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Triage. Learning Objectives . Cognitive Discuss the criteria of MCI implementation. Discuss the goals and purpose of triage. Identify appropriate patient care activities during an MCI. Define the components of the START acronym. Learning Objectives . Cognitive

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Triage

Triage

Triage


Learning objectives
Learning Objectives

Cognitive

  • Discuss the criteria of MCI implementation.

  • Discuss the goals and purpose of triage.

  • Identify appropriate patient care activities during an MCI.

  • Define the components of the START acronym.

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Learning objectives1
Learning Objectives

Cognitive

  • State how patients are categorized in START triage.

  • Explain the role of the Triage Unit Leader.

  • Discuss the role of the EMT in an MCI.

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Learning objectives2
Learning Objectives

Psychomotor

  • Given an MCI scenario, perform triage.

  • Demonstrate rapid patient assessment.

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Key vocabulary

Disaster

Multiple casualty incident

Scene-size up

START Triage System

Triage

Triage officer

Triage tag

Walking wounded

Key Vocabulary

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Overview
Overview

Regardless of the amount of training,

will not be immune to the psychological

impact or emotional stress of disaster

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Overview continued
Overview (continued)

Your best defense is an automatic

response, the tools and the confidence

that comes from the ongoing practice of

triage

Triage


Triage
Triage

  • Good triaging immediately identifies:

    • Patients to be transported first

    • Patients who can assist you

    • Patients impossible to save without further resources

  • Scene safety and your safety are first priority

    • Do not become a victim or part of the problem

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Mci vs disaster
MCI vs. Disaster

  • MCI: any incident in which the number of patients places excessive demands on personnel or equipment

  • Disaster: any incident which exceeds the capacity of a system’s resources - including mutual aid

  • The number of patients constituting an MCI is locally defined

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Mci s
MCI’s

  • The EMT role in an MCI:

    • Recognize incident is an MCI

    • Request additional assistance

    • Establish IMS

    • Identify hazards

    • Perform triage

    • Treat patients according to triage priority

    • Transport patients according to triage priority

    • Document:

      • Patients, conditions and care

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Triage1
Triage

  • French word means “to sort”

  • To do the most good for the greatest number of patients

  • Goals:

    • How many patients?

    • Classify, label, track

    • Assess needs

    • Best utilize scene resources

    • Coordinate with hospitals

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Start triage
START Triage

  • Simple

  • Triage

  • And

  • Rapid

  • Transport

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Start triage continued
START Triage (continued)

All Walking Wounded

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Start triage continued1
START Triage (continued)

  • National standard

    • Developed by City of Newport Beach (CA) Fire Department and Hoag Hospital

    • Used to triage large numbers, simply and rapidly

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Start triage continued2
START Triage (continued)

  • Key assessment elements:

    • Respirations

    • Perfusion

    • Mental status

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30 2 can do
30-2-Can Do

  • Mnemonic

  • Any patient who cannot walk but has:

    • Respiratory rate less than 30 per minute

    • Capillary refill less than 2 seconds, and

    • Can follow commands is a “yellow” category patient

  • All others who cannot walk are “red”

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Triage2
Triage

  • Sort multiple casualties into four priorities for emergency care or transportation to definitive care

    • Red

    • Yellow

    • Green

    • Black

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Priority 1 red
Priority 1 - Red

  • Immediate

  • Patients with readily correctable life-threatening conditions

    • Airway and breathing difficulties

    • Uncontrolled or severe bleeding

    • Decreased mental status

    • Patients with severe medical problems

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Priority 2 yellow
Priority 2 - Yellow

  • Delayed

  • Patients with serious, but not life-threatening conditions

    • Burns without airway problems

    • Major or multiple bone or joint injuries

    • Back injuries with or without spinal cord damage

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Priority 3 green
Priority 3 - Green

  • Minor

  • “Walking Wounded”

    • Minor painful, swollen, deformed extremities

    • Minor soft tissue injuries

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Priority 4 black
Priority 4 - Black

  • Deceased

  • Dead or moribund patients

    • Respiratory or cardiac arrest

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Triage3
Triage

  • Begins as the first unit pulls up on scene

  • Use the PA to direct all “walking wounded” to gather in a certain area

  • Walking wounded are triaged as Green initially

    • Can be re-triaged later

  • Use three basic assessment criteria to triage remaining patients

Triage


Triage continued
Triage (continued)

  • Respirations

    • Is the patient breathing?

    • If no, reposition airway, re-assess breathing

    • If breathing starts, triage Red

    • If no breathing, triage Black

  • Is the respiratory rate greater than 30 per minute?

    • If yes, triage Red

    • If no, assess perfusion

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Triage continued1
Triage (continued)

  • Perfusion

    • Are radial pulses present and capillary refill less than 2 seconds?

      • If no, triage Red

      • If yes, assess mental status

  • Control any profuse bleeding

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Triage continued2
Triage (continued)

  • Mental Status

    • Can the patient follow simple commands?

      • If no, triage Red

      • If yes, triage Yellow

  • If there are injuries incompatible with life, triage black

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Triage officer
Triage Officer

  • Most knowledgeable provider, on-scene first, becomes triage officer

  • Request additional help

  • Perform initial triage assessment

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Triage officer continued
Triage Officer(continued)

  • Use Triage system per protocols

    • Place color-coded triage tag or tape on patient

    • Do not render any treatment more complex than:

      • Repositioning airway

      • Stop major bleeding

        • Use the patient or a Green patient to assist with any bleeding control

  • Move on to next patient and continue until all receive initial triage

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Triage duties
Triage Duties

  • Assign available personnel and equipment to highest priority patients

  • Re-triage patients as resources allow

  • Patient transport decisions based on variety of factors:

    • Patient priority

    • Destination facilities

    • Patient load and resources

    • Transport distance

    • Transportation resources

  • Triage officer remains at scene to assign and coordinate personnel, supplies and vehicles

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Hospital communications
Hospital Communications

  • Incident nature

  • Size location

  • Number / types of injuries

  • Hospital capacity

  • Update regularly

  • Notify when incident ends

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Summary
Summary

  • Knowing how to triage fast and effectively is vital to saving greatest number of lives

  • Practice, drill and use a triage system every time you have more than one patient

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Applications
Applications

  • Local protocols for triage

  • Recent case review of MCI

  • Lessons of Scenario drill

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Triage

24-7 EMS

888.240.4911

Visit our website for additional information

www.24-7ems.com

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