MCI/ Triage

Triage

French word meaning "sorting/picking." It is used to sort multiple victims into four treatment categories.

Which Triage system is used the most?

The "METTAG" system has been approved by california association of fire chiefs (Cal Chiefs)

What other popular triage system is used locally

The S.T.A.R.T System (developed in Orange County - Simple Triage and Rapid Treatment)

When do you triage?

1. Victims are triaged by quick assessment into priority groups (categories)

2. Triaged for treatment within each category

3. Triaged for transport

Category I

Immediate (red) Patients who have a condition that may result in loss of life or limb if not treated immediately.

Category II

Delayed (yellow) patients who need prompt care, but will generally not risk life or limb or be seriously impaired if left untreated for an hour or so.

Category III

Minor (green) Patients who generally need evaluation or treatment, but time is not a critical factor and they will not get worse if left untreated.

Simplistic terms as to why we triage

This way we can quickly and effectively know what kind of patients are present, what injuries need treatment, and which ones to transport in what order.

30-2-Can do

Simple saying used as a memory aid for what we used to rapidly triage patients based on findings.

Respirations < 30

Capillary Refill < 2 seconds

Can follow commands

Category I (injuries)

-Airway obstruction or respiratory insufficiency (above 30)

-Cardiac Arrest (only if no other category I's are present)

-Severe Bleeding (that is not immediately controllable)

-Severe shock

-Severe Head injuries WITH DECREASED LOC (not following commands)

-Open Chest Wounds

-Severe Medical Problems

-Coma due to trauma (not following commands)

Category II (injuries)

-Major or Multiple Fractures (without compromised pulses- which can increase severity, or without open Fractures- Femur Fractures lose 1-4 pints and Pelvic lose 1-6 pints of blood)

-Severe Burns (without complications such as Respiratory compromise)

-Back injuries, with or without spinal cord damage (neurological compromise increases severity)

-Abdominal Eviscerations (unless actively bleeding)

Category III (injuries)

- Minor Fractures

- Minor Injuries (abrasions or other wounds)

- Obviously Dying ( be careful you are planning on leaving this one for dead)

Special considerations regarding triage of critical patients

Often based on the severity of the incident, there may come a time where a patient (who may be critical and in a normal circumstance would be treated) may have to be categorized as green or black. This is difficult especially in the case of pediatrics, but if there is multiple casualties, then the amount of time it would take to treat the one would exhaust the resources available to treat/save other patients. The exception to this rule is if all other patients based on assessment findings, can be categorized as minor.

Category IV

(Patients that are dead )

Policy # 814 EMTs/Paramedics may determine death based upon assessment findings that confirm the absence of respiratory, cardiac, and neurological function.

Including ----

-Decapitation

-Massive crush injury

-Penetrating or blunt injury with evisceration of the heart, lung, or brains

-incineration

-pulseless non breathing patients with extrication time exceeding 15 minutes

-Penetrating trauma with paramedic assessment findings of pulseless, apnea, and asystole

-Blunt trauma patients who are found Pulseless, apneic, and without rhythm

-pulseless non breathing victims of and MCI where there are insufficient resources

-Drowning victims with findings of being submerged longer than an hour

-Rigor mortis

-lividity

Category I (other examples)

- Anaphylaxis

- Status Epilepticus

- Severe hyperpyrexia (106 Degrees F or higher)

- Severe hypothermia (90 degrees F or lower)

- Burns involving the respiratory tract

- Altered or decreased LOC from unknown sources

- Tension pneumothorax

Category II (other examples)

- Seizures

- Fever (102-105 F)

- Fractures without distal pulses (may be category I)

- Drug ingestion (conscious &/or Stable)

- Acute abdominal pain with normal vitals

- Chest pain that is non cardiac in origin

- Asthma without Serious respiratory distress

- Emergency childbirth

- Head injuries with stable LOC

- Respirations >26 but less than 30 with dyspnea

- Eye injuries

Category III (other examples)

- Sprains

- Mild, stable HTN

- Chronic Pain

- Minor to Moderate burns

Describe the application of the triage system

Sometimes called a 3 step system because the 4th level was triaged out. The rest of the patients will be triaged for treatment and again before transportation.

-If there is only one patient, and he is category I then consider load and go and finish secondary enroute to the hospital.

Multiple Patient Incident

"Expanded Medical Emergency" = greater than 5, but less than 15 casualties

Multiple Casualty Disaster

" Major Medical Emergency" = greater than 16, but less than 50 casualties

Mass Casualty Disaster

"Medical Disaster" = greater than 50 casualties

Medical Catastrophe

An incident that overwhelms the available county resources and requires outside assistance

Standard protocol used in a triage situation

The highest medical authority that arrives first immediately triages, determines hazards, number of victims & severity, available resources, needs, and summons addition personnel.

While conducting triage only life threatening problems are touched

Open airway, control profuse bleeding

MAC

Medical alert center (helps coordinate the efforts of prehospital care personnel and tells us which hospitals are available)

In LA county its USC Keck

HEAR

Hospital Emergency Administrative Radio - Radio system used to communicate with the MAC and possibly between hospitals in disaster situations

HERT

Hospital Emergency Response Team (similar to DMAT- disaster management assistance team) is often a team picked up by a helicopter at LA county general hospital and brought to the scene of a disaster- comprised of physicians and nurses

RTS

Revised Trauma Scores- used to triage a patient, and guide patient care, including predicting patient outcome, identify changes in patient status, and evaluate trauma care, especially helping designate a transportation location, also develops statistics regarding the probability of survival for trauma patients.

RTS =?

RTS = SBP (systolic) + RR (respiratory rate) + GCS

Role of The provider agency

(Provide info to the MAC)

- nature of incident

- location of incident

- medcom unit & agency

- agency in charge of incident

- established # of immediate/delayed/minor/peds

- nearest receiving

- transporting provider

- type of hazmat/contamination/ level of decon

What do we document on the paperwork/triage tag

name

age

sex

chief complaint

brief assessment

treatment

sequence #

transport provider

unit #

destination

ICS

incident command system (used for command, control, and coordination)

All incidents have what/who?

An incident commander ( who is responsible for on scene incident management)

Incident command Post

Location of incident command (IC)

Slight changes with pediatric triage

No reps w/ pulse = immediate

Reps present w/o pulse = immediate