12/05/14 Triage: Montgomery Fire Dept

TRIAGETRIAGEEAST GROUPEAST GROUPFIRE DEPT’SFIRE DEPT’S

TRIAGE

• TO SORT OR CATEGORIZE

• FIRST USED BY NAPOLEON

• INITIALLY USED TO IDENTFY THE LEAST INJURED TO PREPARE THEM TO GET BACK INTO THE BATTLE.

Triage?

Triage is the sorting of patients by the severity of injury or illness so

that resources can be more efficiently utilized to do the most

good for the most people…

Triage is a Dynamic Process…

• Regardless of whether patients are moved from point of injury/illness to another location for treatment, or if they are treated in place…triage is repeated before treatment begins. Triage is conducted during the initial contact and when the patient is moved to the treatment sector.

12/05/14 Triage: Montgomery Fire Dept

Triage Tags

• Triage tags are often used to document the patient condition and treatment received. Tags come in a variety of different designs.

• Different colors are used to represent priority of injury.

Red: ImmediateYellow: DelayedGreen: Walking Wounded, MinorBlack: Deceased

12/05/14 Triage: Montgomery Fire Dept

What do the colors mean???

• Green: Minimal/Walking wounded- These are patients that are ambulatory, and have only minimal injuries and are capable of making their own way to the casualty collection point/treatment sector.

12/05/14 Triage: Montgomery Fire Dept

12/05/14 Triage: Montgomery Fire Dept

What do the colors mean???

• Yellow: Delayed- These are patients that have wounds that require attention, but are not immediately life threatening. These patients usually need assistance making their way to the treatment sector.

12/05/14 Triage: Montgomery Fire Dept

12/05/14 Triage: Montgomery Fire Dept

What do the colors mean?

• Red: Immediate- critically-injured patients with treatable life-threatening injuries or illnesses. This might include airway and breathing difficulties, decreased mental status, and uncontrolled bleeding. These patients will be treated and transported from the scene first.

12/05/14 Triage: Montgomery Fire Dept

12/05/14 Triage: Montgomery Fire Dept

What do the colors mean?

• Black: (morgue)- is used for dead and unsalvageable patients such as someone in cardiac arrest. These victims will be removed from the scene, but only after all of the living/salvageable patients.

12/05/14 Triage: Montgomery Fire Dept

12/05/14

DMS Triage Tag, Instructions

The Contaminated strip running the length of the triage tag has three functions. First to prevent the tag from being used until patient contamination has been considered. Second, to identify victims who have been exposed to a hazardous material, and third to aid rescuers with identifying clothing (evidence) belonging to victims.

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Triage Tag Instructions, Cont.

After a victim's clothing has been removed and placed into an airtight clear plastic bag, the long CONTAMINATED tear off strip is placed inside the bag face out. The numbered tag allows for clear identification of items for retrieval by the owner or for investigative purposes.

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Triage Tag Instructions, Cont.

If contamination is not an issue, the strip may be removed and standard triage procedures may be initiated.

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Triage Tag Instructions, Cont.

Once contamination has been ruled out or decon procedures completed, the next step will be to follow START triage guidelines. On the back of the tag the R.P.M. pneumonic will be used while referring to the flow chart located directly above. Once the patients have been categorized they are ready to be moved to the treatment area.

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Triage Tag Instructions, Cont.

The front of the tag is than used to record injuries and their anatomical locations, as well as vital signs and medications.

12/05/14

Triage Tag Instructions, Cont.

The second tear off tag from the top is to be used for recording patient destination. The tag may be removed just prior to the patient leaving the scene. Both the destination and how the patient was transported (ambulance number, helicopter, bus, etc.) shall be recorded on the tag.

Ok, now we know what triage is, and how to use the tags….

LET’S GET TO WORK!!!

12/05/14 Triage: Montgomery Fire Dept

How do we determine what color a patient gets?

• RPM

• Respirations?

• Perfusion?

• Mentation?

S.T.A.R.T.

• First arrival makes the announcement:

– ANYONE WHO CAN WALK, PLEASE GO TO _____________________________.

You have just triaged the green category.

Those who did not leave, perform START.

12/05/14 Triage: Montgomery Fire Dept

Respirations

• Is the patient breathing?

!-If the patient is not breathing, open the airway and reassess. If the patient is still not breathing tag as black and move on.

!- C-Spine control may have to be sacrificed in this situation. Do the best you can…as quickly as you can…

12/05/14 Triage: Montgomery Fire Dept

Respirations

• Assess the rate of respirations.

!- If >30, tag as red and move on to the next patient.

!- As the triage officer, you do not stop to ventilate the patient.

12/05/14 Triage: Montgomery Fire Dept

Respirations

• If the patient requires simple airway maintenance you will need to assign someone to this task. If no EMS personnel are available, remember that you have a pool of human resources in the green tag area. If no one there is available, you will need to improvise by placing something under the patient’s head/neck to keep the airway open. You may also consider placing a simple airway adjunct.

12/05/14 Triage: Montgomery Fire Dept

Perfusion

• Check for the presence of radial pulses. However, note that we are not concerned with a pulse rate at this time. If the patient has no radial pulses, he is critical and in immediate need of care. You apply a red tag to the patient and move on to the next patient.

12/05/14 Triage: Montgomery Fire Dept

Perfusion

• If there are no radial pulses, there is no need to check for carotid pulses

!- If the patient is breathing, the heart is beating…if the radial pulses are absent, the BP is <90mmHG and requires attention from the treatment sector.

12/05/14 Triage: Montgomery Fire Dept

Perfusion

• Is there any immediately life threatening bleeding?

!- Quickly address only life threatening bleeding. Use the cleanest dressing material available, and use green tagged patients to provide pressure.

12/05/14 Triage: Montgomery Fire Dept

Mentation (Mental Status)

• Unconscious patients, or patients that can not follow simple instructions require immediate attention from the treatment sector. Tag these patients with a red tag and move on.

• Patients that can follow instructions may be tagged yellow.

12/05/14 Triage: Montgomery Fire Dept

Putting it all together

• As soon as a patient meets any one of the criteria for triage as critical/immediate, you should apply a red tag, delegate someone to provide rapid treatment (e.g. maintain an airway or control bleeding), stop any further assessment and move on to the next victim.

12/05/14 Triage: Montgomery Fire Dept

Putting it all together• Any patient who makes it through all three

assessments, without any findings that would result in triaging as critical/immediate, is given a yellow tag.

12/05/14 Triage: Montgomery Fire Dept

Putting it all together

• No triage system is 100% fail safe. It is, however, reasonable to assume, that a patient who cannot walk, but is maintaining his own airway, breathing at a rate less than 30 breaths-per-minute, perfusing radial pulses, has no sign of uncontrolled bleeding and follows commands, is in need of medical attention at the hospital, but can wait until all of the critical/immediate (red tags) are removed from the scene.

12/05/14 Triage: Montgomery Fire Dept

Summary

• Anyone who gets up and walks to the designated area is given a green tag

• Anyone who is not breathing is given a black tag

• Anyone who fails one of the RPM assessments is given a red tag

• Anyone who cannot walk but passes all of the assessments is given a yellow tag

Proceed to Part 2