*Triage*
Triage is a French word meaning "to sort."
A. Purpose of triage:
1. Assigns treatment priorities.
2. Separates MCI victims into easily identifiable groups.
3. Determine required resources for treatment, transportation, and definitive care.
4. Prioritization of patient distribution and transportation.
B. Benefits of triage:
1. Identifies patients who require rapid medical care to save life and limb.
2. Provides rational distribution of casualties.
3. By separating out the minor injuries, reduces the urgent burden on each hospital - average 10-15% of MCI patients are serious enough to require extended hospitalization.
C. Problems with triage systems:
1. Some approaches to triage rely on specific injuries and physical findings in order to categorize and prioritize patients.
2. In-depth assessment requires more time than may be available during an MCI.
D. The ideal triage system:
1. Should be simple.
2. Does not require advanced assessment skills.
3. Does not rely on specific diagnosis.
4. Should be easy to perform.
5. Should provide for rapid and simple life-saving interventions.
6. Should be easy to teach and learn.
E. START:
1. Triage ribbons. Surveyor’s tape is used to make the ribbons.
2. Universal colors are used.
F. RED: Immediate (highest priority). Typical problems are:
1. R - Respirations/airway
2. P - perfusion/pulse
3. M - mental status
4. severe burns which compromise airways.
G. YELLOW: Delayed (second priority). Typical problems are:
1. Burn patients without airway problems
2. Major or multiple bone or joint injuries
3. Back and spine injuries.
H. GREEN: Minor (third priority). Typical problems are:
1. "Walking wounded" (The ability to "walk" does not necessarily mean that this is a "minor" patient. Minor cuts and bruises are acceptable criteria for this type of patient.)
2. Minor painful swollen deformities
3. Minor soft tissue injuries.
I. BLACK: Dead/non-salvageable (lowest priority). These are non-breathing patients on whom resuscitation would normally be attempted but who are not salvageable given the resources available early in an MCI response.
V. THE START PROCESS
A. Basic procedures:
1. Begin where you stand.
2. Identify those injured who can walk. Make a clear announcement that those who can walk should get up and do so to an easily recognized point.
B. Relocate GREEN patients:
1. Relocate to a designated area (away from immediate danger and outside the initial triage area).
2. We tape each of these as a GREEN patient. Some systems do not tag GREEN patients. However, without taping you cannot identify them easily as part of the MCI.
C. Move in an orderly pattern:
1. Move through the patients in an orderly pattern.
2. Assess each casualty you come to and mark the category using triage ribbons.
D. Maintain a patient count:
1. Maintain a count of the casualties.
2. Mark on 2-3 inch tape on thigh.
OR
3. Save a small piece of triage ribbon and place in your pocket.
E. Minimal treatment: Give only minimal treatment. Only two patient interventions are used:
1. Open the airway.
2. Stop gross bleeding.
F. Keep moving! EMT-Basics are provided 10 minutes to conduct a full patient assessment and begin treatment in most EMT-Basic Practical Examination. In an MCI, such lengthy patient assessments are not practical. S.T.A.R.T. assessments should last approximately 10 - 15 seconds per patient.
G. Steps in assessment:
1. Step 1 -- Moving Green Patients. This has already been done when you made the first announcement.
2. Step 2 - RESPIRATION. Check for respiratory compromise.
a. If airway closed, open the airway.
b. None - BLACK ribbon (dead).
c. More than 30 per minute - RED ribbon (immediate).
d. Less than 30 per minute - FURTHER EVALUATION REQUIRED - go to step 3 (Perfusion)
3. Step 3 - PEFUSION. Radial Pulse Check.
a. Not palpable - RED ribbon (immediate).
b. Control severe bleeding - bystanders use direct pressure, raise legs.
c. Palpable - FURTHER EVALUATION REQUIRED - go to step 4 (Mental status).
4. Step 4 - MENTAL STATUS. Check for compromise of mental status.
a. Altered mental status - RED ribbon (immediate).
b. Mental status appropriate - YELLOW ribbon (delayed) or GREEN (minor) according to other findings (obvious injuries or illnesses).
H. See START algorithm at end of manual
I. See JumpSTART algorithm at end of manual
J. Secondary triage:
1. Secondary triage and tagging could be done:
a. On a stretcher on the way to a treatment area,
b. In the treatment area, or
c. In the ambulance on the way to the hospital.
2. Secondary triage is an in depth reassessment based on clinical experience and judgment.
K. Triage is an on-going process and should be done continuously.
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