TRIAGE

What is triage?
Triage means to sort
Looks at medical needs and urgency of each individual
patient.
Sorting based on limited data acquisition
Also must consider resource availability


THE NEEDS OF THE MANY OUTWEIGH THE
NEEDS OF THE FEW OR THE ONE
TRIAGE
mass- casualty or multi- casualty incident
Involves >1 patient or situation that places great demand
on resources (stretched to limit)
Triage is the sorting of two or more patients based on the
severity of their conditions to establish priorities for care
based on available resources
Scene Safety
1. Size of hazard area
2. Safe and sheltered location to move patients
3. Self- protective measures

TRIAGE



DAILY EMERGENCIES
DO THE BEST FOR EACH INDIVIDUAL

DISATER SETTINGS
DO THE GREATEST GOOD FOR THE GREATEST NUMBER.
MAXIMIZE SURVIVAL

TRIAGE IS A DYNAMIC PROCESS AND IS USUALLY
DONE MORE THAN ONCE.
THE TRIAGE PROCESS
A. Sort patients to provide the best outcome for the
GREATEST number of patients
1. Rank in order of severity
2. Mark patients for visual identification
B. May need to modify triage process because of environment
1. Weather
2. Equipment
3. Manpower
4. Communication
5. Distance from definitive care
CONTINUOUS INTEGRATED TRIAGE
A. PRIMARY TRIAGE
B. SECONDARY TRIAGE
C. TERTIARY TRIAGE



PRIMARY DISASTER TRIAGE
-Goals: to sort patient based on probable needs for immediate care.
-Triage based on physiology
CONTINUOUS INTEGRATED TRIAGE
B. SECONDARY DISASTER TRIAGE
Incorporates:
-A reassessment of physiology
-An assessment of physical injuries
Initial Treatment and assessment of patient responses
Further knowledge of resource availability


-

SECONDARY TRIAGE TOOLS
Goals is to distinguish between:
Victims needing life saving treatment that can only be provided in
a hospital setting.
Victims needing life saving treatment initially available on scene.

CONTINUOUS INTEGRATED TRIAGE
B. SECONDARY TRIAGE TOOLS
Victims with moderate non life-threatening injuries, at risk for
delayed complications
Victims with minor injuries

TERTIARY DISASTER TRIAGE
Goals: To optimize individual outcomes
Incorporates:
-Sophisticated assessment and treatment
-Further assessment of available medical resources
-Determination of best venue for definitive care.
C. The 5 Ss
1. Safety Assessment
Assess scene for safety
2. Simultaneous scene size up
Size and severity
Type of incident
Approximate number of patients
Severity of injuries
Area involved, access
3. Send information
Contact dispatch with your scene size-up
Request assistance and additional resources
4. Setting up scene
Obtain triage ribbon
Identify triage areas
Consider scene access and egress
5. START triage process
Begin where you are
Relocate green-tagged patients
Move in an orderly pattern
Maintain a patient count of casualties
Provide minimal treatment
D. Triage Priorities
1. Red-
- highest priority patients need immediate care (usually
circulatory or respiratory)
2. Yellow- second highest priority
able to wait longer before transport (45 minutes)
3. Green- Minor injuries that can wait for longer period of
time for treatment
-walking able to wait several hours for transport
4. Black- dead or still with life signs but injuries are
incompatible with survival in austere conditions.
will die during emergency care (have lethal injuries)
Mark triage priorities (tape, tag)




Triage Category: Red
Red (Highest) Priority:
Patients who need
immediate care and
transport as soon as
possible
Airway and breathing
difficulties
Uncontrolled or severe
bleeding
Decreased level of
consciousness
Severe medical problems
Shock (hypoperfusion)
Severe burns
Triage Category: Yellow
Yellow (Second)
Priority: Patients
whose treatment and
transportation can be
temporarily delayed
Burns without airway
problems
Major or multiple
bone or joint injuries
Back injuries with or
without spinal cord
damage
Triage Category: Green
Green (Low) Priority:
Patients whose
treatment and
transportation can be
delayed until last
Minor fractures
Minor soft-tissue
injuries
Triage Category: Green
Green (Low) Priority:
Patients whose
treatment and
transportation can be
delayed until last
Minor fractures
Minor soft-tissue
injuries
Triage Category: Black
Black (Lowest)
Priority: Patients who
are already dead or
have little chance for
survival. If resources
are limited, treat
salvageable patients
before these patients
Obvious death
Obviously
nonsurvivable injury,
such as major open
brain trauma
Full cardiac arrest

TRIAGE TOOLS

Basic Disaster Life Support
*MASS TRIAGE
M- move
A- Assess
S- Sort
S- Send


TRIAGE TOOLS

* SALT TRIAGE
S- sort
A- Assess
L- Life saving intervention
S- Treatment/Transport

The AVPU Scale is used to assess Level of Consciousness
during Primary Survey.

A - Alert
Able to answer questions

V - Verbal
Responds to Verbal Stimulus

P - Pain
Responds to Painful Stimulus

U Unresponsive
Types of simple triage
AVPU Scale

TRIAGE TECHNIQUES
START

Simple
Triage
And
Rapid
Treatment
* In initial START Assessment mark with triage
ribbons, but only provide minimal treatment. Only
two interventions: (1) open the airway and (2) stop
excessive bleeding. START assessments should only
last 15-30 seconds per patient
START

*Used for PRIMARY triage
Used on scene and at hospital
Recommended for patient >100 lbs
SECONDARY TRIAGE.
*All green patients must be individually assessed in
secondary triage
-assess physiology - Assess injuries
-assess probability of deterioration
-assess needs v/s resource availability
1. Get up and walk
-Have patients move to safe location outside triage area that can
-Self defined green patients
2. Respiration: check for respiratory compromise
-not breathing after reposition airway = BLACK
< 30 breaths/minute = RED
> 30 breaths/minute = CONTINUE
3. Perfusion (pulse, circulation): radial pulse check
-weak, irregular or no radial pulse = RED
-strong radial pulse = CONTINUE
4. Mental Status
-fails to follow simple commands (mental status altered) = RED
- follows simple commands = YELLOW

Secondary Triage
1. Once resources are available and patients are transported to
treatment area, secondary triage begins.
2. In- depth reassessment
Triage tags used. Called METTAGS. Used to indicate
triage category and specific injuries or vital signs.
3. Ongoing in treatment area
4. May change categories

Special Triage Situations

1. Injured rescuer
- Automatic Red
2. Hysterical patient or bystander
- Receives higher then usual priority
3. Child
- Receive higher category. If possible they should be transported
with parent. Check cap-refill in children.
4. Lowered body temp in outdoor environment (hypothermia)
- Hypothermic patients change to high priority
Triage of the Patient with multiple injuries
1. - Golden hour: average amount of time that elapses before a
patient with serious or multiple injuries starts to deteriorate rapidly.
For every 30 minute period after the Golden Hour, the patients
chances of survival are cut in half.
- be knowledgeable
- work quickly and efficiently
- establish priorities and improvise when necessary
2. Remember ABCs, then tackle blood loss
3. Long backboard to splint extremity fracture of speed transport
4. EXCEPTION Femur fracture: site should be treated seperately
with a traction splint.
Purpose: to control, coordinate and direct emergency
responders and resources
1. Call incident command system
2. Design to be used in daily operations
3. Effective at mass casualty incidents
4. Use with >1 patient and events that stretch resources and
equipment to limits
5. Types of out door incidents that might require it
- chair lifts, ice, rock, mountain climbing, river rafting
and avalanche

Emergency Operations Plan
1. Well designed
2. Well practices
3. Coordinated with local EMS and others
Typical Plan
Command Center
Run by area manager
Extrication
Triage Area

Treatment Area
Supply Area
Transportation Area
Rehabilitation Area
















Multiple casualty exercise

exercise #1

*Patients states he cant move or feel his legs
*Respiration 26
*Pulse 110 (radial)
*He is awake and oriented
*WHAT TRIAGE CATEGORY
















Multiple casualty exercise

exercise #2

*Patient is soaked with blood no obvious
killer blood
*Respiration 38
*Pulse is weak, no radial
*He is awake
*WHAT TRIAGE CATEGORY
















Multiple casualty exercise

exercise #3

*Patient walk over to you and has an obvious
fracture arm
*Respiration 22
*Pulse 124 (radial)
*He is awake, alert and crying
*WHAT TRIAGE CATEGORY














Multiple casualty exercise

exercise #4

*Patient is face down in the field
* not breathing
*weak carotid pulse
*She is unresponsive

*WHAT DO YOU DO FIRST














Multiple casualty exercise

exercise #5

*Patient gurgles but cant maintain an opens
airway and is not breathing
*weak carotid pulse
*unresponsive

*WHAT TRIAGE CATEGORY














TRIAGE SHOULD BE DONE WITH THE
HEAD NOT THE HEART