EMS chapter 27 - MCI, ICS, and Triage

JumpSTART triage system

the triage for pediatrics.
respirations: check if in normal range - if not theyre RED

if not breathing, you MUST CHECK PULSE (adults have circulatory failure then respiratory, but children is the opposite).

SALT triage system

Sort, Assess, Lifesaving interventions, Treatment/transport.
Same as JUMP, but if you see life threat, care for it as long as it doesn’t take over a minute

START triage system

simple triage and rapid treatment (START). Based off of respirations, perfusion, and mental status (RPM).

Colors:

• red (immediate) - respirations above 30 per minute. No further assessment needed. If below 30, check mental status and cap refill (are immediate if both is bad)

• yellow (delayed) - respirations below 30. Cap refill less than 2 sec. Good mental status, but still injured

• minor (green) - walking wounded

• dead (black/zebra) - no respirations even after head tilt

what does ICS stand for?

Incident command system
(includes: command, operations, planning, logistics, and finance)

what is an incident commander

the person responsible for all aspects of the emergency response, establishing the structure and requesting resources necessary for the event. The incident commander is typically a senior fire department officer

what does NIMS stand for

national incident management system

what counts as an MCI?

any emergency that involves more victims than can safely be cared for by the first responding units
An MCI is a mass-casualty incident or multiple-casualty incident

types of MCIs

Low impact incident (managed by local emergency people)
High- impact: stresses local EMS, fire, and police resources
Disaster or Terrorism incident: overwhelms regional emergency response resources

what is NIMS?

developed by FEMA

system that uses

• unified approach to incident management

• standard command and management structures

• emphasis on preparedness, mutual aid, and resource management.

what does FEMA stand for?

Federal Emergency Management Agency

what does the triage group do?

• determine location of triage areas (safe areas away from danger)

• conduct primary triage

• communicate resource requirements w/ EMS branch director

• communicate w/ treatment group (ensures that care has begun)

what does the treatment group do?

• determine location for treatment group (safe area)

• coordinate w/ triage group to move patients from triage area to treatment areas

• communicate w/ EMS branch director

• reassess patients - conduct secondary triage

• direct movement to the transport division

what does the TRANSPORT group do?

• Manage patient movement and accountability from the scene to the receiving hospitals.

• Work with the treatment group to establish an adequately sized, easily identifiable patient loading area.

• Designate an ambulance staging division.

• Maintain communication with the EMS branch director.

what does the medical staging group do?

• locate area to collect resources

• go somewhere that the arriving resources can easily find

• determine if several staging divisions will be needed

• determine if staging divisions need to be relocated as situation

steps of START triage

1. scene safety - then enter.

2. direct everyone who can walk away from scene (self-triage)

3. triage remaining patients. Start checking patients from where YOU are, then work outwards

4. respirations above 30 - red catagory

5. respirations below 30 - check perfusion (red if no radial pulse, yellow or green there is pulse)

6. if have radial pulse - check mental status

steps in jumpSTART triage system

1. move all children who can walk to area for minor injuries.

   • there rescuers preform secondary triage

2. assess children who cant walk over there - check for breathing. If there is any, assess RR. Open airway if child isn’t breathing (or stops breathing for more than 10 sec at a time). Clear foreign body object if you see it. Spontaneous breathing = RED

   • if no spontaneous breathing after airway opened, check peripheral pulse.

   • If no pulse = black/zebra

   • if pulse but no breathing, ventilate 5 times w/ barrier device

3. In this step, all patients have spontaneous respirations. If the respiratory rate is 15 to 45 breaths per minute, proceed to Step 4 and assess perfusion. If the respiratory rate is slower than 15 (slower than 1 breath every 4 seconds) or faster than 45 breaths per minute or very irregular, categorize the child as immediate and move on

4. In this step, all patients have adequate respirations. check peripheral pulse rather than cap refill. if no pulse, categorize as immediate. if pulse, check mental status

5. In this step, all patients have adequate ABCs. Check the child’s mental status by using a rapid AVPU assessment.

   • if appropriate reaction to pain (knows where you are pressing or grasping and withdraws or pushes you away) = delayed

   • if inappropriate reaction to pain (posturing, moves sporadically, or does not localize the pain) = immediate.

6. move on to next patient