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Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson.

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Presentation on theme: "Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson."— Presentation transcript:

1 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley CHAPTER Introduction to Multiple-Casualty Incidents, the Incident Command System, and Triage 26

2 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 1.Define the following terms: a.Incident Command System (ICS) b.Incident Commander c.JumpSTART pediatric triage system d.Multiple-Casualty Incident (MCI) e.National Incident Management System (NIMS) f.START triage system g.Triage Objectives (continued)

3 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 2.Explain the criteria that defines a Multiple-Casualty Incident. 3.Describe common causes of Multiple- Casualty Incidents. 4.Explain the role of the Emergency Medical Responder in the multiple- casualty situation. 5.Explain the key principles and structure of an Incident Command System. Objectives (continued)

4 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 6.Explain the key principles of triage at a Multiple-Casualty Incident. 7.Differentiate patient priorities related to triage. 8.Explain the assessment criteria of the START triage system. 9.Differentiate primary and secondary triage. 10.Demonstrate the ability to properly categorize patients of a simulated multiple-casualty situation. Objectives (continued)

5 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 11.Recognize the importance of patient priorities during a multiple-casualty event. Objectives

6 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Topics Multiple-Casualty Incidents Incident Command System Triage

7 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley MULTIPLE-CASUALITY INCIDENTS

8 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Multiple-Casualty Incidents Multiple-Casualty Incident (MCI): any emergency that involves multiple victims and overwhelms first responding units. – Multiple vehicles – Earthquakes – Floods – Large explosions – Building collapses

9 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Multiple-casualty incidents require the resources of many agencies.

10 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Multiple-Casualty Incidents Low-Impact Incidents – Manageable by local emergency personnel. High-Impact Incidents – Stresses local EMS, fire, and police resources. Disaster, Terrorism Incidents: overwhelms regional emergency response resources.

11 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Think About It You respond alone to a serious MVC. You find two patients. One is bleeding severely from a neck wound and the other is complaining of head pain. Which patient do you treat first? Would you consider this scene an MCI?

12 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley INCIDENT COMMAND SYSTEM

13 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Incident Command System Incident Command System (ICS) – Model tool for command, control, coordination of resources at scene of large- scale emergency involving multiple agencies. Procedures for organizing personnel, facilities, equipment, and communications.

14 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Incident Command System Incident Commander – Responsible for all aspects of an emergency response. Modules in Incident Command System: – Command – Operations – Planning – Logistics – Finance

15 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley The incident commander delegates duties to the various group officers.

16 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Incident Command System National Incident Management System (NIMS) – Developed so that federal, state, local, and tribal resources can respond more efficiently to natural disasters and emergencies. (continued)

17 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Incident Command System National Incident Management System – Teaches unified approach to incident management, standard command and management structures; emphasis on preparedness, mutual aid, resource management, common terminology among agencies

18 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Incident Command System The Medical Branch – Branch of ICS – Designates and coordinates three functional areas or groups: Triage Treatment Transport

19 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Incident Command System Triage Group – Determines location of triage areas. – Conducts primary triage and ensures all patients are assessed and sorted using START triage protocol (or similar) – The triage group leader communicates resource requirements to the medical group supervisor. (continued)

20 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Incident Command System Triage Group – Communicates with treatment group leader to allow for movement of patients into treatment area for prehospital care.

21 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Incident Command System Treatment Group – Determines treatment group location. – Coordinates with triage group to move patients from triage to treatment areas. – Maintains communications with medical group supervisor. (continued)

22 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Incident Command System Treatment Group – Reassesses patients, conducts secondary triage to match patients with resources – Directs movement to transport group

23 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Incident Command System Transport Group – Coordinates transportation of victims to appropriate facilities for treatment – Manages patient movement and accountability from scene to hospitals – Works with treatment group to establish adequately sized, easily identifiable patient loading area (continued)

24 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Incident Command System Transport Group – Designates ambulance staging division – Maintains communication with medical group supervisor

25 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Incident Command System Medical Staging – Designates easily located site for resources to stage near incident area – Determines whether several staging divisions required – Determines whether staging will need to be relocated as situation evolves

26 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Think About It You are first on scene of a MVC involving 20 patients who have been ejected into the median after a bus overturned. Should you immediately begin triage? Do you have other immediate responsibilities?

27 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley TRIAGE

28 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Triage Triage – Method of sorting patients for care and transport based on severity of injuries or illnesses. Used in hospital emergency departments, battlefields, emergencies when there are multiple victims and limited medical resources.

29 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley At the scene of a multiple-casualty incident, triage is the system used to identify victims who are most in need of immediate medical care.

30 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Triage EMRs first on scene; must be able to triage patients and initiate care rapidly. Patients with serious medical- or trauma-related problems (heart attack, shock, major injuries, heat stroke) must be transported quickly. Patients with minor injuries or illnesses are transported later.

31 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Triage START Triage System – START: Simple Triage And Rapid Treatment – Based on rapid assessment of patients using three criteria: respirations, perfusion, mental status (RPM) – 60 seconds or less per patient – Do not begin treatment during triage. (continued)

32 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Triage START Triage System – Patients classified into one of four categories; tagged with denoted color- coded tag indicator. Immediate (red) Delayed (yellow) Minor (green) Deceased (black)

33 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley An example of a standard triage tag, front and back.

34 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley The START triage algorithm.

35 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Triage Primary triage – When patient is first identified and triaged. Secondary triage – When patient is relocated to treatment area, he will immediately be re-triaged by treatment team.

36 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley START Triage System

37 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Triage JumpSTART Pediatric Triage System – Specialized pediatric triage system designed for patients from one to eight years of age. – Assessment categories for JumpSTART system are the same as for START system: respirations, perfusion (peripheral pulses), mental status (AVPU).

38 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley The JumpSTART pediatric triage algorithm.

39 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Triage Be aware of your mental and physical stress levels. Critical Incident Stress Debriefing (CISD) sessions or other qualified psychological support should be available after a disaster or unusual emergency to address needs of rescuers.

40 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Think About It You respond to an MCI following an explosion at an outdoor café. You are assigned to the triage group and are given tags. You see significantly injured patients everywhere. A woman with a localized ankle fracture screams out to you for help. What do you do? How will you proceed?

41 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley SUMMARY

42 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary While rare, Multiple-Casualty Incidents (MCIs) can easily overwhelm first responding units at scene. First units quickly request additional resources and begin to establish command over incident.

43 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary Incident Command System (Incident Management System): tool used to manage overall control of large scenes involving many resources and multiple agencies.

44 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary Triage: sorting of patients based on severity of injuries or illnesses – Goal is to save as many patients as possible using available resources.

45 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary Triage Categories – Immediate: for most critical but salvageable patients – Delayed: for less critical but still in need of care – Minor: for those ambulatory at scene – Deceased: who show no signs of life

46 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary START SystemSimple Triage And Rapid Treatment program that uses respirations, perfusion, and mental status assessments to categorize patients into one of four treatment categories.

47 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary Variation of START Triage System designed specifically for pediatric patients is the JumpSTART system. – Takes into account unique needs and presentation of pediatric patients.

48 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley REVIEW QUESTIONS

49 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 1.What are the criteria that define a Multiple-Casualty Incident? 2.What are common causes of Multiple- Casualty Incidents? 3.What is the role of the Emergency Medical Responder in the multiple- casualty situation? 4.What are the key principles and structure of an Incident Command System? 5.What are the key principles of triage at a Multiple-Casualty Incident? Review Questions (continued)

50 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 6.What are the assessment criteria of the START triage system? 7.What is the difference between primary and secondary triage? Review Questions

51 Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Please visit and follow the Resource Central links to access content for this text.


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