simple triage and rapid treatment l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Simple Triage and Rapid Treatment PowerPoint Presentation
Download Presentation
Simple Triage and Rapid Treatment

Loading in 2 Seconds...

play fullscreen
1 / 41

Simple Triage and Rapid Treatment - PowerPoint PPT Presentation


  • 113 Views
  • Uploaded on

Immediate. Patients. Delayed. Deceased. Simple Triage and Rapid Treatment. John P. Frey, LP. Immediate. Patients. Delayed. Deceased. Objectives. Define START and MCI Identify the need for START Learn the START Algorithm Learn how to effectively use START. Immediate. Patients.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Simple Triage and Rapid Treatment' - merton


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
simple triage and rapid treatment

Immediate

Patients

Delayed

Deceased

Simple Triage and Rapid Treatment

John P. Frey, LP

objectives

Immediate

Patients

Delayed

Deceased

Objectives
  • Define START and MCI
  • Identify the need for START
  • Learn the START Algorithm
  • Learn how to effectively use START
what is an mci

Immediate

Patients

Delayed

Deceased

What is an MCI
  • An event that produces more patients than you have medics
  • Produces minimal casualties but has unusual events surrounding the incident
    • HazMat, Rail, Aircraft, Marine
  • Effects local hospitals ability to adequately treat patients
elements of an command system

Immediate

Patients

Delayed

Deceased

Elements of an Command System
  • Unified command
  • Limited span of control
  • Clear chain of command
  • Line and staff functions
  • Intelligence gathering
  • Flexibility
incident command system ics

Immediate

Patients

Delayed

Deceased

Incident Command System (ICS)

ICS is a system of establishing command and control of an emergency incident

Command

Treatment

Transport

Staging

Triage

qualities of a great commander

Immediate

Patients

Delayed

Deceased

Qualities of a Great Commander
  • All knowing
  • Forceful, yet sensitive
  • Totally calm under fire
  • Likes dogs and small children
  • Free of impure thoughts
  • Brave, clean, honest, trustworthy
so who s in charge

Immediate

Patients

Delayed

Deceased

So..Who’s In Charge?
  • First Responder
  • EMS
  • Supervisor
  • Line Officer
  • Chief
  • Governmental Official
first responders responsibility

Immediate

Patients

Delayed

Deceased

First Responders Responsibility
  • One member becomes “Command”
  • Other members starts the Triage process
  • Start calling for any additional resources that you think you will need
triage

Immediate

Patients

Delayed

Deceased

Triage
  • French for “sorting” or “to sort”
  • A process for determining who to treat and transport first in the case of a multi casualty incident (MCI)
  • Refined during the Vietnam conflict by military medics
what is start

Immediate

Patients

Delayed

Deceased

What is START?

START is an acronym for Simple Triage And Rapid Treatment

It is a simple step-by-step triage and treatment method to be used by the first rescuers responding to a multi casualty incident. It allows these rescuers to identify victims at greatest risk for early death and to provide basic stabilization maneuvers

why start

Immediate

Patients

Delayed

Deceased

Why START?
  • Medically responsible
  • Easily learned
  • Easily remembered
  • Clear-cut decision process
  • Relies only on BLS skills
3rd law of the house of god

Immediate

Patients

Delayed

Deceased

3rd Law of the House of God

In cases of cardiac arrest (or triage), the first thing you do is check your own pulse!

your first action

Immediate

Patients

Delayed

Deceased

Your First Action

If you can walk, go stand over there!

All of Ya’ll, go over there! (Texas version )

the next step

Immediate

Patients

Delayed

Deceased

The Next Step
  • Take a DEEP breath
  • Ensure that your scene is safe
  • Start to triage all patients that were unable to move
  • Spend about 60 seconds/patient
  • Put triage tag on and note group
  • Move to the next patient
start algorithm airway breathing

NONE

YES

REPOSITION AIRWAY

ASSESS RESPIRATIONS/VENTILATIONS

> 30/MINUTE

YES

NONE

IMMEDIATE

Immediate

Patients

Delayed

Deceased

START Algorithm (Airway/Breathing)

RESPIRATIONS/VENTILATIONS

<30/MINUTE

ASSESS

PERFUSION

IMMEDIATE

DECEASED

start algorithm circulation

Immediate

Patients

Delayed

Deceased

START Algorithm (Circulation)

PERFUSION

> 2 SECONDS

CONTROL

BLEEDING

<2 SECONDS

ASSESS

MENTAL STATUS

IMMEDIATE

start algorithm disability

Immediate

Patients

Delayed

Deceased

START Algorithm (Disability)

MENTAL STATUS

FAILS TO FOLLOW

SIMPLE

COMMANDS

FOLLOWS

SIMPLE

COMMANDS

IMMEDIATE

DELAYED

triage tags front

TRANSPORTATION OFFICER

NAME______________________

AMBULANCE _______________

HOSPITAL __________________

PRIORITY-1 2

10945

NAME

AGE MALE FEMALE

MEDICATION/TIME:

________________________________

________________________________

________________________________

________________________________

________________________________

10945

Immediate

IMMEDIATE

10945

Patients

Delayed

DELAY

10945

Deceased

Triage Tags (front)
triage tag back

Immediate

IMMEDIATE

Patients

Delayed

DELAY

Deceased

Triage Tag (back)
other triage id methods

Immediate

Patients

Delayed

Deceased

Other Triage ID Methods
  • Different tags
  • Bracelets
  • Duct tape
  • Survey tape
  • Marker on forehead
after primary triage

Immediate

Patients

Delayed

Deceased

After Primary Triage
  • Move to secondary triage
  • Provide primary treatment
  • Complete triage tags
  • Call for necessary transport
  • Continue to reassess patients
field triage

Immediate

Patients

Delayed

Deceased

Field Triage
  • Primary Triage (Triage)
    • Implement START
    • Immediate, life saving care
  • Secondary Triage (Treatment)
    • Document information on triage tags
    • Provide medical treatment
  • Tertiary Triage (Transport)
    • Transport patients
example 1

Immediate

Patients

Delayed

Deceased

Example 1
  • 57 year old female complaining of chest pain. Respirations 24, capillary refill 3 seconds, responds to all verbal commands
triage tags

Immediate

Patients

Delayed

Deceased

Triage Tags

TRANSPORTATION OFFICER

NAME______________________

AMBULANCE _______________

HOSPITAL __________________

PRIORITY-1 2

10945

NAME

AGE 57 MALE FEMALE X

MEDICATION/TIME:

________________________________

________________________________

________________________________

________________________________

________________________________

10945

IMMEDIATE

10945

example 2

Immediate

Patients

Delayed

Deceased

Example 2
  • 24 Year old male, with a 3’ pole impaled through his abdomen, respirations 28, capillary refill <2 seconds, responds to all commands
example 2 tag

TRANSPORTATION OFFICER

NAME______________________

AMBULANCE _______________

HOSPITAL __________________

PRIORITY-1 2

10945

NAME

AGE 24 MALE X FEMALE

MEDICATION/TIME:

________________________________

________________________________

________________________________

________________________________

________________________________

10945

Immediate

IMMEDIATE

10945

Patients

Delayed

DELAY

10945

Deceased

Example 2 Tag
example 2 tag back

Immediate

IMMEDIATE

Patients

Delayed

DELAY

Deceased

Example 2 Tag (back)
example 3

Immediate

Patients

Delayed

Deceased

Example 3
  • 3 year old child with no obvious injury. No respirations, capillary refill 6 seconds, unconscious
example 3 tag

Immediate

Patients

Delayed

Deceased

Example 3 Tag

TRANSPORTATION OFFICER

NAME______________________

AMBULANCE _______________

HOSPITAL __________________

PRIORITY-1 2

10945

NAME

AGE 3 MALE X FEMALE

MEDICATION/TIME:

________________________________

________________________________

________________________________

________________________________

________________________________

10945

other mci concerns

Immediate

Patients

Delayed

Deceased

Other MCI Concerns
  • What caused (or is causing) the problem?
  • Medical Supplies
  • Communications
  • Transportation
  • Media Coverage
  • Crowd Control
what s causing the problem

Immediate

Patients

Delayed

Deceased

What’s Causing the Problem?
  • Was it an acute event?
  • Is it still occurring?
  • Are we in a safe area?
  • Is a chemical involved?
texas a m bonfire collapse

Immediate

Patients

Delayed

Deceased

Texas A&M Bonfire Collapse
  • November 18, 1999
  • 2:30 AM bonfire stack collapsed
  • 150 people believed to be on bonfire site at time of collapse
  • As stack collapsed, all lighting was pulled down leaving the area in total darkness
  • First Responders reported hearing screaming in the darkness
first responder actions
First Responder Actions
  • Immediate call for additional help with description of bonfire collapse
  • Dispatch issued a MCI and paged all personnel as well as CSFD and BFD and Texas Fire Training Center resources. MCHD ambulances requested as well.
  • Fire Department and TxDot light trucks were immediately called for
  • Triage started by flashlight
triage actions
Triage Actions
  • START was used immediately
  • Separate Triage areas established early to isolate patients needing triage
  • All site resources used the ICS system for unified incident command. Command was ultimately run by DPS.
  • Texas Task Force 1 (FEMA) was mobilized for specialty rescue
  • Mobile morgue was sent to site
final outcome
Final Outcome
  • All recoverable patients triaged and transported in less than 1 hour
  • Last bodies recovered about 20 hours after the collapse
  • 27 patients injured, 12 killed
  • Investigative committees universally credited first responders with saving many lives
so how does this apply to me

Immediate

Patients

Delayed

Deceased

So....How does this apply to me?
  • Major incidents can occur
  • First responders are generally involved in these incidents
  • Most responders face few large incidents in their career
  • Preparation is the key to successful handling of these incidents
start card
START Card

WALKING WOUNDED - Walks and follows commands

IMMEDIATE - Respirations greater than 30; capillary refill 2 sec's or longer; mental confusion or no response

DELAYED - Cannot walk; respirations less than 30; Cap refill less than 2 sec's; responds to questions

DECEASED - Patient with no respirations after one attempt to manually establish an airway

START Triage Steps:

1. “If you can get up and walk, follow me”

2. Respiration

Perfusion

Mental Status

3. “Thirty and two, can do”

Front

Back

additional resources
Additional Resources
  • The EMS Incident Management System, Christen/Maniscalco (Brady)
  • START Training Manual Texas Department of Health
    • http://www.tdh.state.tx.us/hcqs/ems/startman.exe