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PRINSIP TRIAGE pada Kasus Bencana Masal

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Presentation on theme: "PRINSIP TRIAGE pada Kasus Bencana Masal"— Presentation transcript:

1 PRINSIP TRIAGE pada Kasus Bencana Masal
Photo used with permission of the Emergency Education Council of Maryland Region 5.

2 What is Triage? “Triage”  sortir
Evaluasi berdasarkan kebutuhan medis dan urgensi pada masing2 klien dalam waktu terbatas The word “triage” is based upon a French term that means “to sort”. In the emergency medical setting the triage process attempts to sort and prioritize patients according to their acute medical needs. This process is not meant to discover the fine details of a patient’s condition and needs but to grossly sort those seeking care based upon a limited history and physical assessment by triage personnel. Triage categorization may not be strictly dependent upon patient-specific information. Resource availability and time factors may influence triage decisions. For example, in normal Emergency Department triage, a patient who ordinarily would be triaged in an intermediate category when patients are being seen rapidly after triage may be classified as critical if the patient load is high and the patient is likely to be endangered by a longer wait if classified as intermediate.

3 Triage is a dynamic process and is usually done more than once.
Triage is a dynamic process. Every time we reevaluate a patient we are, in essence, re-triaging them. We add, subtract or maintain resources based upon our assessment of the progress of the patient’s condition. The same holds true in disaster triage. Additional information is acquired with each stage of triage. The additional information about patient condition and incoming information about resource availability may result in any patient being upgraded or downgraded in triage priority at any stage. Hopefully, no MCI patient will be medically assessed only once.

4 Primary Disaster Triage
Triage based on physiology Kemampuan pasien dalam menghadapi /mengkompensasi trauma atau injuri Bila gagal  prioritas tinggi Primary MCI triage is similar to the primary survey (or initial assessment in the EMT-B curriculum) in that it focuses on physiology rather than actual injuries or medical illnesses. By assessing the most vital physiologic functions, primary triage helps to determine whether or not a patient’s systems are able to compensate for the acute insult. Those who are unable to maintain vital body functions on initial assessment are assigned higher priority.

5 Primary Disaster Triage
The most commonly used adult tool in the US and Canada is the START tool. The pediatric MCI primary triage tool most commonly used in the US and Canada is Jump START. The most commonly used adult primary MCI triage tool used in North America is the START tool. The most commonly used pediatric tool is JumpSTART. START and JumpSTART are also utilized in other countries around the world. Both tools will be discussed in depth in the “START and JumpSTART” session of this resource. Other tools are used by some agencies for MCI primary triage but few are tailored specifically for the MCI setting.

6 The Best Tool? No MCI primary triage tool has been validated by outcome data. No primary MCI triage tools, including START and JumpSTART, have been validated by clinical outcome data. Research is needed to determine how to best perform primary triage for patients of all ages and for various incident types. Although not validated by research, START and JumpSTART have gained acceptance because they are based on physiology, are relatively simple to perform and provide at least a basic objective structure for the task of primary triage. Wiseman DB, Ellenbogen R, Shaffrey CI. “Triage for the Neurosurgeon”, Neurosurg Focus 12(3), Available on the Internet at


8 Triage Categories

9 NATO Guidelines Red Airway obstruction, cardiorespiratory failure, significant external hemorrhage, shock, sucking chest wound, burns of face or neck Yellow Open thoracic wound, penetrating abdominal wound, severe eye injury, avascular limb, fractures, significant burns other than face, neck or perineum

10 NATO Guidelines Green Minor lacerations, contusions, sprains, superficial burns, partial-thickness burns of < 20% BSA Black Head injury with GCS<8, burns >85% BSA, multisystem trauma, signs of impending death

11 All ambulatory patients are initially tagged as Green.
START: Step 1 Triage officer announces that all patients that can walk should get up and walk to a designated area for eventual secondary triage. All ambulatory patients are initially tagged as Green.

12 START: Step 2 Triage officer assesses patients in the order in which they are encountered Assess for presence or absence of spontaneous respirations If breathing, move to Step 3 If apneic, open airway If patient remains apneic, tag as Black If patient starts breathing, tag as Red

13 START: Step 3 Assess respiratory rate If ≤30, proceed to Step 4
If  30, tag patient as Red

14 START: Step 4 Assess capillary refill If ≤ 2 seconds, move to Step 5
If  2 seconds, tag as Red

15 START: Step 5 Assess mental status
If able to obey commands, tag as Yellow If unable to obey commands, tag as Red

16 Mnemonic R P M 30 2 Can do

17 Photo used with permission of the Emergency Education Council of Maryland Region 5.

18 What’s your call? An adult kneels at the side of the road, shaking his head. He says he’s too dizzy to walk. RR 20 CR 2 sec Obeys commands

19 What’s your call? Adult female driver still in the bus, trapped by her lower legs under caved-in dash. RR 24 Cap refill 4 sec Moans with verbal stimulus

20 What’s your call? An adult male lies inside the bus. Apneic
Remains apneic with jaw thrust

21 What’s your call? An adult male lies on the ground RR 20
Good distal pulse Obeys commands but cries that he can’t move his legs OR

22 Key Points about MCI Triage
MCI triage will never be logistically, intellectually, or emotionally easy… but we must be prepared to do it using the best of our knowledge and abilities. FEMA Photo Library

23 Key Points The physiology of adults and children differ; therefore different primary triage systems should be used Use JumpSTART for infants through older children Use START for young adults and older Primary triage is just the first look at an MCI victim, similar to the primary/initial survey/assessment

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