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TRIAGE. START and JumpStart Triage: The Basics. Adapted and Edited by LeMay Hupp, MPH, RN. MEP – P Project.

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TRIAGE


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    1. TRIAGE START and JumpStart Triage: The Basics Adapted and Edited by LeMay Hupp, MPH, RN

    2. MEP – P Project This course is brought to you by the MEP-P (Medical Emergency Preparedness – Pediatrics) Project, and is funded by a grant from the federal government to the state of Alaska to increase preparedness for Alaska’s children.

    3. TRIAGE Simple Triage and Rapid Treatment developed by Newport Beach Fire Department and Hoag Memorial Hospital, Newport Beach, CA www.start-triage.com JUMP START Triage developed by Dr. Lou Romig, Miami, FL www.jumpstarttriage.com

    4. Triage Objectives The student will be able to: • Discuss the concept of triage • Utilize the S.T.A.R.T. and JumpStart methods to triage victims • Explain the international triage color code system and how it is utilized

    5. TRIAGE • Triage means “to sort” • Looks at medical needs and urgency of each patient • Sorting based on limited data acquisition • Must consider resource availability

    6. TRIAGE GOLDEN HOUR • Trauma patient has the best chance for recovery if ACLS within one hour from the time of the injury • With multiple victims, the Golden Hour can slip away due to limited rescuers and / or resources

    7. TRIAGE KEY PRINCIPLE Doing the Greatest Good, For the Greatest Number

    8. TRIAGE Goal of Multicasualty Triage “To do the best for the most using the least.”

    9. Basic Disaster Life Support Triage MASS Triage • M ove • A ssess • S ort • S end National Disaster Life Support Foundation

    10. TRIAGE Disaster Acronyms… • M.P.I. -- Multi-patient Incident • M.C.I. -- Mass Casualty Incident • M.O.I. -- Mechanism of Injury • M.V.C. -- Motor Vehicle Collision • M.V.A. – Motor Vehicle Accident

    11. TRIAGE

    12. TRIAGE

    13. Triage SCENE SAFETY: Size Up Size up the scene, Make sure the scene is safe for you to enter CREATE ORDER: Next, ask those who are not injured or who have minor injuries to identify themselves

    14. Walking Wounded… Triage When entering room or area, shout out, “if you can hear me, come to the sound of my voice.” Self rescue is best rescue Tag GREEN for minor, Send to a safe area Ask about other victims in area

    15. Triage Categories

    16. Triage Color Codes Triage GREEN– minor RED – immediate YELLOW – delayed BLACK – deceased

    17. TRIAGE Sample Triage Tag

    18. TRIAGE Sample Triage Tag

    19. Triage Triage tags should be placed: • Where they can be seen quickly • Attached to arm, wrist, leg, or ankle

    20. S.T.A.R.T. Simple Triage and Rapid Treatment developed by Newport Beach Fire Department and Hoag Memorial Hospital Newport Beach, California

    21. S.T.A.R.T. When performing the triage function, regardless of incident size DON’T GET DISTRACTED! • Move quickly • Focus your attention on IMMEDIATE patients The goal is to stay focused on RED

    22. S.T.A.R.T. Triage Priorities Your initial goal is to find IMMEDIATE patients • You want to “find the red and get it out” (kind of like Visine!) • Your efforts should focus on locating all IMMEDIATE patients, getting them treated and transporting them as soon as possible

    23. S.T.A.R.T. Triage Priorities Once IMMEDIATE patients have been treated and transported • Reassess all DELAYED patients and upgrade any to “IMMEDIATE” depending on their injury, age, medical history, etc.

    24. S.T.A.R.T. Victims who have self-extricated themselves prior to arrival can be labeled MINOR All other patients should be tagged IMMEDIATE, DELAYED or DEAD/DYING depending on your assessment

    25. S.T.A.R.T. With START one patient is assessed every 30 seconds First responder quickly assesses to categorize a patient’s condition • Airway and respiration • Pulse and / or capillary refill • Level of consciousness

    26. S.T.A.R.T. The only treatment rendered by the triage team is to: • Open a patient’s airway (head tilt / neck lift) • Apply direct pressure to stop an obvious bleed • Elevating the extremities

    27. S.T.A.R.T. Only three items are checked when using START: • Respiration • Pulse • Mental Status Just remember… RPM

    28. TEST: Triage Put the triage evaluation steps in the correct order. • Check mental status • Check airway/breathing • Check bleeding/circulation

    29. Triage ANSWER: Check mental status 3 Check airway/breathing 1 Check bleeding/circulation 2

    30. S.T.A.R.T. Step 1 Triage officer announces that all patients that can walk should get up and walk to a designated area for eventual secondary triage. All ambulatory patients are initially tagged as Green

    31. S.T.A.R.T. Step 2 Assess respiratory rate • If ≤30, assess Perfusion • If  30, tag patient as RED

    32. S.T.A.R.T. Step 3 Assess capillary refill • If ≤ 2 seconds, assess Mental Status • If  2 seconds, tag as RED

    33. S.T.A.R.T. Step 4 Assess mental status • If able to obey commands, tag as YELLOW • If unable to obey commands, tag as RED

    34. START Flow Chart

    35. Mnemonic… S.T.A.R.T. R 30 P 2 M Can Do

    36. S.T.A.R.T. SELF TEST Patient A is 21 year old male complaining of pain to his upper right leg. You see an obvious open right femur fracture. What is your START assessment?

    37. S.T.A.R.T. SELF TEST Patient A is 21 year old male complaining of pain to his upper right leg. You see an obvious open right femur fracture. The patient is awake, his airway is open, he’s talking and his respirations are over 30/minute. • Using RPM, the patient is categorized as IMMEDIATE - RED. • Because his respirations are over 30 per minute. • What is your treatment? None during triage.

    38. S.T.A.R.T. SELF TEST Patient B is a 15-year-old female, complaining of numbness to her legs, is unable to move them. You see a 2“ laceration on left skull, moderate bleeding. What is your START assessment?

    39. S.T.A.R.T. SELF TEST Patient B is a 15-year-old female, complaining of numbness to her legs, is unable to move them. You see a 2" laceration on left skull, moderate bleeding. • She is awake, her airway is open, her respirations are under 30 a minute and she has a radial pulse. • Her RPM assessment indicated she is DELAYED - YELLOW. • Why? Her respirations were under 30, she has a radial pulse and she is alert and oriented.

    40. S.T.A.R.T. SELF TEST Patient C is a 40-year-old male who looks really bad. He’s unconscious, pale and limp. What is your START assessment?

    41. S.T.A.R.T. SELF TEST Patient C is a 40-year-old male who looks really bad. He’s unconscious, pale and limp. • He is unconscious, pale, limp. He is not breathing. You reposition his airway, but no respirations. • His RPM assessment is DEAD - BLACK. • Why? His respirations were 0 and repositioning his airway did not help.

    42. S.T.A.R.T. To review: There are three medical treatments performed when utilizing START triage: • Open an airway • Stop any visible bleeding • Elevate the extremities for shock

    43. S.T.A.R.T. The DEAD / DYING are those who cannot breathe after the airway is opened and are mortally wounded • The patient will probably die despite the best resuscitation efforts • It is often a difficult decision to leave a dying patient, especially if it is a child • Remember, resources are often wasted on unsalvageable victims

    44. Triage Triage is a dynamic process and is usually done more than once.

    45. Triage Primary Triage Secondary Triage Tertiary Triage

    46. S.T.A.R.T. SELF TEST 1. The goal of triage is to: a. Ensure an even flow of victims to patient treatment areas b. Decide who will treat victims c. Identify and treat victims who are “immediates” as rapidly as possible 2. The four triage categories are: a. Critical, noncritical, and undetermined, dead b. Immediate, delayed, minor, dead c. Emergency, delayed, elective, dead

    47. S.T.A.R.T. SELF TEST 1. The goal of triage is to: c. Identify and treat victims who are “immediates” as rapidly as possible 2. The four triage categories are: b. Immediate, delayed, minor, dead

    48. Use of Gloves S.T.A.R.T. Considerations in glove use during triage • Change if become soiled • After assessing all patients the first time • In extreme field conditions, may need to sterilize by washing in bleach and water solution • Check your agency policy

    49. Triage Tips S.T.A.R.T. • Time will be critical! There will be very little time with any single victim • Take advantage of local exercises as a means of maintaining your triage skills