Triage

Objectives
Explain

the role and practice of

triage
Identify the processes of triage

Aim of Triage

To achieve the greatest

good for the greatest
number of casualties

Basis of Triage ( in Mass

Casualty Incident)
Severity of injury
Number of injured
Available resources and
Survival chances of the
victims

Triage

Assess victims vital signs and

condition
Assess their likely medical needs
Assess their probability of survival
Assess medical care available
Prioritize the definitive management
Color tag
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Triage

Prioritization can decrease

morbidity, mortality and
disability of injured during
disaster

Procedures of Triage

TRIAGE FIRST BEFORE

TREATMENT!
Do not take more than 60 seconds
per patients
Determine best facility for definitive
care in the emergency department
and the field

ED Day To Day TRIAGE

True Emergency
A, B, C, D & E
False Emergency

Single Patient Triage

Single patient triage - important in ED's that are

overcrowded or operating at almost full capacity.
Single patient triage allows ED to prioritize patient
and minimize morbidity or mortality.
The triage categories include
a) Emergent
b) Urgent
c) Non-urgent

Emergent Category

Major trauma
Acute myocardial infarction
Airway obstruction
Tension pneumothorax
Flail Chest
Hypovolemic shock (Class III and IV)
Burns with inhalation injury
management should begin upon arrival

Urgent

Vertebral and Spine Injury

Femoral shaft fracture
Closed head injury
Burns
Acute Appendicitis
They all are at risk if not treated in a few hours

Non-urgent
Skin

lacerations
Contusions
Abrasions
Upper extremity fractures
Fever
Associated medical conditions

THE GOLDEN HOUR

Amount of time from injury to

the definitive care.
Care given within the first hour,
mortality and morbidity is
favorably reduced

Mass casualty triage

Mass casualty triage -- allows large numbers

of injured be given the best possible care in
the disaster situation.
The level of ambition may be adjusted to the
needs of the situation.
Triage categories are:
a) Immediate
b) Delayed
c) Walking wounded
d) Dead and dying

START Triage
Simple Triage And Rapid Treatment
Observe:
Respiration
Circulation
Mental Status
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START
Aims to correct the main threats
to life:
Blocked airways
Severe bleeding

Categories
1.

2.

3.
4.

Deceased (BLACK) No

ventilations present after

clearing airway
Immediate (RED)
RR >30/min
delayed capillary refill(>2
secs)
unable to follow simple
commands
Delayed (YELLOW)
Minor (GREEN)
Walking wounded

Procedures of START
(time <60 seconds / patient)

Respiratory

assess for RR and adequacy

not breathing check for foreign body
obstruction; remove loose dentures;
reposition head with C-spine precautions

Does not initiate respiratory effort

BLACK
RR > 30/min RED
RR< 30/min do not tag;
assess perfusion

Procedures of START

Perfusion
assess capillary refill (> or < 2 secs)
>2 secs RED
<2 secs do not tag yet; assess
mental status
If capillary refill cannot be assessed
radial pulse not palpable SBP <
80mmHg
Control hemorrhage using walking
patients or self

Procedures of START

Mental Status
simple commands:
open and close your eyes
squeeze my hands
cannot follow RED
can follow -- YELLOW

Secondary Assessment of
Victim Endpoint

System of triage that strives to

provide care to those in the field
who are most likely to benefit when
faced with extremely limited
emergency medical support systems
SAVE is used along with the START
system
help triage and stratify treatment of
multiple victims especially when
access to definitive hospital-based
care is delayed or unavailable

SAVE

The triage categories in SAVE are

divided into three categories:
Victims who will die regardless of
the amount of care they receive
Victims who will survive regardless
of any treatment measures
Victims who will benefit
tremendously from limited field
interventions
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TRIAGE component in
emergency management
flow
BLACK

Receivi
ng Area

YELLOW

Triag
e

RED

GREEN

Key to success
Mock

up drill exercise in
regular intervals
policy of accreditation for
hospitals