NURSING

What is Triage?
• French verb “trier” means to sort
• Assigns priorities when resources limited
• Do the best for the greatest number of patients
 Why is Disaster Triage needed
• Inadequate resource to meet immediate needs
• Infrastructure limitations
• Inadequate hazard preparation
• Limited transport capabilities
• Multiple agencies responding
• Hospital Resources Overwhelmed
 Advantages of Triage
• Helps to bring order and organization to a chaotic scene.
• It identifies and provides care to those who are in greatest need
• Helps make the difficult decisions easier
• Assure that resources are used in the most effective manner
• May take some of the emotional burden away from those doing triage
 Role of nursing in disasters
Disaster preparedness, including risk assessment and multi-disciplinary
management strategies at all system levels, is critical to the delivery of
effective responses to the short, medium, and long-term health needs of a
disaster-stricken population.
International Council of Nurses (2006)
 Nurses’ roles in disasters
Determine magnitude of the event
Define health needs of the affected groups
Establish priorities and objectives
Identify actual and potential public health problems
Determine resources needed to respond to the needs identified
Collaborate with other professional disciplines, governmental and non-
governmental agencies
Maintain a unified chain of command
Communication
 START Triage
• Simple Triage and Rapid Triage
• Designed to perform by first responders
• Assumes personnel under a great deal of stress
• Considered as primary survey
 Color Tags START Triage
• Green – those who are able to get up and walk away
• Red – those with respiratory compromise, no palpable wrist or unable to
follow commands
• Yellow – those who are not red but can’t walk basically patients that can be
delay the treatment
• Black - dead
 Initial Assessment: START Case #1
• 30 year old male found with bleeding head wound
• RR = 22
• Wrist Pulse: palpable
• Mental Status: unresponsive
• START Category: Red (immediate)
• Treatment: apply pressure to stop bleeding
 SAVE Triage
• Secondary Assessment of Victim Endpoint
• All patients with at least 50% chance of survival using available resources get
care
• Patient assessed by SAVE methodology in order of priority determined by
START
 SAVE Triage Areas of Assessment
• Vital signs
• Airway
• Chest
• Abdomen
• Pelvis
• Spine
• Extremities
• Skin
• Neurological Status
• Mental Status
 SAVE Triage Categories
• Red – require immediate intervention
• Yellow – require intervention but can tolerate a brief delay
• Green – do not require intervention to prevent loss of life or limb
• Black – dead or unsalvageable
• Note: Periodic Assessment of all categories is important
• Patients may move to one area to another
 Secondary Assessment: SAVE Case #2
• 30 year old male found with bleeding head wound
• START Category: red (immediate)
• EXAM: neurological status
• - Does not open eyes, does not speak, and withdraws to pain
• - GCS = 6
• SAVE Category: Black (unsalvageable)
 SAVE Triage Guidelines
• Head Injury (adults)
• use GCS
• Score 8 or above: treat
• Better than 50% chance of a normal or good neurological recovery
• Score of 7 or less: comfort care only
 Emergency Rescue and Transfer (ERT)
• Is a procedure moving a victim from a dangerous to safe place
• Indications:
• 1. danger of fire and explosions
• 2. danger of toxic gases or asphyxia
• 3. danger of collapsing wall
• 4. exposure to cold or intense heat
• 5. risk of drowning
 Basic Principles of Emergency Rescue and
Transfer Rescue
• Ensure or maintenance of an open airway
• Control of severe bleeding
• Moving victim as one unit and in proper body position
• Methods of ERT should be safe, comfortable, and fast
• Check victim’s conditions regularly before and during and after ERT
• Immobilization of the injured body parts before extrication and transfer
• Taller first aider must stay at the head part of the victim
 Criteria for Selection of Methods of Transfer

• Nature and severity of the injury

• Size of the victim
• Physical capabilities of rescuer
• Availability of equipment
• Evacuation route
• Distance of the place where the victim will be transfered
 Methods of Transfer
• One-man assist – assist to walk, piggyback carry, fireman’s carry, inclined
drag, blanket drag.
• Two-man Carry – two man hand as litter, two man four hand seat
• Three-man Carry – bearer’s along side, hammock carry
• Four/six/eight-man carry – blanket, use of stretcher, use of long spinal
board
 Things to Consider
• Move only the victim if his ABC’s are stable
• As much as possible, let the victim move on his own
• Always ask permission of the victim and keep him informed
• Observe ergonomics in lifting and transfer