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Disaster and Multi-Casualty Triage. Amado Alejandro Báez MD MSc Matthew Sztajnkrycer MD PhD. Learning Objectives. Describe the key elements of disaster triage Understand the basic principles of Mass Casualty Triage (START). Performance Objectives.

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disaster and multi casualty triage

Disaster and Multi-Casualty Triage

Amado Alejandro Báez MD MSc

Matthew Sztajnkrycer MD PhD

learning objectives
Learning Objectives
  • Describe the key elements of disaster triage
  • Understand the basic principles of Mass Casualty Triage (START)
performance objectives
Performance Objectives
  • At the end of the course the student should be able to:
  • Apply the principles of disaster triage
  • Understand the concept of reverse triage
triage
Triage
  • [French, from trier, to sort, from Old French.]
  • A method of quickly identifying victims who have immediately life-threatening injuries AND who have the best chance of surviving.
tagging
Tagging
  • Complements Triage
  • Rapid Identification of patient
  • Color Coded / Bar Coded system
  • Plastic “bands” can substitute tags
start system
START SYSTEM
  • Created in the 1980’s by Hoag Hospital and the Newport Beach CA Fire Dept
  • Allows rapid assessment of victims
  • It should not take more than 15 sec/ Pt
  • Once victim is in treatment area more detailed assessment should be made
start system9
START SYSTEM

Clasification is based on three items

  • Respiratory
  • Perfusion
  • Mental status evaluation
start first step
START First Step

Can the Patient Walk?

YES

NO

Evaluate Ventilation

(Step-2)

Green

(Minor)

start step 2
START Step-2

Ventilation Present?

NO

YES

Open Airway

Ventilation Present?

> 30/Min

< 30/min

NO

YES

Red/ Immediate

Black

Evaluate Circulation

(Step-3)

Red/ Immediate

start step 3
START Step-3

Circulation

Absent Radial Pulse

Present Radial Pulse

Control Hemorrhage

Evaluate Level of Consciousness

Red/ Immediate

start step 4
START Step-4

Level of Consciousness

Can Follow Simple

Commands

Can’t Follow Simple

Commands

Yellow/ Delayed

Red/ Immediate

contaminated patients
Contaminated Patients
  • Patients with exposure (potential or real) to contaminants should be tagged as BLUE
  • This category will continue to stay until patient is adequately decontaminated then follow START as usual
  • Some recommend a “double tagging” with blue and the standard START color
start overview
START-Overview
  • Remember RPM
  • R- Respirations- 30
  • P- Perfusion- Radial Pulse
  • M- Mental- Follows Commands
reverse triage
Reverse Triage
  • Used in mass-casualty lightning injuries
  • The dead are treated first
  • High potential for respiratory arrest
  • Potential for resuscitative success
conclusions
Conclusions
  • Triage is a method of quickly identifying victims who have immediately life-threatening injuries AND who have the best chance of surviving
  • Key elements of the START Triage System are: Respiration, Perfusion and Mentation
  • Reverse Triage is used for mass casualty lightning incidents.