PRE- HOSPITAL TRIAGE

C.C.P. TRIPOLI, RN, EMT-B

OBJECTIVES: At the end of this lecture, the student nurses will be able to:

•Explain comprehensively the role and practice of triage.

•Identify correctly the processes of triage.

AIM OF TRIAGE To achieve the greatest good for the greatest number of casualties

BASIS OF TRIAGE in

(MASS CASUALTY INCIDENTS) Severity of injury Number of injured Available resources and Survival chances of the victims

TRIAGE SYSTEM

Is designed to allow each emergency personnel to rapidly:

Assess victims’ vital signs and condition

Assess their likely medical needs Assess their probability of survival Assess medical care available Prioritize the definitive management Color tag patients by priority

TRIAGEPrioritization can decrease morbidity, mortality and disability of injured during disaster

PROCEDURES OF TRIAGE

1.TRIAGE FIRST BEFORE TREATMENT!

2. Do not take more than 60 seconds per patients

3. Determine best facility for definitive care in the emergency department and the field

TWO TRIAGE SYSTEM:

SINGLE PATIENT TRIAGE

MASS CASUALTY TRIAGE

SINGLE PATIENT TRIAGE

Important in ED's that are overcrowded or operating at almost full capacity

Allows ED to prioritize patient and minimize morbidity or mortality

Basic formula is to treat patients who may die if not treated w/in minutes or immediately

CATEGORIES OF SINGLE PATIENT TRIAGE:

1.Emergent

2. Urgent

3.Non-urgent

EMERGENT CATEGORY Major trauma Acute myocardial infarction

Airway obstruction Tension pneumothorax Flail Chest Hypovolemic shock (Class III and IV)

Burns with inhalation injury

management should begin upon arrival

URGENT

Vertebral and Spine Injury Femoral shaft fracture Closed head injury Burns Acute Appendicitis

They all are at risk if not treated in a few hours

NON-URGENT

Skin lacerations Contusions Abrasions Upper extremity fractures Fever Associated medical conditions

MASS CASUALTY TRIAGE

Allows large numbers of injured be given the best possible care in the disaster situation

The level of ambition may be adjusted to the needs of the situation

CATEGORIES:

a) Immediate

b) Delayed

c) Walking wounded

d) Dead and dying

1.Immediate (RED)RR >30/mindelayed capillary refill(>2 secs)unable to follow simple commands

2.Delayed (YELLOW) not fit either immediate or minor

3.Minor (GREEN)“Walking wounded”

4.Deceased (BLACK)No ventilations present after clearing airway

S.T.A.R.T. TRIAGE Observe:

RespirationCirculation

Mental Status

PROCEDURES: RESPIRATORY

assess for RR and adequacy not breathing – check for foreign body obstruction

a. remove loose dentures b. reposition head with C-spine precautions

RR > 30/min – RED RR< 30/min – do not tag assess the perfusion

Does not initiate respiratory effort – BLACK

PERFUSION assess capillary refill (> or < 2 secs)

>2 secs – RED <2 secs – do not tag yet; assess mental status

If capillary refill cannot be assessed radial pulse not palpable SBP < 80mmHg

Control hemorrhage – using walking patients or self

MENTAL STATUS simple commands:

“open and close your eyes” “squeeze my hands”

cannot follow – RED

can follow -- YELLOW

TRIAGE component in emergency management flow

BLACK GREEN

YELLOWRED

Evacuation

Triage

Area

KEY TO SUCCESS Mock drill exercise in regular intervals

policy of accreditation for hospitals

OBJECTIVES: At the end of this lecture, the student nurses will be able to:

•Explain comprehensively the role and practice of triage.

•Identify correctly the processes of triage.

THANK YOU...