Module 1- Triage & Disasters- student

Triage and Disaster Management

  • Lecturer: Brooklyn Derksen, BSN, RN, DTN, MN, ENC(C), University of Saskatchewan College of Nursing

Objectives

  • Overview of triage

  • Prioritization systems:

    • Modified Early Warning Score (MEWS)

    • Canadian Triage and Acuity Scale (CTAS)

    • Emergency Triage Assessment Tool (ETAT)

  • Disaster:

    • Types of disasters

    • 4 phases of emergency management

    • Disaster triage compared to conventional triage

    • The nursing role within disaster contexts

Triage Defined

  • Triage means priority setting

    • Originates from the French verb "trier" which means to sort

    • Assigns priorities based on available resources

    • Prioritization involves deciding which issues require immediate action and which can be deferred

  • Basic nursing competency: Develop decision-making skills during nursing education

  • Key question: What tools or frameworks do you know for triage?

Practical Application in Triage

  • Scenario: Starting a shift with 6 patients

    • Questions:

      • How to prioritize care for the first patient

      • How to determine the most critical tasks

Prioritization Systems

Modified Early Warning System (MEWS)

  • Definition:

    • A scoring tool to identify patients in hospitals who are at risk of deterioration

  • Components include:

    • Level of consciousness

    • Respiratory rate

    • Systolic blood pressure

    • Temperature

    • Heart rate

    • Oxygen saturation

    • Urinary output

  • Image of MEWS: Not memorization needed, focus on usage

    • modified early warning system

Example: Patient Assessment (John)

  • Details for John:

    • Age: 48, admits with pancreatitis

    • Vital signs upon assessment:

      • Alert and experiencing 7/10 pain

      • Temp: 37.5°C, BP: 168/72, RR: 22, O2: 96% on 3L NP, HR: 102, Urine output: 50ml/hr

    • Tasks: Determine MEWS score and appropriate nursing actions

    • 3

Canadian Triage and Acuity Scale (CTAS)

  • Definition:

    • A 5-level scale used to prioritize patients based on urgency in an Emergency Department setting

  • Key details:

    • Focusing on presenting conditions and modifiers such as age and vitals

    • Graduated response times for each level (15m, 30m, 60m, 120m)

    • modifiers: (i.e. pain level, vitals, bleeding disorders, hemodynamic stability, age, etc.)​ these can change a number of someone

    • older people always get signed 1 higher than they actual are

CTAS Levels

  1. Level 1: Resuscitation: Immediate assessment required, life threats

  2. Level 2: Emergent: Potential threat to life; assess within 15 minutes

  3. Level 3: Urgent: Needs evaluation within 30 minutes, could potentially progress to a problem

  4. Level 4: Less urgent: Needs evaluation within 60 minutes- ex stitches

  5. Level 5: Non-urgent; assess within 120 minutes- acute but not urgent
    - more examples on powerpoint slides

Triage Process

  • Clients with life-threatening or potentially life-threatening problems enter the hospital through the emergency department (ED) ​

  • Helps to bring order and organization to a chaotic scene. ​

  • It identifies and provides care to those who are in greatest need​

  • Assure that resources are used in the most effective manner​

Helps make the difficult decisions easier - relieve emotional burden

Interagency Integrated Triage Tool [IITT]4

  • 3-colour system: red (high acuity; need to be seen immediately), yellow (moderate acuity; need to be seen soon), and green (low acuity; can wait)

Disaster Management

Types of Disasters

  • Natural Disasters: earthquakes, floods, hurricanes

  • Human-Made Disasters:

    • Chemical disasters (e.g. nerve agents)

    • Biological agents

    • Radiological events

  • Need to differentiate between shelter-in-place and evacuation strategies

Disaster Planning

  • Ensures readiness for

  • internal (emergency in the facility ex: fire) vs external disasters (natural disasters, such as floods or earthquakes).

  • Understand the difference between

  • multi-casualty- These involve a limited number of patients, usually less than 100, that can be managed within the capabilities of a typical hospital emergency department

  • mass-casualty events- These involve a large number of patients, typically more than 100, that exceed the capacity of immediate care facilities and require a coordinated response from multiple agencies.

  • Consider resource limitations when responding to disasters

The Disaster Cycle

  • Phases:

    1. Mitigation (prevention)

    2. Preparedness

    3. Response

    4. Recovery

  • Assess overlap and concurrency of disaster cycles

Mitigation Strategies

  • Identify and implement preventive measures for top hazards

Preparedness Measures

  • Disaster plans must include training and supplies

Response During Disasters

  • Implement prior disaster plans to safely meet needs

  • Aim to save lives and reduce suffering

Triage Tag and Patient Care

  • Use of triage tags to convey vital information such as injuries and vitals

Triage helps in assessing patients in mass casualty incidents

  • colour coded

Start triage algorithm

tested on colours

  1. Identify and prioritize patients based on the severity of their conditions.

  2. Sort patients into categories such as immediate, delayed, expectant, and minor.

  3. Communicate effectively with the medical team to ensure timely care for those in critical need.

  4. RPM- resps <30, perfusion (cap refill) <2s, mental status- can do commands

Examples of Patient Situations

  1. Patient with crushing chest pain- yellow, cause cant walk

  2. Patient with right upper quadrant abdominal pain- green

  3. Patient with a head injury and unresponsive- black

  4. Pediatric patient with difficulty breathing- red

  5. Patient with pain and deformity in left arm- green

  6. Non-ambulatory pediatric case with leg pain

Codes and Emergency Response

  • Codes:

    • Code Red – Fire ​

    • Code Orange – Incoming mass casualties​

    • Code Green – Evacuation ​

    • Code Black – Bomb Threat ​

    • Code Purple – Hostage taking ​

    • Code White – Violent act ​

    • Code Silver – active assailant with weapon​

    • Code Yellow – Missing Patient / Resident ​

    • Code Blue – Cardio-Respiratory arrest ​

    • Code Brown – Hazardous Material or Spill ​

    • Code T Alert – Tornado ​Understanding response protocols can enhance safety and efficiency during emergencies

Recovery After Mass Casualties

Shooting

1) run/escape- leave patient (not at fault for leaving)

  • try to make pt look dead

  • turn off lights

  • make it look like no one is in that room

2) hide- if escape is not possible

3) fight- only as last resort

  • Essential tasks post-incident:

    • Manage mass fatality responses

    • Family reunification processes

    • Psychological triage (support for patients, staff, visitors)

    • CISM- critical Incident Stress Management - a structured approach to help individuals cope with the emotional aftermath of a disaster or traumatic event.