BAD GUY LEFT ALREADY? OK, MOVE AWAY FROM ME TO THE OTHER WALL DOWN ON YOUR KNEES, FACE THE WALL AND PUT YOUR HANDS ON THE BACK OF YOUR HEAD

  27. EVERYONE THAT I HAVENT TALKED TO YET, MOVE AWAY FROM ME TO THAT OTHER FAR WALL DOWN ON YOUR KNEES, FACE THE WALL AND PUT YOUR HANDS ON THE BACK OF YOUR HEAD

  28. WE NEED TO GET THESE REDS OUT SOON, LETS REASSESS THEIR INJURIES AND TREATMENT. LETS ESTABLISH OUR CCP HERE AND HOLD WHAT WE GOT GUY IN GREEN SHIRT, COME OVER HERE AND HOLD PRESSURE ON THIS GUY’S ARM WHERE ITS BLEEDING ALRIGHT PARTNER, ANYTHING CHANGE OUT THERE? ANY LINK-UP WITH SECONDARY RESPONDERS YET?

  29. Casualty Collection Point • Is a designated area established to evaluate, control and treat casualties during an MCI event • MCI is defined as a situation when victims overwhelm resources. • Is Active Shooter an MCI?

  30. Establishing a CCP • When to establish • Leadership is VITAL • Location • Best Location? • How many locations? • Setting it up • Who sets it up? • When do you set it up? • Security • Door/Overwatch • Zones • Red/Yellow/Logistics • Suspects

  31. Sample CCP

  32. Special Situation - MCI • No CPR • No Spinal Immobilization • Don’t waste resource on people that will not live • Do the most good you can with the limited resources you have

  33. Extraction • Establish safe travel cordons • Remove IMMEDIATES first • leave the dead where found • Use DELAYED to assist with the moving of IMMEDIATES to CCP • If supplies and time allow; all wounds should be bandaged and splinted prior to evacuation • Do not delay evacuation to complete non-life threatening medical procedures • Return with additional resources

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