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Triage 2016.

Published by Jewel Griffin Modified over 8 years ago

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Presentation on theme: "Triage 2016."— Presentation transcript:

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START Triage - PowerPoint PPT Presentation

START Triage

Title: triage author: administrator last modified by: fujitsu created date: 10/6/2004 7:50:49 pm document presentation format: on-screen show (4:3) company – powerpoint ppt presentation.

• During a Mass Casualty
• Gina Smith RN
• Gina Smith RN CHEP
• Team Commander MA-2 DMAT
• UMass Memorial Medical Center Program Director
• Emergency Management
• Injury Prevention
• I have no actual or potential conflict of interest in relation to this program/presentation.
• Describe the key elements of disaster triage
• Recognize the basic principles of START Mass Casualty Triage
• Demonstrate options for Start Triage tagging
• Mass Casualty Incident
• An incident which generates more patients than available resources can manage using routine procedures
• number of patients
• number of ambulances.
• number of available, qualified personnel.
• personnel efficiency.
• number of appropriate hospital beds.
• minus the number of beds occupied by patients.
• communications system capacity.
• Search and rescue
• Triage and initial stabilization
• Definitive medical care
• Local population is usually your first search and rescue team
• Communities are now developing specially trained Search and rescue teams
• Technical specialists knowledgeable in HAZMAT, structural engineering, and technical search and rescue equipment such as listening devices, remote cameras etc.
• May include trained canines
• Developed in the early 1980s
• Rapid approach to triaging large numbers of casualties
• Easy to remember
• Initial assessment and treatment should take less than 30 seconds for each patient
• Red (Priority 1)
• Yellow (Priority 2)
• Green (Priority 3)
• Black (Dead or death is imminent)
• Life threatening but treatable injuries requiring rapid medical care
• Potentially serious injury but stable enough to wait a short time for treatment
• Minor injury that can wait longer for treatment
• Patients with irreversible injuries for which death is imminent
• Clear the walking wounded from site using verbal instruction
• Direct them to treatment areas for detailed assessment and treatment
• Tag as GREEN or Priority 3
• Respirations
• Mental Status
• An adult, shaking his head, non ambulatory. He says hes too dizzy to walk.
• Obeys commands
• Adult female, had been trapped by her lower legs under caved-in wreckage.
• Cap refill 4 sec
• Moans with verbal stimulus
• A woman is carrying a crying infant. She is able to walk.
• An adult male lies on the ground
• Good distal pulse
• Obeys commands but cries that he cant move his legs
• Adult Female apparent Compound fracture, left femur
• Respirations over 36/minute
• Radial pulse weak
• Secondary Triage
• Quickly reassess
• Triage should take place outside of ER dept.
• Initial hospital triage can be changed from initial field triage.
• Triage is a dynamic process and is often done more than once for each patient.
• Commercial product
• Skin Markers
• Colored tape
• Thank you for all that you do!

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SMART System & START Triage

Dec 19, 2012

1.46k likes | 4.48k Views

SMART System & START Triage . Bureau of Emergency Medical Services New York State Department of Health. Jim Soto Associate Director. Objectives: . What is an MCI ? Review Incident Management from EMS perspective Review Triage & Practice START. What is the Goal of MCI Management?.

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Presentation Transcript

SMART System & START Triage Bureau of Emergency Medical Services New York State Department of Health Jim Soto Associate Director

Objectives: • What is an MCI ? • Review Incident Management from EMS perspective • Review Triage & Practice START

What is the Goal of MCI Management?

EMS GOAL: TO SAVE THE LARGEST NUMBER OF SURVIVORS FROM A MULTIPLE CASUALTY INCIDENT

What is an MCI Scene?

What are some Common things affecting your MCI response? • Typical staffing of your ambulance service? • What does EMS routinely do daily? • How do you handle the following? • 4 victims in a two car “head-on” • 17 victims in a “team” van • 43 victims on a school bus • 350 victims on a train Need Resources & Coordination

TRIAGE STAGING COMMUNICATIONS COMMAND IMMODIUM SAFETY TREATMENT ASSESSMENT So what do you have to think about?

THE INITIAL PROBLEM ON SCENE Casualties Resources

THE OBJECTIVE Casualties Resources

THE OBJECTIVE Casualties Resources Achieve balance

BUT - HOW IS EMS TRAINED? • BLS, ALS • CPR, ACLS, PALS • PHTLS, BTLS • CFR, EMT, EMT-I, EMT-CC, EMT-P How many patients are you taught to treat at one time?

WHAT CHANGES WHEN YOU HAVE AN MCI ? • What are my resources? • Who is a Patient? • Which Patient do I treat first? • Who can be salvaged? • Who gets transported first? • Who needs a Trauma/Specialty Center? • Who can help care for others?

TIME IS IMPORTANT ARRIVAL OF REQUESTED RESOURCES

TIME IS VERY IMPORTANT THE GOLDEN HOUR “The critical trauma patient has only 60 minutes from thetime of injuryto reach definitive surgical care, or the odds of a successful recovery diminish dramatically”. Pre-Hospital Trauma Life Support, Second Edition, Patient Assessment and Management, page 42. 1990. To the Victim

Casualties Resources Balancing Act Management Golden Hour Resources Arrive Time Management

Casualties Resources + = Maximum survivors

TIME H The Scene H H Definitive Care SCENE MANAGEMENT Command Safety Assessment Communication Triage Treatment Transport MANAGEMENT EMS OPERATIONS

Command Who is in Charge? Who is in charge of what? Who is going to do what? Who else needs to be here? EMS is generally in Operations (Ops) Safety Is there a hazard or threat? Should I be here? Am I protected? What should I worry about? Scene Management

Assessment What is going on? How big is this, how many people? What do I need? How does what I do affect others? What are they doing that can affect me? Communications Who needs to know? What do they need to know? Does Command & Ops know? Do the other players know? Scene Management

Triage Who is doing it? Where are they doing it? What are they finding? Treatment What the typical EMS provider comes “preloaded” with… How to organize? How much can we do? Scene Management

Transport Who is doing it? From where are they doing it? Where are the patients going? How many patients going where? Scene Management

TRIAGE “Large scale triage is the hardest job anyone in pre-hospital care will ever do”. A.J Heightman, Mass Casualty Incident Management. A practical approach to solving complex operational dilemmas.

TRIAGE WHEN ? Casualties exceed the number of skilled rescuers.

Types of Triage • Primary • On Scene prior to movement • Secondary • Incident dependant, probably prior to or during transport

Priority Treatment Color RED Yellow Green Black TRIAGE CODING Immediate 1 Urgent 2 Delayed 3 Dead 0

TRIAGE TAGS What is the same ? What is improved ? What is different ?

Triage Protocol (START)

PRIMARY TRIAGE The Scene

PRIMARY TRIAGE The first attempt at balancing EMS resources and casualties / injured

PRIMARY TRIAGE Determining whether there is an airway and breathing

PRIMARY TRIAGE If breathing, at what rate & is it good enough?

PRIMARY TRIAGE They have an airway, and are breathing. Are they circulating blood sufficiently?

Circulatory Check…

PRIMARY TRIAGE A B C Mental Status

PEDIATRIC TRIAGE Children are involved in multiple casualty incidents. The over prioritizing of children will take valuable resources away from more seriously injured adults. Triage systems based on adult physiology will not provide accurate triage.

SMART Pediatric Tape • Developed by Pediatricians to use the existing START protocol but modified to reflect appropriate values for pediatric respirations and circulation.

START EXERCISE

START EXERCISE • Female, 30’s, walking • Female, teens, walking, pale, complaining of severe abdominal pain • Male, teens, walking, confused • Male, teens, you open airway, does not breathe • Male, 20’s, unconscious, breathing, RR 36, radial pulse absent • Male, 20’s, holding left ankle, cannot walk, RR 20, CRT 1, responds to instructions 1

START EXERCISE • Female, 30’s, walking • Female, teens, walking, pale, complaining of severe abdominal pain • Male, teens, walking, confused • Male, teens, you open airway, does not breathe • Male, 20’s, unconscious, breathing, RR 36, radial pulse absent • Male, 20’s, holding left ankle, cannot walk, RR 20, CRT 1, responds to instructions 1 A

START EXERCISE • Female, 60’s, fracture LL leg, cannot walk, RR 25, CRT 1, obeys commands • Male, 30’s, you open airway, does not breathe • Male, 30’s, lying on ground, breathing, gurgling sounds, RR 37, pulse absent, unresponsive • Male, 50’s, you open airway, does not breathe • Male, child, 75 cm, not alert, breathing, RR 30, CRT 2.5, pulse 100 • Male, child, 130 cm, not walking, breathing, RR 24 CRT 1 2

START EXERCISE • Female, 60’s, fracture LL leg, cannot walk,RR 25, CRT 1, obeys commands • Male, 30’s, you open airway, does not breathe • Male, 30’s, lying on ground, breathing, gurgling sounds, RR 37, pulse absent, unresponsive • Male, 50’s, you open airway, does not breathe • Male, child, 75 cm, not alert, breathing, RR 30, CRT 2.5, pulse 100 • Male, child, 130 cm, not walking, breathing, RR 24 CRT 1 2 A

START EXERCISE • Female, child, 145 cm, lying on ground holding chest, breathing with gurgling sounds, RR 37, CRT 3 • Female, child, 47 cm, breathing, crying, pulse 160 3

START EXERCISE • Female, child, 145 cm, lying on ground holding chest, breathing with gurgling sounds, RR 37, CRT 3 • Female, child, 47 cm, breathing, crying, pulse 160 3 A

SECONDARY TRIAGE

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