Technical Skills

Triage Vocabulary and Core Concepts

• Definition of Triage: This is the process of sorting patients based on the severity of their condition to ensure that those with the most critical needs are treated first.

• Historical Origin: Triage originated in military battlefield medicine during the Napoleon era.

• Date of Inception: The practice dates back to the late $1700s$ within the French army.

• Primary Responsibility of a Responder: To do the greatest good for the greatest number of people.

• Purpose and Necessity: Triage is required because of the limited resources available during emergencies.

• Key Vocabulary Terms:     * START: Simple Triage And Rapid Treatment. This is a quick method used to sort patients specifically in mass emergency situations.     * Golden Hour: The first hour immediately following an injury when medical treatment is most critical to the patient's survival.     * Triage Tag: A color-coded tag used to classify and identify patients based on the severity of their injuries.     * PPE: Personal Protective Equipment, including items such as gloves and masks.     * VS: Vital Signs, which encompass pulse, breathing, blood pressure (BP), and other indicators.     * Incident Command Center: The physical location from which the emergency response is coordinated.     * Standard of Care: The specific level of care that is expected in a given situation.     * Central Treatment Area: The dedicated area where patients are transported for medical treatment after they have been triaged.     * MOI: Mechanism of Injury, referring to the specific way an injury occurred.     * RPM: Respirations, Pulse, and Mental status.

START Triage Methodology and Classifications

• Steps of Proper Triage (START):     1. Check for Mobility: Determine if the patient can walk. If they can, they are classified as minor (green).     2. Check Breathing: Assess the patient’s respiratory status.     3. Check Circulation: Assess the patient’s pulse and capillary refill.     4. Check Mental Status: Evaluate the patient’s cognitive state.

• Triage Tag Color Classifications:     * Red (Immediate): These patients have life-threatening injuries and require immediate care.     * Yellow (Delayed): These patients have serious injuries but their treatment can be delayed.     * Green (Minor): These patients are referred to as the "walking wounded."     * Black (Deceased/Expectant): These patients are either not breathing or have virtually no chance of survival.

Stop the Bleed: Emergency Hemorrhage Control

• Critical Statistic: Severe bleeding is the #1 cause of preventable death following an injury.

• Primary Goals:     1. Stop the bleeding as quickly as possible.     2. Save lives before Emergency Medical Services (EMS) arrive on the scene.

• First Priority: The first priority in any emergency is ensuring scene safety.

• The ABCs of Bleeding Control:     * A – Alert/Assess: Look for heavy bleeding, characterized by spurting or pooling blood.     * B – Bleeding: Identify the specific source of the blood loss.     * C – Compress:         * Apply firm, direct pressure using a cloth or bandage.         * Use both hands to maintain pressure.

• Wound Packing: Pack gauze tightly into the wound and apply pressure directly on top of the packing.

• Tourniquet Application:     * Place the tourniquet $2-3\,\text{inches}$ above the wound.     * Tighten the device until the bleeding stops.     * Do NOT remove the tourniquet once it has been applied.

• Pediatric Considerations: Use the same steps for children but apply appropriate pressure. Tourniquets should only be used on children if absolutely necessary.

Medical Emergencies and First Aid

• Anaphylaxis:     * Signs: Swelling, difficulty breathing, and hives.     * Treatment: Administer Epinephrine (EpiPen) and call $911$.

• Fractures, Sprains, and Dislocations:     * Signs: Pain, swelling, and visible deformity.     * Treatment: Immobilize the affected area, apply ice, and elevate the limb.

• Naloxone:     * Function: Reverses the effects of an opioid overdose.     * Naloxone vs. Narcan: Naloxone is the name of the drug itself; Narcan is the brand name for the nasal spray version of the drug.

• Diabetes Management:     * Low Blood Sugar: Characterized by shaking and confusion. Treatment involves giving the patient sugar.     * High Blood Sugar: Characterized by thirst and fatigue. Treatment requires professional medical help.

• Seizures:     * Protocol: Protect the patient's head.     * Restrictions: Do NOT restrain the person and do NOT put anything in their mouth.

• Stroke Identification (FAST):     * F (Face): Look for drooping on one side of the face.     * A (Arm): Check for arm weakness.     * S (Speech): Listen for speech difficulty.     * T (Time): It is time to call $911$.

Cardiopulmonary Resuscitation (CPR) Foundations

• Definition: CPR stands for Cardiopulmonary Resuscitation.

• Good Samaritan Act: This law protects individuals who provide emergency care in good faith from legal liability.

• CPR Age Range Definitions:     * Adult: Individuals at the stage of puberty and older.     * Child: Individuals from $1\,\text{year}$ of age until they reach puberty.     * Infant: Individuals under $1\,\text{year}$ of age.

• Scene Safety and Activation:     * Do not enter an area that is unsafe.     * Call $911$.     * With a phone: Call $911$ immediately.     * No phone: If no phone is available, perform CPR for $2\,\text{minutes}$ and then leave to call for help.     * Witnessed Collapse: Call $911$ first.     * Unwitnessed Collapse: Perform CPR first.

Technical CPR Execution and Procedures

• Pulse and Breathing Assessment:     * Check for no more than $10\,\text{seconds}$.     * Agonal Gasps: These are not considered adequate breathing.     * Heart Rate Threshold: For children and infants, a Heart Rate (HR) of < 60 is treated as having no pulse.

• Pulse Check Locations:     * Adult/Child: Access the carotid artery.     * Infant: Access the brachial artery.

• Compression to Breath Ratios:     * 1 Rescuer: $30:2$ across all ages.     * 2 Rescuers (Adult): $30:2$.     * 2 Rescuers (Child/Infant): $15:2$.

• Compression Rate: Perform between $100-120\,\text{compressions per minute}$.

• Hand Placement:     * Adult: Two hands on the center of the chest.     * Child: Use one or two hands.     * Infant: Use two fingers, or two thumbs if there are two rescuers.

• Compression Depth:     * Adult: $2\,\text{inches}$.     * Child: Approximately $2\,\text{inches}$.     * Infant: $1.5\,\text{inches}$.

• Criteria to Stop CPR:     1. The scene becomes unsafe.     2. Trained medical help arrives.     3. The victim showing signs of life.

• High-Quality CPR Requirements:     * Fast and deep compressions.     * Allowance for full chest recoil between compressions.     * Minimal interruptions to compressions.

• Effective Ventilation:     * A breath is effective if the chest rises.     * If a breath does not go in, re-tilt the head and try again.

Automated External Defibrillator (AED) Operations

• Usage: Use the AED as soon as it is available (ASAP).

• AED Step-by-Step Instructions:     1. Turn on the AED.     2. Attach the pads to the patient.     3. Clear the victim (ensure no one is touching them).     4. Deliver a shock if the AED advises it.

• Pad Placement: Place one pad on the upper right chest and the other on the lower left side.

• Chest Preparation:     * The chest must be dry.     * Remove chest hair if it interferes with pad adhesion.     * Remove any medication patches from the skin.

• Critical Rule: The most important safety factor is making sure no one is touching the patient when a shock is delivered.