42
TRIAGE OF MASS CASUALTIES MSF 11th Surgical Day Paris, 3 December 2011 Marco Baldan ICRC Head Surgeon
| Date post: | 21-Sep-2015 |
| Category: |
Documents |
| Upload: | wirdiyanadian |
| View: | 11 times |
| Download: | 5 times |
TRIAGE
OF MASS CASUALTIESMSF 11th Surgical DayParis, 3 December 2011Marco BaldanICRC Head Surgeon
Al Hussein HospitalKarbala, Iraq2 March 2004First bomb attack in the city Total victims = 277 Dead = 94 Wounded = 183
Hospital SituationBeds in ER = 24No place for cadaversNo communication with/among ambulancesMinimal hospital security systemNo triage system / disaster planMedical supplies on 4th floorOperating theatres on 1st and 2nd floorsLifts not functioning
Clinical practiceNormal clinical practiceMultiple-casualty incidentMass casualties
Triage = Processby which priorities are set for the management of mass casualties.
The aim in a mass casualty situation is
to do the best for the most,
not
everything for everyone.
JFK Memorial Hospital, Maternity BuildingMonrovia 2003
Triage Tent
Inside the Triage Tent
JFK Memorial Hospital, Main Building
Main Building, Triage Department
Triage Department, in use
Triage cannot be organised ad hoc. It requires planning:Preparation before the crisisOrganisation of the personnelOrganisation of the spaceOrganisation of the infrastructureOrganisation of the equipmentOrganisation of suppliesTrainingCommunication SecurityConvergence reaction = relatives, friends & the curious (especially the armed ones)
Triage involves a dynamic equilibrium between needs and resources.Needs = number of wounded and types of wounds Resources = infrastructure and equipment at hand & competent personnel present
The Triage TeamTriage team leader: co-ordinator Clinical triage officer Head nurse, matron: chief organiser Nursing groups Follow-up medical groups
Clinical Triage OfficerNo task in the medical services requires greater understanding,skill,and judgementthan the sorting of casualtiesand the establishment of priorities for treatment.
Triage decisions must be respected.
Discuss afterwards.
Triage is a dynamic process:begins at the point of wounding, occurs all along the chain of casualty care, occurs at the hospital reception, and continues inside the hospital wards: continuous reassessment of patients.
Triage DocumentationInclude basic informationShort-formClearConciseComplete
Triage DocumentationReality checkWhat really happens! During post-triage evaluation:decided to use plasticsleeve to hold the documentation.
The triage process:Sift Place patients in main categories: priority Sort Priority amongst the priorities
Sift1) Select those most severely injured and 2) identify and remove: the dead the slightly injured the uninjured
SortCategorise the most severely injured based on: life-threatening conditions (ABC) anatomic site of injury Red Cross Wound Score treatment available in terms of personnel and supplies
ICRC TRIAGE CATEGORIESI.Serious wounds: resuscitation and immediate surgery II.Second priority: need surgery but can wait III.Superficial wounds: ambulatory management IV.Severe wounds: supportive treatment
Category I: Resuscitation and immediate surgeryPatients who need urgent surgery life-saving and have a good chance of recovery. (E.g. Airway, Breathing, Circulation: tracheostomy, haemothorax, haemorrhaging abdominal injuries, peripheral blood vessels)
Distal pulse absent
Category II: Need surgery but can waitPatients who require surgery but not on an urgent basis.
A large number of patients will fall into this group.
(E.g. non-haemorrhaging abdominal injuries, wounds of limbs with fractures and/or major soft tissue wounds, penetrating head wounds GCS > 8.)
Category I for Airway; Category II for debridement
Femoral vessels intact
Category III: Superficial wounds(no surgery, ambulatory treatment)Patients with wounds requiring little or no surgery. In practice, this is a large group, including superficial wounds managed under local anaesthesia in the emergency room or with simple first aid measures.
Multiple superficial fragments
Category IV: Very severe wounds(no surgery, supportive treatment)Patients with such severe injuries that they are unlikely to survive or would have a poor quality of survival. The moribund or those with multiple major injuries whose management could be considered wasteful of scarce resources in a mass casualty situation.
War Wounded in the FieldFirst AidDressing30 - 40 %No surgery12-15% Head10% Chest10% Abdomen60-65% Limbs90% SurgerySmall woundsParaplegiaQuadriplegiaObservation10% NO Surgery60 - 70 %Hospital careWW in the field(GSW, mine, blast)100 wounded
Epidemiology of Triage:short evacuation timeCategory I 5 - 10% Category II25 30% Category III50 - 60% Category IV 5 - 7%
Triage in Monrovia 20033 June 22 AugustTotal patients triaged = 2588 Total admitted = 1015 (40% of triaged) War wounded = 88.5% of admissions Operations = 1433 Admitted but not operated = 296 All category 1 patients triaged, admitted and operated within 24 hours
Patients triaged by date:three peaks
Chart2
15
3
54
49
36
50
37
45
42
17
26
37
20
43
23
30
20
18
17
15
30
85
185
135
81
20
19
21
15
9
19
15
7
4
14
26
10
8
14
12
4
7
13
3
16
11
42
97
135
69
53
51
84
55
99
22
56
33
20
51
82
13
24
21
13
6
8
9
11
11
10
11
19
20
5
6
13
9
4
9
17
Date
Number Patients
TAO stats
DateArrived in Triage DeptAdm without Tri DeptTotal triaged with & w/o DeptAdmW/O Tri No Opwith Tri No OpNo Op totalTAO SD-NDTAO +2TAO+3TAO+4TAO+5TAO+6TAO+7>total# Operations daily
3.0615151555811151313
4.0633300331313
5.062525256616111252020
6.062020208831314201919
7.061919192211511977
8.06191919885112111999
9.06232323881322388
10.062828286617131282222
11.061111116650112020
12.06999226192525
13.0610101022701101616
14.066661130261515
15.0688833311888
16.06333001231919
17.062220001122828
18.06222002021818
19.068122014224100141826018
20.065131813404801131616
21.061611790005021191313
22.061051511123711166
23.0627330191341302192626
24.067213855051924230111504040
25.061671818542781519422421818
26.061171813541571216116122411717
27.066417813244810262112321818
28.0617320140226312141111
29.061631980330121181313
30.06147213031114411316301919
1 July114151141542111919
2.07729612320162121
3.07190196011202161919
4.071321571452073030
5.07617501130151111
6.07404101100188
7.0710414811231282828
8.07232251223530112122020
9.0782107022301172424
10.07448410110241616
11.078614134483011131919
12.0712012403300141010
13.074047033111171313
14.077073000101133131
15.071301350113151717
16.0730310001012020
17.071511670006171752117
18.07831162024062020
19.0742042180775114181414
20.078710973948122112210391313
21.07119161352864101602282323
22.076546918156822181515
23.07503531603354211161212
24.0741105137281011232324372222
25.07804841301180211131818
26.0755055110332132111313
27.0794599190111021122191313
28.072112213022233111132121
29.0752456111235012112020
30.07330331405532112142020
31.07155201521332151152323
1 Aug48351122137011121616
2.087848214022912141919
3.0812113801160182121
4.0821324111013331112121
5.08183211725724211172929
6.081211340112142424
7.0842613112221213132121
8.0880840113041717
9.0890910110012020
10.081011120002021616
11.081101140113041717
12.088210110112422112020
13.0811011801160182121
14.0818119602221161919
15.081552010426301101919
16.0850530002131313
17.08606401121444
18.089413900062192020
19.0863952132051515
20.08404300011131515
21.08729301110131111
22.08152171202240312121010
17972432243101513316310151433652
2964356668453620491015
203
2000
not operated, what day triage to admission?
&F
Page &P of &N
TAManagement
Triage DateTotal TriagedTriaged to AdmissionTri to Adm as % of Total TriagedTAM SD-NDTAM +2TAM+3TAM+4TAM+5TAM+6TAM+7>total# Operations daily
3.0615*15-1386.7%1115.8666666667
4.063*3-3100.0%4
5.06542546.3%2288.0%11125.88
6.06492040.8%1155.0%131420.55
7.06361952.8%1368.4%5119.6842105263
8.06501938.0%1368.4%1121119.6842105263
9.06372362.2%2191.3%223.9130434783
10.06452862.2%2382.1%13128.8214285714
11.06421126.2%11100.0%12
12.0617952.9%888.9%19.8888888889
13.06261038.5%990.0%110.9
14.0637616.2%466.7%26.6666666667
15.0620840.0%675.0%118.75
16.064337.0%133.3%23.3333333333
17.062328.7%00.0%112
18.063026.7%2100.0%3
19.06201680.0%1487.5%1116.875
20.06181688.9%1487.5%216.875
21.0617847.1%675.0%118.75
22.06151173.3%11100.0%12
23.06301653.3%1487.5%216.875
24.06855160.0%4792.2%111151.9215686275
25.061856434.6%3351.6%525621164.515625
26.061354231.1%2969.0%11621242.6904761905
27.06813543.2%1851.4%38201335.5142857143
28.0620945.0%666.7%3000009.6666666667
29.0619842.1%225.0%1121018.25
30.06211466.7%1071.4%111114.7142857143
1 July151173.3%872.7%2111.7272727273
2.079444.4%375.0%14.75
3.0719631.6%350.0%216.5
4.0715853.3%787.5%18.875
5.077571.4%480.0%15.8
6.074125.0%0.0%0
7.0714964.3%777.8%119.7777777778
8.0725936.0%666.7%1119.6666666667
9.0710660.0%466.7%116.6666666667
10.078562.5%240.0%215.4
11.07141178.6%1090.9%111.9090909091
12.0712866.7%675.0%118.75
13.074250.0%150.0%12.5
14.077342.9%133.3%113.3333333333
15.0713538.5%480.0%15.8
16.073133.3%1100.0%2
17.0716743.8%685.7%17.8571428571
18.0711654.5%6100.0%7
19.07421945.2%1473.7%11420.7368421053
20.07973839.2%3284.2%122138.8421052632
21.071353928.9%2564.1%2521439.641025641
22.07692536.2%1456.0%442125.56
23.07532547.2%1456.0%223425.56
24.07511835.3%1372.2%12218.7222222222
25.07842631.0%1038.5%24342126.3846153846
26.075559.1%480.0%15.8
27.07991919.2%1157.9%321219.5789473684
28.0722731.8%228.6%417.2857142857
29.07561628.6%850.0%214116.5
30.07331339.4%538.5%212313.3846153846
31.0720735.0%571.4%117.7142857143
1 Aug511631.4%1168.8%31116.6875
2.08822024.4%1260.0%331120.6
3.0813861.5%562.5%128.625
4.08241250.0%758.3%4112.5833333333
5.08211257.1%758.3%31112.5833333333
6.0813538.5%360.0%115.6
7.086466.7%375.0%14.75
8.088225.0%2100.0%3
9.089222.2%2100.0%3
10.081119.1%1100.0%2
11.0811872.7%675.0%28.75
12.0810770.0%114.3%427.1428571429
13.0811872.7%787.5%18.875
14.0819631.6%466.7%116.6666666667
15.08201050.0%990.0%110.9
16.085240.0%150.0%12.5
17.086350.0%266.7%13.6666666667
18.0813969.2%666.7%219.6666666667
19.089555.6%5100.0%6
20.084375.0%133.3%113.3333333333
21.089444.4%375.0%14.75
22.08171164.7%545.5%31211.4545454545
2549101539.8%7037574474022541015
TAM table
Triage DateTotal TriagedTriaged to AdmissionTri to Adm as % of Total TriagedTAM SD-NDTAM SD-ND %TAM +2TAM+3TAM+4TAM+5TAM+6TAM+7>total# Operations daily
3.0615151386.7%
4.06333100.0%
5.0625252288.0%
6.0620201155.0%
7.0619191368.4%
8.0619191368.4%
9.0623232191.3%
10.0628282382.1%
11.06111111100.0%
12.0699888.9%
13.061010990.0%
14.0666466.7%
15.0688675.0%
16.0633133.3%
17.062200.0%
18.06222100.0%
Total20320316078.8%
Triage DateTotal TriagedTriaged to AdmissionTri to Adm as % of Total TriagedTAM SD-NDTAM SD-ND %TAM +2TAM+3TAM+4TAM+5TAM+6TAM+7>total# Operations daily
19.06201680.0%1487.5%
20.06181688.9%1487.5%
21.0617847.1%675.0%
22.06151173.3%11100.0%
23.06301653.3%1487.5%
24.06855160.0%4792.2%
25.061856434.6%3351.6%
26.061354231.1%2969.0%
27.06813543.2%1851.4%
28.0620945.0%666.7%
29.0619842.1%225.0%
30.06211466.7%1071.4%
1 July151173.3%872.7%
2.079444.4%375.0%
3.0719631.6%350.0%
4.0715853.3%787.5%
5.077571.4%480.0%
6.074125.0%0.0%
7.0714964.3%777.8%
8.0725936.0%666.7%
9.0710660.0%466.7%
10.078562.5%240.0%
11.07141178.6%1090.9%
12.0712866.7%675.0%
13.074250.0%150.0%
14.077342.9%133.3%
15.0713538.5%480.0%
16.073133.3%1100.0%
Total82538446.5%27170.6%
Triage DateTotal TriagedTriaged to AdmissionTri to Adm as % of Total TriagedTAM SD-NDTAM SD-ND %TAM +2TAM+3TAM+4TAM+5TAM+6TAM+7>total# Operations daily
17.0716743.8%685.7%
18.0711654.5%6100.0%
19.07421945.2%1473.7%
20.07973839.2%3284.2%
21.071353928.9%2564.1%
22.07692536.2%1456.0%
23.07532547.2%1456.0%
24.07511835.3%1372.2%
25.07842631.0%1038.5%
26.075559.1%480.0%
27.07991919.2%1157.9%
28.0722731.8%228.6%
29.07561628.6%850.0%
30.07331339.4%538.5%
31.0720735.0%571.4%
1 Aug511631.4%1168.8%
2.08822024.4%1260.0%
3.0813861.5%562.5%
4.08241250.0%758.3%
5.08211257.1%758.3%
6.0813538.5%360.0%
7.086466.7%375.0%
8.088225.0%2100.0%
9.089222.2%2100.0%
10.081119.1%1100.0%
11.0811872.7%675.0%
12.0810770.0%114.3%
13.0811872.7%787.5%
14.0819631.6%466.7%
15.08201050.0%990.0%
16.085240.0%150.0%
17.086350.0%266.7%
18.0813969.2%666.7%
19.089555.6%5100.0%
20.084375.0%133.3%
21.089444.4%375.0%
22.08171164.7%545.5%
Total121542835.2%27263.6%
Adm Stats
Adm DateWWPreviousOtherRe-admissionArme BlancheTotal AdmissionsAdm DateArrived in Triage DeptAdm W/O Triage Dept with OPAdm W/O Triage Dept NO OPTotal Adm W/O Triage DeptAdm from Triage with OPAdm from Tri NO OpTotal Triaged prior to 19 June
3.06140100151511415151511415
4.06201003330333303
5.06220300252919625545419625
6.06120800202912820494912820
7.06170200191717219363617219
8.06180100193111819505011819
9.06191300231415823373715823
10.06260200281722628454522628
11.06803001131561142425611
12.0670200987291717729
13.06811001016821026268210
14.06411006315163737516
15.06404008125382020538
16.06300003403034343303
17.06200002212022323202
18.06200002282023030202
168332002033421475620354514756203
19.061013001419-June8102120214
20.061101101320-June594130013
21.0690000921-June16101809
22.061001001122-June104154211
23.061711001923-June2721314219
24.064901005024-June728513181950
25.064002004225-June1671171816842
26.064100004126-June1171351816741
27.063002003227-June641341711432
28.061400001428-June173039214
29.0671000829-June16303238
30.062703003030-June14437121130
1 July60500111-July110446111
2.075010062-July7112226
3.074020063-July19000516
4.073040074-July13112147
5.074010055-July6101315
6.070010016-July4000011
7.074022087-July10314318
8.0751600128-July230227312
9.075020079-July8202327
10.0710210410-July4314004
11.07507101311-July82463413
12.074000412-July12000134
13.0730400713-July4000437
14.0710200314-July7000303
15.0730101515-July13000415
16.0700100116-July3000101
31845551383685944614015687383
17.0760100717-July15101607
18.0730030618-July8123306
19.071701001819-July4200011718
20.073702003920-July87731021839
21.07280002821-July119106168428
22.07180001822-July653149518
23.07160001623-July5030310316
24.07360013724-July41821019837
25.071201001325-July804048113
26.071001001126-July550008311
27.07190001927-July9450513119
28.07130001328-July2110110213
29.07100101129-July523145211
30.07130011430-July330009514
31.071401001531-July153259115
1 Aug110100121-Aug481238112
2.08120110142-Aug784048214
3.087010083-Aug12101618
4.0811000114-Aug212138011
5.08140300175-Aug181239517
6.082020046-Aug12101214
7.0812010137-Aug411210113
8.08400048-Aug8000314
9.08100019-Aug9000011
10.082000210-Aug10101102
11.084000411-Aug11000314
12.08802101112-Aug82028111
13.088000813-Aug11000718
14.0840200614-Aug18101326
15.08307001015-Aug151453210
16.083000316-Aug5000303
17.0830100417-Aug6000314
18.0850301918-Aug9404509
19.0820300519-Aug6123115
20.0810200320-Aug4000303
21.0820100321-Aug7202013
22.08605101222-Aug152028212
377041834291112742910325175
1021212
941313
1011
4155
2133
851313
1171818
1351818
1341717
3033
3033
4377
0444
1122
0000
1122
1011
0000
3144
1233
2022
3144
2466
0000
0000
0000
0000
0000
1011
1233
0000
731010
1061616
3144
3033
821010
4044
0000
5055
1011
4155
0000
3255
1233
4044
1011
2133
1233
1011
1122
0000
0000
1011
0000
2022
0000
1011
1455
0000
0000
4044
1233
0000
2022
2022
17075245245
&F
Page &P of &N
Reception in ER, W/O Triage Dept is equivalent to triage and admission same day.
Triage chart
3.0615
4.063
5.0654
6.0649
7.0636
8.0650
9.0637
10.0645
11.0642
12.0617
13.0626
14.0637
15.0620
16.0643
17.0623
18.0630
19.0620
20.0618
21.0617
22.0615
23.0630
24.0685
25.06185
26.06135
27.0681
28.0620
29.0619
30.0621
1 July15
2.079
3.0719
4.0715
5.077
6.074
7.0714
8.0726
9.0710
10.078
11.0714
12.0712
13.074
14.077
15.0713
16.073
17.0716
18.0711
19.0742
20.0797
21.07135
22.0769
23.0753
24.0751
25.0784
26.0755
27.0799
28.0722
29.0756
30.0733
31.0720
1 Aug51
2.0882
3.0813
4.0824
5.0821
6.0813
7.086
8.088
9.089
10.0811
11.0811
12.0810
13.0811
14.0819
15.0820
16.085
17.086
18.0813
19.089
20.084
21.089
22.0817
Triage chart
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Date
Number Patients
Total Patients Triaged by Date
Chart Admissions
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Date
Number Patients
Total Patients Triaged by Date
Sheet4
Admissions
3.0615
4.063
5.0625
6.0620
7.0619
8.0619
9.0623
10.0628
11.0611
12.069
13.0610
14.066
15.068
16.063
17.062
18.062
19.061414
20.061313
21.0699
22.061111
23.06191919
24.06505050
25.06424242
26.06414141
27.06323232
28.06141414
29.06888
30.06303030
1 July11236283
2.076
3.076
4.077
5.075
6.071
7.078
8.0712
9.077
10.074
11.0713
12.074
13.077
14.073
15.075
16.071
17.077
18.076
19.071818
20.073939
21.072828
22.071818
23.071616
24.073737
25.071313
26.071111
27.071919
28.071313
29.071111
30.071414
31.071515
1 Aug1212
2.081414
3.088278
4.0811
5.0817
6.084
7.0813
8.084
9.081
10.082
11.084
12.0811
13.088
14.086
15.0810
16.083
17.084
18.089
19.085
20.083
21.083
22.0812
Sheet4
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Date
Number of Patients
Admissions by Date
DateTriagedAdmissions19195406/19/037/18/036/3/036/19/037/17/031515492040.8%
3.0615151550500426/19/037/18/036/3/036/19/037/17/0333361952.8%
4.0633342426076/19/037/19/036/3/036/19/037/17/032525501938.0%
5.06252525414183126/19/037/19/036/3/036/19/037/17/032020372362.2%
6.06202020323224106/20/037/19/036/3/036/19/037/17/031919452862.2%
7.06191919141482466/20/037/19/036/3/036/19/037/17/031919421126.2%
8.061919198881536/20/037/19/036/3/036/19/037/17/03232317952.9%
9.062323233030612106/20/037/19/036/3/036/19/037/18/032828261038.5%
10.062828282362366816/22/037/19/036/3/036/19/037/18/03111137616.2%
11.061111112236/22/037/20/036/3/036/19/037/18/039920840.0%
12.069992316/22/037/20/036/4/036/20/037/18/0310104337.0%
13.0610101011426/23/037/20/036/4/036/20/037/19/03662328.7%
14.066663536/23/037/20/036/4/036/20/037/19/03883026.7%
15.068880356/23/037/20/036/5/036/20/037/19/033334220359.4%
16.063330136/23/037/20/036/5/036/20/037/19/0322
17.062220536/24/037/20/036/5/036/20/037/19/0322542546.3%
18.0622257126/24/037/20/036/5/036/20/037/19/031414
19.0620141630116/24/037/20/036/5/036/20/037/19/031313
20.0618131326216/24/037/20/036/5/036/20/037/19/0399
21.06179817576/24/037/20/036/5/036/21/037/19/031111
22.0615111122216/24/037/20/036/5/036/21/037/19/031919
23.0630191635126/24/037/21/036/5/036/21/037/19/035050
24.06855051101816/24/037/21/036/5/036/21/037/20/034242
25.061854264106316/24/037/21/036/5/036/21/037/20/034141
26.06135414283306/24/037/21/036/5/036/21/037/20/033232
27.0681323567016/24/037/21/036/5/036/21/037/20/031414
28.062014923116/24/037/21/036/5/036/21/037/20/0388
29.06198816016/24/037/21/036/5/036/21/037/20/033030
30.062130144413426/24/037/21/036/5/036/22/037/20/031111
1 July1511112266/24/037/21/036/5/036/22/037/20/0366
2.079641006/24/037/21/036/5/036/22/037/20/0366
3.0719661216/24/037/22/036/5/036/22/037/20/0377
4.0715781506/24/037/22/036/6/036/22/037/20/0355
5.077551036/24/037/22/036/6/036/22/037/20/0311
6.07411206/24/037/22/036/6/036/22/037/20/0388
7.0714891716/24/037/22/036/6/036/22/037/20/031212
8.07261292126/24/037/22/036/6/036/23/037/20/0377
9.071076131056/24/037/23/036/6/036/23/037/20/0344
10.0784596/24/037/23/036/6/036/23/037/20/031313
11.07141311246/25/037/23/036/6/036/23/037/20/0344
12.071248126/25/037/24/036/6/036/23/037/20/0377
13.0747296/25/037/24/036/6/036/23/037/20/0333
14.0773366/25/037/24/036/6/036/23/037/20/0355
15.071355106/25/037/24/036/6/036/23/037/20/0311
16.0731126/25/037/24/036/7/036/23/037/20/0377
17.0716777646/25/037/24/036/7/036/23/037/20/0366
18.0711666/25/037/24/036/7/036/23/037/20/031818
19.074218196/25/037/24/036/7/036/23/037/20/033939
20.079739386/25/037/24/036/7/036/23/037/20/032828
21.0713528396/25/037/24/036/7/036/23/037/21/031818
22.076918256/25/037/25/036/7/036/23/037/21/031616
23.075316256/25/037/26/036/7/036/24/037/21/033737
24.075137186/25/037/26/036/7/036/24/037/21/031313
25.078413266/25/037/26/036/7/036/24/037/21/031111
26.07551156/26/037/27/036/7/036/24/037/21/031919
27.079919196/26/037/28/036/7/036/24/037/21/031313
28.07221376/26/037/28/036/7/036/24/037/21/031111
29.075711166/26/037/29/036/7/036/24/037/21/031414
30.073314136/26/037/29/036/7/036/24/037/21/031515
31.07201576/26/037/29/036/7/036/24/037/21/031212
1 Aug5112166/26/037/30/036/7/036/24/037/21/031414
2.088214206/26/037/30/036/8/036/24/037/21/0388
3.0813886/26/037/30/036/8/036/24/037/21/031111
4.082411126/26/037/30/036/8/036/24/037/21/031717
5.082117126/26/037/30/036/8/036/24/037/21/0344
6.0813456/26/037/31/036/8/036/24/037/21/031313
7.0861346/27/037/31/036/8/036/24/037/21/0344
8.088426/27/037/31/036/8/036/24/037/22/0311
9.089126/27/038/1/036/8/036/24/037/22/0322
10.0811216/27/038/1/036/8/036/24/037/22/0344
11.0811486/27/038/1/036/8/036/24/037/22/031111
12.08101176/27/038/2/036/8/036/24/037/22/0388
13.0811886/27/038/2/036/9/036/24/037/22/0366
14.0819666/27/038/3/036/9/036/24/037/22/031010
15.082010106/28/038/4/036/9/036/24/037/22/0333
16.085326/28/038/5/036/9/036/24/037/22/0344
17.086436/29/038/5/036/9/036/24/037/22/0399
18.0813996/29/038/5/036/9/036/25/037/22/0355
19.089556/29/038/5/036/9/036/25/037/22/0333
20.0843336/30/038/5/036/9/036/25/037/23/0333
21.0893446/30/038/5/036/9/036/25/037/23/031212
22.08171211116/30/038/5/036/9/036/25/037/23/03
10156/30/038/6/036/9/036/25/037/23/03
6/30/038/7/036/9/036/25/037/23/03
6/30/038/7/036/9/036/25/037/23/03
6/30/038/8/036/9/036/25/037/23/03
6/30/038/9/036/9/036/25/037/23/03
6/30/038/11/036/10/036/25/037/23/03
6/30/038/12/036/10/036/25/037/23/03
6/30/038/13/036/10/036/25/037/23/03
6/30/038/14/036/10/036/25/037/23/03
6/30/038/14/036/10/036/25/037/23/03
6/30/038/15/036/10/036/25/037/24/03
7/1/038/15/036/10/036/25/037/24/03
7/1/038/15/036/10/036/25/037/24/03
7/1/038/15/036/10/036/25/037/24/03
7/1/038/15/036/10/036/25/037/24/03
7/1/038/15/036/10/036/25/037/24/03
7/2/038/17/036/10/036/25/037/24/03
7/2/038/19/036/10/036/25/037/24/03
7/2/038/19/036/10/036/25/037/24/03
7/3/038/19/036/10/036/25/037/24/03
7/4/038/21/036/10/036/25/037/24/03
7/4/038/22/036/10/036/25/037/24/03
7/4/038/22/036/10/036/26/037/24/03
7/4/036/10/036/26/037/24/03
7/4/036/10/036/26/037/24/03
7/5/036/10/036/26/037/24/03
7/6/036/10/036/26/037/24/03
7/7/036/11/036/26/037/24/03
7/7/036/11/036/26/037/24/03
7/8/036/11/036/26/037/24/03
7/8/036/11/036/26/037/24/03
7/8/036/11/036/26/037/24/03
7/8/036/12/036/26/037/24/03
7/8/036/12/036/26/037/24/03
7/9/036/12/036/26/037/24/03
7/9/036/12/036/26/037/24/03
7/10/036/12/036/26/037/24/03
7/11/036/12/036/26/037/25/03
7/11/036/12/036/26/037/25/03
7/11/036/13/036/26/037/25/03
7/11/036/13/036/26/037/25/03
7/11/036/13/036/26/037/25/03
7/11/036/13/036/26/037/25/03
7/11/036/13/036/26/037/25/03
7/11/036/13/036/26/037/25/03
7/12/036/13/036/26/037/25/03
7/12/036/13/036/26/037/25/03
7/12/036/14/036/26/037/25/03
7/13/036/14/036/26/037/25/03
7/13/036/14/036/26/037/26/03
7/13/036/14/036/26/037/26/03
7/15/036/14/036/27/037/26/03
6/15/036/27/037/26/03
6/15/036/27/037/26/03
6/15/036/27/037/26/03
6/15/036/27/037/26/03
6/15/036/27/037/26/03
6/16/036/27/037/27/03
6/16/036/27/037/27/03
6/16/036/27/037/27/03
6/17/036/27/037/27/03
6/17/036/27/037/27/03
6/18/036/27/037/27/03
6/18/036/27/037/27/03
6/27/037/27/03
6/27/037/27/03
6/27/037/27/03
6/27/037/27/03
6/27/037/27/03
6/27/037/27/03
6/27/037/27/03
6/27/037/27/03
6/27/037/27/03
6/27/037/27/03
6/27/037/27/03
6/28/037/28/03
6/28/037/28/03
6/28/037/28/03
6/28/037/28/03
6/28/037/28/03
6/28/037/28/03
6/28/037/28/03
6/28/037/28/03
6/28/037/28/03
6/28/037/28/03
6/28/037/28/03
6/28/037/29/03
6/29/037/29/03
6/29/037/29/03
6/29/037/29/03
6/29/037/29/03
6/29/037/29/03
6/30/037/29/03
6/30/037/29/03
6/30/037/30/03
6/30/037/30/03
6/30/037/30/03
6/30/037/30/03
6/30/037/30/03
6/30/037/30/03
6/30/037/30/03
6/30/037/30/03
6/30/037/30/03
6/30/037/31/03
6/30/037/31/03
6/30/037/31/03
6/30/037/31/03
6/30/037/31/03
7/1/037/31/03
7/1/037/31/03
7/1/037/31/03
7/1/037/31/03
7/1/037/31/03
7/1/037/31/03
7/2/037/31/03
7/2/038/1/03
7/2/038/1/03
7/3/038/1/03
7/3/038/1/03
7/3/038/1/03
7/3/038/1/03
7/3/038/1/03
7/4/038/1/03
7/4/038/1/03
7/5/038/2/03
7/5/038/2/03
7/5/038/2/03
7/5/038/2/03
7/7/038/2/03
7/7/038/2/03
7/7/038/2/03
7/7/038/2/03
7/7/038/2/03
7/7/038/2/03
7/8/038/2/03
7/8/038/2/03
7/8/038/3/03
7/8/038/3/03
7/8/038/3/03
7/8/038/3/03
7/8/038/3/03
7/9/038/3/03
7/9/038/3/03
7/9/038/4/03
7/9/038/4/03
7/9/038/4/03
7/10/038/4/03
7/10/038/4/03
7/10/038/4/03
7/11/038/4/03
7/11/038/4/03
7/11/038/4/03
7/11/038/4/03
7/11/038/5/03
7/12/038/5/03
7/13/038/5/03
7/13/038/5/03
7/13/038/5/03
7/13/038/5/03
7/14/038/5/03
7/14/038/5/03
7/14/038/5/03
7/15/038/5/03
7/15/038/6/03
7/15/038/6/03
7/15/038/6/03
7/16/038/7/03
8/7/03
8/7/03
8/7/03
8/7/03
8/7/03
8/7/03
8/7/03
8/7/03
8/7/03
8/7/03
8/8/03
8/8/03
8/8/03
8/10/03
8/10/03
8/11/03
8/11/03
8/11/03
8/12/03
8/12/03
8/12/03
8/12/03
8/12/03
8/12/03
8/12/03
8/12/03
8/12/03
8/12/03
8/13/03
8/13/03
8/13/03
8/13/03
8/13/03
8/13/03
8/13/03
8/14/03
8/14/03
8/14/03
8/14/03
8/15/03
8/15/03
8/15/03
8/15/03
8/16/03
8/16/03
8/16/03
8/17/03
8/17/03
8/17/03
8/18/03
8/18/03
8/18/03
8/18/03
8/18/03
8/18/03
8/18/03
8/18/03
8/18/03
8/19/03
8/19/03
8/20/03
8/20/03
8/20/03
8/21/03
8/21/03
8/22/03
8/22/03
8/22/03
8/22/03
8/22/03
8/22/03
8/22/03
8/22/03
8/22/03
8/22/03
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
Date
Admissions
Date
Number Patients
Patients Triaged & Admitted per Day
Summary of triage theory & philosophy: sorting by priority A simple emergency plan: personnel, space, infrastructure, equipment, supplies = system
"Best for most" policy
Priority patients are those with a good chance of good survival.
Normal clinical practice: one doctor or nurse and one patient. = Do everything possible for every patient.Multiple-casualty incident: one doctor and many patients. = Triage, but still capable of dealing with all patients.Mass casualty: one doctor overwhelmed by casualties. = Triage, do what you can for the greatest number.Smallest surgery for biggest results.Triage = not dogmatic, not a series of rules, but a LOGICAL approach and a philosophy.Triage tent inside.Notice: enough space to move aroundsmall light-weight bedssmall carts for medical suppliesIV fluid hanging on a ropepatient carried on a stretcherfew people who appear to know what they are doingThis means organisation, which requires planning of the space, infrastructure, equipment, supplies and personnel.Note the tree outside the barrier leading to the parking lot.By the tree.How many patients? 10, 50 or 100?How many operating tables & instrument boxes? Surgeons & anaesthetists?Surgeon or anaesthetist? Most experienced, most respected. Team must live with the decisions.Name, time of injury, cause of injury, first aid given.Vital signs: BP, pulse, respiration rate, neurological status.Diagnosis: concise and complete.Category of triage.Complete pre-operative orders.Especially if patients are being transferred.Documentation includes: registration, marking of patient, personnel effects and papers.Priorities are according to life-threatening conditions : A B C D EICU while waiting for operating table to free up.Special ward where they can receive treatment (antibiotics, analgesics, IV fluids, dressings) and are under close observation while awaiting surgery.Many patients. Patients are lucid, frightened (shooting and shelling), and often in pain (superficial wounds invovle subcutaneous and periosteal pain receptors). Organisation of space important to isolate such patients, given rapid treatment, and then discharge.E = 1, X = 0, C = 0, F = 0, V = 0, M = 2. Minimial debridement, if at all; disinfection, dressings, antibiotics.Leave to die peacefully, return after treatment of priority patients and, if still alive, may contemplate surgery at such time.First peak, incomplete triage registration.Emergency plan does not cost money, organisation does not cost money. It costs time, effort and motivation.
