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disaster management wk 3 triage

Terms in this set (31)

Meaning "to sort"
Independent role
Requires the ability to assess, prioritize, and classify the level of injury
triage
Used to evaluate patient respiratory, circulatory, and neurological function and categorizes them accordingly using color schemes
Simple Triage and Rapid Triage (START)
In a normal situation severely ill are treated first and less ill or injured treated last
However, in reverse triage, people who most severely injured and require the expenditure of large amounts of supplies are treated last
Reverse Triage
Type and seriousness of injury
Likelihood of survival
Availability of resources
Mass casualty triage is the sorting of patients according to:
Greatest good for the individual patient
Goal of Conventional Medical Care
Greatest good for the greatest number of patients
Goal of Disaster Medical Care
Do the greatest good for the
greatest number of patients
Make the best use of:
Personnel
Equipment
Medical and facility resource
Limit the spread of the
contamination
Mass Casualty Event Management
Most casualties arrive to the hospital within
1 ½- 2 hours
80-90% may self-transport and may arrive prior to event notification
Victims may bypass closest hospital and go to a familiar healthcare provider or facili
Principles of TRIAGE
During disaster. No treatment-Simply sorting patients

Suturing not likely to happen

Only treatment is controlling uncontrolled bleeding
START triage
No CPR
No ACLS
No BLS
No PALS
Only RPM
start triage
no respiratory effort - expectant
resp > 30 - immediate
normal resp - go to next step
START respiratory status
radial pulse absent - immediate
cyanotic - immediate
radial pulse present - go to next step
START perfusion
change in mental status - immediate
unconscious- immediate
normal mental status - move to next victim
START mental status
red
Patients in this group have an obvious threat to life
immediate
yellow
need care but not likely to decompensate rapidly if treatment is delayed
delayed
GREEN
Would not have any serious ill effects even if care were delayed for days
Minimal
BLACK
Little or no chance of survival, and the resources available for immediate patients cannot be diverted to their care
Expectant
Upgrading classifications
Downgrading classifications
Remembering that Expectant patients may not be dead - they still require care and comfort
Reassessment Hints in Mass Triage and
Prepare for EDs to be saturated
Everybody is closed means all EDs are open
Identify alternative medical treatment areas
Planning for use of available space:
Open areas
Isolated areas
Temporary morgue
Once you have triaged where do these patients go now??
Casualty arrival is uncoordinated
Arrival times vary
Closest hospital is typically overwhelmed
Medical needs of unaffected community continues
May present at distant hospitals
Hospital Arrivals
Chemical weapon exposure
Biological weapon exposure
Radiological/nuclear exposure
Bombing and blasting victims
Special considerations during triage
unconsciousness or convulsions
2 or more body systems involved
immediate
initial symptoms are improving
recovering well from antidote
delayed
walking and talking which indicates intact breathing
minimal
apneic for more than 5 min
no pulse or blood pressure
expectant
Triage of biological agent casualties is different
Symptoms are delayed
Initial cases may go unrecognized
More difficult to detect
Epidemiological information becomes critical
Triage of Biological Casualties
Radioactive material
May potentially expose the patient and staff
External Contamination
Most survivors suffer secondary and tertiary blast effects
Triage made more challenging because tympanic membrane and hollow injury ruptures are most common
15% of survivors require hospital admission
Triage of bombing and blasting patients
Where do we store them?
How large is your morgue capacity?
Problems are agent specific:
Decontamination
Refrigeration until definitive disposal
Follow local coroner and medical examiner protocols
Expectant/dead victims and contaminated human remains
Life Support
Advance trauma life support
Resources
Small # pts
Triage
Acutely ill FIRST
Specialty
ER and ICU respond to trauma/code
civilian
Life Support
Not designed
Nurses improvised
Resources
Large # pts
Triage
Disaster Triage
Specialty
Multiple specialties, cross trained
military
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