1. Unit #3-Triage Objectives
1. Identify the “killers.”
2. Apply techniques for opening airways, controlling bleeding, and treating for shock.
3. Conduct triage under simulated disaster conditions.

2. Safety / Health Considerations
Remember Rule # 1!
Assess the situation….
Avoid contact with body fluids….
Wash hands frequently using soap and water
Wear medical gloves; change after each patient.
Wear a mask and goggles.
Keep bandages/dressings sterile.
Discard infectious materials
properly.

3. THE GOOD OF THE MANY OUTWEIGHS ….
What is Triage?
Triage (n, v) from the French ~~~
means = to Sort (circa 1918)
CERT goal in a disaster situation – where victims overwhelm 1st responders – is to treat as many as possible; as efficiently as possible
THE GOOD OF THE MANY OUTWEIGHS ….

4. Treatment of Life-Threatening Conditions
The “Killers”:
Airway obstruction- Lack of oxygen intake can
lead to brain damage or death in a very few
minutes.
Bleeding, excessive- Life cannot continue
without an adequate volume of blood to carry
oxygen to body tissues.
Shock- Unless shock is prevented or
treated, death may result even though the injury would not otherwise be fatal.

5. Opening The Airway
A patient with suspected air way obstruction must
be treated immediately.
Common obstruction is the tongue.
Steps in Opening Airway:
(Spinal Damage ? - Head - Tilt/Chin Lift Method)
1. Shake the patient by touching the shoulder and
shout “ Can you hear me”.
2. No response, place fingers on each side of
jawbone and lift up.
3. Look for chest rising.
4. Listen for air exchange.
5. Feel for abdominal movement.
NO 2nd Response -
MOVE ON

6. Controlling Bleeding - Types
ARTERIAL bleeding is bright ,oxygen-rich red
blood, under pressure, which spurts from the wound.
VENOUS bleeding is dark, oxygen poor blood flows
from a wound in a steady stream.
CAPILLARY bleeding is dark red blood which
tends to ooze from a wound.
Arterial Venous Capillary

7. Controlling External Bleeding
Wear disposable gloves to protect against disease
Direct pressure stops most bleeding.
Place a sterile gauze pad or a clean cloth over the wound. If bleeding does not stop in 10 minutes, press harder over a larger area.
If bleeding persists, use elevation
combined with direct pressure over
the wound.

8. Controlling With Bleeding Using Pressure Points
Form the arm, Compress
the Brachial artery.
For the leg, compress the
Femoral artery

9. Recognizing & Treating For Shock
Shock is the results of insufficient oxygenated
blood being delivered to every part of the body.
This creates irreversible damage to the body.
Systems of Shock:
1. Rapid, shallow breathing ( rate greater than
30 per minute).
2. Cold, pale skin ( capillary refill greater than
2 sec.
3. Extreme thirst
4. Anxiety
5. Failure to respond to simple commands, <=====
such as “Squeeze my Hand.”
Cont. next slide

10. Recognizing & Treating For Shock
Treatment for Shock:
1. Lay patient on his/her back.
2. Elevate the feet inches.
( No signs of head or back
injury).
3. Maintain body temperature
( e.g., cover the ground and
patient with a blanket).
4. Maintain airway.
5. Control Bleeding.
DO NOT give a patient anything
to eat or drink.
(Patient in shock often vomit)

11. S.T.A.R.T. System of Triage
START – Simple Triage and Rapid treatment
Provides an rapid approach to triage a large
number of patients.
60 Second assessment of patient based on:
1. Respiration “A”
2. Circulation “B”
3. Mental Status “S”
Uses plastic stripes or ribbons (placed on wrist).
1. Red - Immediate Care
2. Yellow - Delayed Care
3. Green - Ambulatory ( minor)
4. Black – Dead
Video===PC

12. Professional Responders use Tags

13. START STEPS Call out for ‘walking wounded’ [GREEN]
Triage the nearest victim [60 seconds]
Treat life-threatening situations [ABS]
Move on to next victim
Report findings to ICS
ICS – assign transport teams to Medical treatment area

14. AMBULITORY( Green -Minor )
S.T.A.R.T. - Simple
Triage& Rapid
Treatment
START Where You Stand
Assess the Scene
Callout to patient for Assistance
Determine Safety
Call Out
Walking
Wounded & Uninjured
Non - Walking
Adult Respiration's Rate
(12 – 20 Breaths/Min.)
RESPIRATIONS
AMBULITORY( Green -Minor )
YES NO
Hold in a Specific Location
Position Airway
Look, Listen & Feel
Over 30/Min. or
Under 10/Min.
Under 30/Min. or
Over 10/Min.
Remember to Fully TRIAGE ASAP
Blood flow through
organs and tissues
of the body
IMMEDIATE (Red)
PERFUSION NO
Blanch Test: Pinch nail
Bed; Color should return
In less than 2 seconds
Reposition Airway
Adult Pulse
60 – 100/ min.
Radial Pulse
Capillary Refill NO
Absent
Present
Under 2/Sec.
Over 2/Sec.
DEAD ?
IMMEDIATE (Red)
IMMEDIATE (Red)
MENTAL STATUS
IMMEDIATE (Red)
Follows Simple Commands
Can’t Follow Simple Commands
DELAYED (Yellow)
IMMEDIATE (Red)

15. If Respirations <30, Capillary refill <2, Alert = Yellow
TRIAGE Simplified
Rule # 5: Thirty, two, How are you?
Walking wounded – GREEN
Respirations Greater 30 – RED
No Respirations? Airway reposition.
Now Breathing? RED
No result- BLACK
4. Capillary refill > 2 seconds; excessive bleeding? RED
5. No Simple commands (squeeze hand)? RED
If Respirations <30, Capillary refill <2, Alert = Yellow

16. Triage
Practice examples
Exercise
Questions

17. Triage Pitfalls No team plan, organization, or goal
Indecisive leadership
Too much time/focus on one injury/victim
Treatment (rather than triage) performed

18. Review: Triage Three killers: A, B, S
Use START technique – 30,2,How are you?
Call out for “Walking wounded”
A – Reposition airway
B – Direct pressure
C – Simple command
Report to ICS for victim transport