- Disaster Triage - Taking It The Next Level
- Disaster Triage - Taking It The Next Level
- Disaster Triage - Taking It The Next Level
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- <strong>Disaster</strong> <strong>Triage</strong> -<br />
<strong>Taking</strong> <strong>It</strong> <strong>The</strong> <strong>Next</strong> <strong>Level</strong><br />
LT Christine Collins, RN, BSN, MA<br />
Mr. David Torres, Director of Operations<br />
Mr. Jerry Gomez, BSOE
TRIAGE - SESSION OBJECTIVES<br />
• Understand the concept of disaster triage<br />
• State responsibility of triage officer<br />
• List & define colors/categories of triage<br />
• Case scenario - attendee will be able to:<br />
– Verbalize & demonstrate ability to triage<br />
• State mechanism of injury<br />
• Sort patient casualty in respective category & color<br />
• Provide appropriate lifesaving intervention<br />
• Group discussion post scenario
Concept of <strong>Disaster</strong> <strong>Triage</strong><br />
• Provide care for the greatest # of patients<br />
• Simple model of triage to classify patients<br />
– CDC’s Model Uniform Core Criteria<br />
• Maximize resources<br />
• Protect on-scene personnel<br />
• Stage & triage patients<br />
• Transport & distribution of patients<br />
• Manage fatalities<br />
www.emergency.cdc.gov/masscasualties
<strong>Triage</strong> Officer<br />
• Held by emergency physician or surgeon<br />
experienced in trauma care<br />
• Management of hospital medical response<br />
• Set-up initial triage site located at or near ED<br />
– Secondary triage site, if initial becomes<br />
overwhelmed by influx of casualties<br />
• Set-up triage teams<br />
• Coordinate assignments of first responders<br />
• Quickly evaluate & tag patients<br />
• Continuation of patient sorting<br />
www.emergency.cdc.gov/masscasualties
<strong>Triage</strong> Colors & Categories<br />
• Red (immediate)<br />
• Yellow (delayed)<br />
• Green (minimal)<br />
• Grey (expectant)<br />
CDC’s Model Uniform Core Criteria - www.emergency.cdc.gov/masscasualties
<strong>Disaster</strong> <strong>Triage</strong> Step 1–Sort: Global Sorting<br />
• Walking<br />
• Do NOT typically require EMS & include the worried-well who are noninjured<br />
but exposed to the event<br />
• Non-walking<br />
• Patients who should receive immediate EMS/treatment or too injured to<br />
survive<br />
www.emergency.cdc.gov/masscasualties
<strong>Disaster</strong> <strong>Triage</strong> Step 2 - Assessment<br />
• Individual Assessment and Life Saving Intervention<br />
www.emergency.cdc.gov/masscasualties
Red - Immediate<br />
• Is the patient breathing?<br />
– Yes<br />
• Obeys commands or makes purposeful<br />
movements? Has peripheral pulse? Is not is<br />
respiratory distress? Has major hemorrhage<br />
controlled?<br />
– No (if any of the above is no)<br />
• Likely to survive given current resources?<br />
– Yes<br />
• *Pt would be classified as IMMEDIATE
Yellow - Delayed<br />
• Is the patient breathing?<br />
– Yes<br />
• Obeys commands or makes purposeful<br />
movements? Has peripheral pulse? Is not is<br />
respiratory distress? Has major hemorrhage<br />
controlled?<br />
– Yes (all the above must be YES)<br />
• Minor injuries only?<br />
– No<br />
• *Pt would be classified as DELAYED
Green - Minimal<br />
• Is the patient breathing?<br />
– Yes<br />
• Obeys commands or makes purposeful<br />
movements? Has peripheral pulse? Is not is<br />
respiratory distress? Has major hemorrhage<br />
controlled?<br />
– Yes (all the above must be YES)<br />
• Minor injuries only?<br />
– Yes<br />
• *Pt would be classified as MINIMAL
Grey - Expectant<br />
• Is the patient breathing?<br />
– Yes<br />
• Obeys commands or makes purposeful<br />
movements? Has peripheral pulse? Is not is<br />
respiratory distress? Has major hemorrhage<br />
controlled?<br />
– No (if any of the above is no)<br />
• Likely to survive given current resources?<br />
– No<br />
• *Pt would be classified as EXPECTANT
• Is the patient breathing?<br />
– No<br />
• *Pt would be classified as
Case Scenarios – Hands On<br />
• Casualties placed on the ground - semi-circle<br />
• <strong>The</strong>re will be 10 casualties<br />
• <strong>The</strong>re will be 8 triage teams<br />
– 4 member teams<br />
• Each triage team will have 1-min or less to:<br />
– Assess & <strong>Triage</strong> each casualty<br />
• Once all the casualties have been triaged, the<br />
groups will debrief on each casualty
<strong>The</strong> Threat<br />
• Local terrorist cell has executed a major<br />
offensive attack against the US<br />
– Near the National Monument, Washington, DC<br />
• Injured civilians and local US soldiers are<br />
being evacuated to your medical facility<br />
• First aide has not been rendered<br />
– Patients will enter your area as they are<br />
• Be aware of hazardous objects entering your<br />
facility<br />
• <strong>Triage</strong> your casualties according to your<br />
refresher course
Case Based Scenarios<br />
•<br />
1st<br />
Degree Flash Burn to<br />
Face & Neck<br />
• Bilateral knee amputations<br />
• Laceration to head & face<br />
• Gunshot wound to left<br />
chest<br />
• Open Fracture to right<br />
lower leg/laceration to face<br />
• Neck Pain weakness to<br />
arms & legs<br />
• Puncture wound to left<br />
forearm<br />
• Protruding abdominal<br />
organs<br />
• GSW to forehead-bleeding<br />
from both ears<br />
• Multiple GSW to chestbruising<br />
on right side of<br />
forehead
Real World Discussion – Group Breakout<br />
http://www.michaelyon-online.com/watch-yourstep.htm#.T7gIkcYx0Wk.email
THANK YOU<br />
• LT Christine Collins<br />
– Christine.Collins@hhs.gov<br />
• Mr. Jerry Gomez<br />
– jerry.gomez@icfi.com<br />
• Mr. David Torres<br />
– david.torres.12.ctr@us.af.mil
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