1. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC Triage

2. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC Learning Objectives Cognitive 1.Discuss the criteria of MCI implementation. 2.Discuss the goals and purpose of triage. 3.Identify appropriate patient care activities during an MCI. 4.Define the components of the START acronym.

3. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC Learning Objectives Cognitive 5.State how patients are categorized in START triage. 6.Explain the role of the Triage Unit Leader. 7.Discuss the role of the EMT in an MCI.

4. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC Learning Objectives Psychomotor 1.Given an MCI scenario, perform triage. 2.Demonstrate rapid patient assessment.

5. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC Key Vocabulary  Disaster  Multiple casualty incident  Scene-size up  START Triage System  Triage  Triage officer  Triage tag  Walking wounded

6. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC Overview Regardless of the amount of training, will not be immune to the psychological impact or emotional stress of disaster

7. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC Overview (continued) Your best defense is an automatic response, the tools and the confidence that comes from the ongoing practice of triage

8. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC Triage  Good triaging immediately identifies: Patients to be transported first Patients who can assist you Patients impossible to save without further resources  Scene safety and your safety are first priority Do not become a victim or part of the problem

9. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC MCI vs. Disaster  MCI: any incident in which the number of patients places excessive demands on personnel or equipment  Disaster: any incident which exceeds the capacity of a system’s resources - including mutual aid  The number of patients constituting an MCI is locally defined

10. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC MCI’s  The EMT role in an MCI: Recognize incident is an MCI Request additional assistance Establish IMS Identify hazards Perform triage Treat patients according to triage priority Transport patients according to triage priority Document:  Patients, conditions and care

11. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC Triage  French word means “to sort”  To do the most good for the greatest number of patients  Goals: How many patients? Classify, label, track Assess needs Best utilize scene resources Coordinate with hospitals

12. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC START Triage  Simple  Triage  And  Rapid  Transport

13. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC START Triage (continued) All Walking Wounded

14. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC START Triage (continued)  National standard Developed by City of Newport Beach (CA) Fire Department and Hoag Hospital Used to triage large numbers, simply and rapidly

15. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC START Triage (continued)  Key assessment elements: Respirations Perfusion Mental status

16. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC 30-2-Can Do  Mnemonic  Any patient who cannot walk but has: Respiratory rate less than 30 per minute Capillary refill less than 2 seconds, and Can follow commands is a “yellow” category patient  All others who cannot walk are “red”

17. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC Triage  Sort multiple casualties into four priorities for emergency care or transportation to definitive care Red Yellow Green Black

18. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC Priority 1 - Red  Immediate  Patients with readily correctable life- threatening conditions Airway and breathing difficulties Uncontrolled or severe bleeding Decreased mental status Patients with severe medical problems

19. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC Priority 2 - Yellow  Delayed  Patients with serious, but not life- threatening conditions Burns without airway problems Major or multiple bone or joint injuries Back injuries with or without spinal cord damage

20. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC Priority 3 - Green  Minor  “Walking Wounded” Minor painful, swollen, deformed extremities Minor soft tissue injuries

21. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC Priority 4 - Black  Deceased  Dead or moribund patients Respiratory or cardiac arrest

22. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC Triage  Begins as the first unit pulls up on scene  Use the PA to direct all “walking wounded” to gather in a certain area  Walking wounded are triaged as Green initially Can be re-triaged later  Use three basic assessment criteria to triage remaining patients

23. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC Triage (continued)  Respirations Is the patient breathing? If no, reposition airway, re-assess breathing If breathing starts, triage Red If no breathing, triage Black  Is the respiratory rate greater than 30 per minute? If yes, triage Red If no, assess perfusion

24. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC Triage (continued)  Perfusion Are radial pulses present and capillary refill less than 2 seconds?  If no, triage Red  If yes, assess mental status  Control any profuse bleeding

25. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC Triage (continued)  Mental Status Can the patient follow simple commands?  If no, triage Red  If yes, triage Yellow  If there are injuries incompatible with life, triage black

26. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC Triage Officer  Most knowledgeable provider, on- scene first, becomes triage officer  Request additional help  Perform initial triage assessment

27. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC Triage Officer (continued)  Use Triage system per protocols Place color-coded triage tag or tape on patient Do not render any treatment more complex than:  Repositioning airway  Stop major bleeding Use the patient or a Green patient to assist with any bleeding control  Move on to next patient and continue until all receive initial triage

28. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC Triage Duties  Assign available personnel and equipment to highest priority patients  Re-triage patients as resources allow  Patient transport decisions based on variety of factors: Patient priority Destination facilities Patient load and resources Transport distance Transportation resources  Triage officer remains at scene to assign and coordinate personnel, supplies and vehicles

29. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC Hospital Communications  Incident nature  Size location  Number / types of injuries  Hospital capacity  Update regularly  Notify when incident ends

30. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC Summary  Knowing how to triage fast and effectively is vital to saving greatest number of lives  Practice, drill and use a triage system every time you have more than one patient

31. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC Applications  Local protocols for triage  Recent case review of MCI  Lessons of Scenario drill

32. Class # - 3.04.1Triage © Copyright 2006 JSL Communications LLC 24-7 EMS 888.240.4911 Visit our website for additional information www.24-7ems.com