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Triage “To Sort” Look at medical needs and urgency of each individual patient Triage in Daily Emergencies –Do the best for each individual Disaster Triage.

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Presentation on theme: "Triage “To Sort” Look at medical needs and urgency of each individual patient Triage in Daily Emergencies –Do the best for each individual Disaster Triage."— Presentation transcript:

1 Triage “To Sort” Look at medical needs and urgency of each individual patient Triage in Daily Emergencies –Do the best for each individual Disaster Triage –Do the greatest good for the greatest number –Make an impossible task manageable

2 Following a large disaster, 80% of people involved will transport themselves to the closest ER. These people are ambulatory, most have minor injuries, and the sheer number will overwhelm most ER’s. Then, the critically ill patients start arriving by ambulance….

3 Triage Categories RED- immediate/emergency YELLOW- Urgent GREEN- nonurgent/walking wounded BLACK- dead/ little to no hope of survival

4 SMART Tag System System of triage adopted by Illinois Triage tags have standard barcodes for tracking patients and reuniting families Triage tags have a unique folded design that allows patients to be re- triaged to another color classification without having to replace the tag

5 START Triage Simple Triage And Rapid Transport Gold standard for field adult MCI triage in US and numerous other countries Utilizes the four standard color triage categories Used for primary triage

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7 JumpSTART Triage Tool for pediatric mass casualty field triage Provides objective framework Based primarily on physiologic differences between children and adults Useful for kids of all ages Designed for use in Disaster/MCI events –If positioning airway does not restart breathing, a ventilatory trial is administered in JumpSTART –Peripheral pulse is used to assess perfusion in JumpSTART –The AVPU scale is used in JumpSTART Adapted from the Dr. Lou Romig slide set available at

8 JumpStart In children, circulatory failure usually follows respiratory failure. Apnea may occur relatively rapidly, rather than after a prolonged period of hypoxia. There may be a brief period when the child is apneic but not yet pulseless since the heart has not yet experienced prolonged hypoxia. It is felt that providing a brief trial of ventilations may help “jumpstart” their respirations.

9 Adult or Child?? It can be difficult to discern the age of a child especially pre-teen and early teen years, and which triage tool to use If a victim appears to be a child use JumpSTART If a victim appears to be a young adult use START

10 Differences Between START and JumpSTART © STARTJumpSTART AirwayIf positioning the airway does not restart breathing, pt tagged as black/deceased If positioning the airway does not restart breathing, 5 rescue breaths ( the jumpstart) is given Perfusion/CirculationCapillary refill is used to assess perfusion Peripheral pulses are used to assess perfusion Mental StatusAbility to follow commands is used to assess mental status AVPU is used to assess mental status

11 RED - Immediate Severely injured but able to be saved with relatively quick treatment and transport Examples –Severe bleeding –Shock –Open chest or Abdominal wounds –Emotionally out of control

12 Yellow - Delayed Injured but unable to walk on their own Examples –Burns with no respiratory distress –Spinal injuries –Moderate blood loss –Conscious with head injuries

13 Green – Non-Urgent Minor injuries that need to be assessed or treated but not right away Examples –Minor fractures –Minor bleeding

14 Black - Deceased Dead or obviously dying Depends on local protocols Examples –Cardiac arrest –Resp arrest with a Pulse Can be psychologically difficult to tag a child as black

15 START: Step 1 Patients who are able to walk are assumed to have stable, well compensated physiology, regardless of the nature of their injuries or illness. “If you can hear me, go stand near the big tree.”

16 START: Step 2 Next begin triaging the remaining victims –Open the airway of the apneic adult –If they start to breathe, triage them a red

17 START: Step 3 If after opening the airway, the adult patient does not breathe, tag them a black

18 START: Step 4 Assess the respiratory rate of the breathing adult Move on to the next assessment if respiratory rate is under 30/min If respiratory rate is over 30/min, tag the patient red

19 START: Step 5 If the radial pulse is absent OR If the capillary refill is over 2 seconds, control bleeding and tag the patient red

20 START: Step 6 If the radial pulse is present, Assess the mental status If the patient can follow simple commands, tag them yellow If the patient cannot follow simple commands, tag them red

21 JumpSTART: Step 1 Patients who are able to walk are assumed to have stable, well compensated physiology, regardless of the nature of their injuries or illness. “If you can hear me, go stand near the big tree.”

22 JumpSTART: Step 2 Next begin triaging the remaining victims Open the upper airway of the apneic child. If they start to breathe, tag them as red

23 JumpSTART: Step 3 If the patient has a palpable pulse but is not breathing, give 5 breaths to open the lower airways. Tag as below, depending on response to ventilations. DO NOT CONTINUE TO VENTILATE THE PATIENT. RESUME TRIAGE DUTIES.

24 JumpSTART: Step 4 Assess the resp rate of the breathing child Move on to next assessment if respiratory rate is breaths/minute. If respiratory rate is 45, tag the patient as

25 If the child’s pulse is palpable, move on to the next assessment. If no palpable pulse but child is breathing, tag the patient as JumpSTART: Step 5

26 If patient is inappropriately responsive to pain, posturing, or unresponsive, tag as If patient is alert, responds to voice or appropriately responds to pain, tag as JumpSTART: Step 6

27 Exercise

28 Scenario # 1 VICTIM: 39 y.o. male RESPIRATORY RATE: 28/min PERFUSION: cap refill 4 seconds MENTAL STATUS: moaning OTHER: Bus driver trapped under collapsed dash in front 1.RED 2.YELLOW 3.GREEN 4.BLACK

29 Scenario # 2 VICTIM: 7 y.o. male RESPIRATORY RATE: 22/min PERFUSION: distal pulse present MENTAL STATUS: obeys commands OTHER: complains cannot move or feel legs 1.RED 2.YELLOW 3.GREEN 4.BLACK

30 Scenario # 3 VICTIM: 8 y.o. male RESPIRATORY RATE: 18, talking PERFUSION: distal pulse present MENTAL STATUS: asking for help OTHER: Walks toward you, clothing is torn, no bleeding evident 1.RED 2.YELLOW 3.GREEN 4.BLACK

31 Scenario # 4 VICTIM: 8 y.o. female RESPIRATORY RATE: 24/min PERFUSION: distal pulse present MENTAL STATUS: asking for her wheelchair OTHER: found wedged under bus seat 1.RED 2.YELLOW 3.GREEN 4.BLACK

32 Scenario # 5 VICTIM: 6 y.o. female RESPIRATORY RATE: 0/min PERFUSION: pulseless MENTAL STATUS: unresponsive OTHER: legs trapped under seat from bus 1.RED 2.YELLOW 3.GREEN 4.BLACK

33 Scenario # 6 VICTIM: 25 y.o. female RESPIRATORY RATE: 12/min PERFUSION: capillary refill >4 seconds MENTAL STATUS: eye movement in response to stimuli OTHER: appears six months pregnant 1.RED 2.YELLOW 3.GREEN 4.BLACK

34 Scenario # 7 VICTIM: 8 y.o. male RESPIRATORY RATE: 36/min PERFUSION: distal pulse present MENTAL STATUS: screaming OTHER: partial amputation of foot with minimal bleeding, found in ditch 1.RED 2.YELLOW 3.GREEN 4.BLACK

35 Scenario # 8 VICTIM: 7 y.o. male RESPIRATORY RATE: 38/min PERFUSION: distal pulse absent MENTAL STATUS: groans, stops when spoken to OTHER: lying near bus 1.RED 2.YELLOW 3.GREEN 4.BLACK

36 Scenario # 9 VICTIM: 6 y.o. male RESPIRATORY RATE: 40/min PERFUSION: pulseless MENTAL STATUS: withdraws from painful stimuli OTHER: arm deformity, sucking chest wound 1.RED 2.YELLOW 3.GREEN 4.BLACK

37 Scenario # 10 VICTIM: 6 y.o. male RESPIRATORY RATE: 28/min PERFUSION: distal pulse present MENTAL STATUS: not following commands OTHER: sitting on side of road, blood in ears 1.RED 2.YELLOW 3.GREEN 4.BLACK

38 Scenario # 11 VICTIM: 50 y.o. female RESPIRATORY RATE: 20/min PERFUSION: cap refill 2 seconds MENTAL STATUS: obeys commands OTHER: sitting on side of road complaining of dizziness 1.RED 2.YELLOW 3.GREEN 4.BLACK

39 Scenario # 12 VICTIM: 7 y.o. female RESPIRATORY RATE: 24/min PERFUSION: distal pulse present MENTAL STATUS: crying OTHER: limping near buses 1.RED 2.YELLOW 3.GREEN 4.BLACK

40 Scenario # 13 VICTIM: 7 y.o. male RESPIRATORY RATE: 48/min PERFUSION: distal pulse present MENTAL STATUS: blank stare OTHER: lying in wreckage, bilateral lower extremity deformity 1.RED 2.YELLOW 3.GREEN 4.BLACK

41 Scenario # 14 VICTIM: 6 y.o. female RESPIRATORY RATE: 0/min PERFUSION: faint distal pulse MENTAL STATUS: unresponsive OTHER: found in rubble outside rear bus, apneic after 5 rescue breaths 1.RED 2.YELLOW 3.GREEN 4.BLACK

42 Scenario # 15 VICTIM: 8 y.o. RESPIRATORY RATE: 28/min PERFUSION: distal pulse present MENTAL STATUS: follows commands OTHER: facial and scalp lacerations, moderate bleeding 1.RED 2.YELLOW 3.GREEN 4.BLACK

43 Scenario # 16 VICTIM: 45 y.o. female RESPIRATORY RATE: 0/min PERFUSION: pulseless MENTAL STATUS: unresponsive OTHER: driver of rear bus, found under front of bus 1.RED 2.YELLOW 3.GREEN 4.BLACK

44 Scenario # 17 VICTIM: 30 y.o. male RESPIRATORY RATE: 20/min PERFUSION: capillary refill < 2 seconds MENTAL STATUS: obeys commands OTHER: walking at the scene 1.RED 2.YELLOW 3.GREEN 4.BLACK

45 Scenario # 18 VICTIM: 7 y.o.female RESPIRATORY RATE: 10/min PERFUSION: distal pulse present MENTAL STATUS: groans in response to painful stimuli OTHER: lying in ditch 15 feet from accident 1.RED 2.YELLOW 3.GREEN 4.BLACK


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