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MASS Triage Scenario

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Objectives

During a facilitator led mass casualty scenario-based discussion you will:

• Discuss DISASTER paradigm • List components of MASS triage • Identify victim triage categories

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Triage “Tabletop”

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Triage Scenario• Shooting incident at a local

shopping center–Multiple gunshots were fired–You are first at the scene–10 victims

• What do you do?

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Is Need > Resources?• D- Detect

– Is this a disaster / MCI? (need>resources)• I- Incident Command

– Who is in charge? (incident commander) Who will you contact?• S- Scene Safety/Security

– Is it safe enough to enter?• A- Assess Hazards

– Active shooter? Secondary device? Further penetrating trauma• S- Support

– Law enforcement, EMS, Medical Control, Trauma Center, etc..• T- Triage/Treatment

– 10 victims• E- Evacuation

– What vehicles are available? What route is safe?• R- Recovery

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D-I-S-A-S-T-E-R ParadigmTriage

M.A.S.S. Triage System

M – MoveA – AssessS – SortS – Send

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MASS Flow Chart

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Step 2: M.A.S.S Triage

• Move • What are the two action steps?

• Assess • Who are you going to approach first?

• Sort • How will you categorize your patients? • Name the three variables impacting decision

making?

• Send• When and what transportation methods are

available?

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MASS Triage• Move

–Two walk–Three move

• Assess–Five do not move

• Sort– IDME categories

• Send

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MASS Triage• Move

–Two walk (Minimal Group)–Three move (Delayed Group)

• Assess–Five do not move (Immediate Group)

• Sort– IDME categories

• Send

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Triage Status

Category Group

Immediate 5

Delayed 3

Minimal 2

Expectant

DEAD 

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• 29 yr male – GSW to left chest, awake in severe respiratory distress

• 8 yr female– GSW to head (through and through) RR=4, HR=101

• 50 yr male – GSW to abdomen & chest, RR=0, HR=0, not moving

• 40 yr female – GSW to neck with gurgling respirations, marked

respiratory distress

• 16 yr male – GSW right chest, No respiratory effort, HR=130 thready

MASS: Immediate GroupUnable to “MOVE”

Immediate

Expectant

Dead

Immediate

Immediate Vs Expectant

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MASS: Delayed GroupAble to “MOVE”, not walk

• 14 year male– GSW to R upper arm, active massive

hemorrhage, good pulses

• 65 year male –No obvious GSW, c/o severe chest pain,

diaphoretic, and SOB

• 22 year female –GSW to R leg, good pulses, no active

bleeding, normal VS

Immediate

Immediate

Delayed

**after pressure dressing

Delayed

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MASS: Minimal GroupAble to “MOVE”, can walk

• 29 yr male –Superficial “scratch” wound to L

arm, no deeper penetration

• 37 yr male –GSW to left hand, exposed muscle,

tendon and bone fragments, capillary refill < 2 sec

Minimal

Delayed

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Triage Status

Category Group SORT

Immediate 5 4-5*

Delayed 3 2

Minimal 2 1

Expectant 1-2*

DEAD  1

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• 29 yr male – GSW to left chest, awake in severe respiratory distress:

Needle decompression of L chest successful, VSS • 40 yr female

– GSW to neck with gurgling respirations, marked respiratory distress: Airway management unsuccessful, profuse bleeding occurred, pt now apneic and pulseless

• 14 year male– GSW to R upper arm, active massive hemorrhage, good

pulses: Now well controlled, no active bleeding, VSS• 65 year male

– No obvious GSW, c/o severe chest pain, diaphoretic, and SOB: Symptoms continue

SORT: ImmediateDelayed

Dead

Immediate

Delayed

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SORT: Delayed• 22 year female

–GSW to R leg, good pulses, no active bleeding, normal VS: Splinted leg, VSS

• 37 yr male –GSW to left hand, exposed muscle,

tendon and bone fragments, initial capillary refill < 2 sec: Now L hand is pulseless and cyanotic

Delayed

Immediate

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SORT: Minimal• 29 yr male

–Superficial “scratch” wound to L arm, no deeper penetration: No clinical change, desires to leave and go home

Minimal

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SORT: Expectant• 16 yr male

–GSW right chest, No respiratory effort, HR=130 thready: Now no palpable pulse, no respiratory effort

• 8 yr female–GSW to head (through and through)

RR=4, HR=101: RR=6-8, HR=100

Dead

Immediate?

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Triage Status

Category Group SORTSORT

Immediate 5 4-5* 3

Delayed 3 2 3

Minimal 2 1 1

Expectant 1-2* 0

DEAD  1 3

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Summary

Now you can:

During a facilitator led mass casualty scenario-based discussion you can

• Discuss DISASTER paradigm • List components of MASS triage • Identify victim triage categories

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Questions?