how do you triage a mass casualty

Emergency medical services (EMS) providers arrive on the scene of a mass casualty incident (MCI) and implement triage, moving green patients to a single area and grouping red and yellow patients using triage tape or tags. Patients are then transported to local hospitals according to their priority group.

Full Answer

What is mass casualty triage?

EMS Mass Casualty Triage - StatPearls - NCBI Bookshelf The World Health Organization defines mass casualty incidents as disasters and major incidents characterized by quantity, severity, and diversity of patients that can rapidly overwhelm the ability of local medical resources to deliver comprehensive and definitive medical care.

How do you manage a mass casualty incident?

Management of many of those tasks can be turned over to police and firefighters. After the scene is determined to be safe, providers at a mass casualty incident (MCI) must analyze the number and severity of patients. Triage identifies the most severely injured patients with the greatest chance of surviving.

What is the difference between a disaster and a mass casualty?

While a disaster by definition overwhelms response capabilities, a mass casualty incident (MCI) occurs more commonly and is defined as a situation that places a significant demand on medical resources and personnel [2]. Local response capabilities are not overwhelmed, but there are still a large number of patients requiring triage.

How do you triage a patient with a MCI?

Patients with severe injuries that are less life-threatening should be cared for and transported first. There are different models that can be used to triage MCI s, such as START (Simple Triage and Rapid Treatment) and SALT (Sort, Assess, Lifesaving Interventions, Treatment/Transport).

How do you triage in a disaster?

The injured people are placed in four urgent (red), emergency (yellow), delayed (green) and non-salvageable (black) classes. The noteworthy point is that in this method the criterion of obeying the commands is examined before the evaluation of breathing and pulse rate.

How do you triage multiple victim scenes?

For categorizing patients at multiple casualty incidents, first responders use colored triage tape and/or tags. Tagging patients early helps in tracking them and their condition. All tags should be waterproof and color-coded with the triage categories clearly shown.

What is the START triage method?

START: Simple Triage and Rapid Treatment. * START includes rapidly assessing (in less than 1 minute) every patient, determining which of 4 clinical categories the patient belongs, and visibly identifying the category for rescuers who will treat the patient.

What is the goal of triage in a mass casualty event?

The goal is to move patients away from the incident and toward resources that offer more comprehensive care. Most mass casualty incident triaging systems use tags or colored designations for categorizing injured persons.

What are the 3 categories of triage?

TriageImmediate category. These casualties require immediate life-saving treatment.Urgent category. These casualties require significant intervention as soon as possible.Delayed category. These patients will require medical intervention, but not with any urgency.Expectant category.

Who treats first in triage?

Triage Levels and Color CodingRed Triage Tag (“Immediate” or T1 or Priority 1): Patients whose lives are in immediate danger and who require immediate treatment;Yellow Triage Tag (“Delayed” or T2 or Priority 2): Patients whose lives are not in immediate danger and who will require urgent, not immediate, medical care;More items...

What are the three key assessments during START triage?

The Simple Triage And Rapid Treatment (START) system was developed to allow first responders to triage multiple victims in 30 seconds or less, based on three primary observations: Respiration, Perfusion, and Mental Status (RPM).

What is the most commonly used triage system?

Emergency Department Triage in the United States (U.S.) The most common triage system in the United States is the START (simple triage and rapid treatment) triage system. This algorithm is utilized for patients above the age of 8 years.

Which is better salt or START triage?

Conclusions: In our study, the SALT triage system was overall more accurate triage method than START at classi-fying patients, specifically in the delayed and immediate categories. In our field exercise, paramedic use of the START methodology yielded a higher rate of undertriage compared to the SALT classification.

What is the order of priorities when triaging a casualty?

Step 1: Take charge – poor communication leads to casualties being missed or triaged twice. Step 2: Triage everyone – use Bystanders and the Category 3 casualties to sit with or tend to Category 1 and 2 casualties as you identify them. Step 3: Identify all of the Category 1 casualties.

What is multiple casualty triage?

Multiple casualty triage is a process designed to prioritise casualties at the scene of an incident, to ensure care is available to those who need it most urgently and that the greatest number of casualties survive.

What would be the priority when dealing with multiple casualties?

As a general rule, the "quiet" casualty is more in need of help compared to the casualty with a serious cut who is screaming in agony. Whilst this is distressing - the unconscious casualty should take priority.

What is the order of priorities when triaging a casualty?

Step 1: Take charge – poor communication leads to casualties being missed or triaged twice. Step 2: Triage everyone – use Bystanders and the Category 3 casualties to sit with or tend to Category 1 and 2 casualties as you identify them. Step 3: Identify all of the Category 1 casualties.

What is the most commonly used triage system?

Emergency Department Triage in the United States (U.S.) The most common triage system in the United States is the START (simple triage and rapid treatment) triage system. This algorithm is utilized for patients above the age of 8 years.

Why is mass casualty triage important?

Mass casualty incidents triage systems are implemented to offer the greatest good to the greatest amount of people as healthcare resources are limited or strained due to the number of injured individuals. Treatment during triage is minimal, and this is counterintuitive to normal pre-hospital protocols. The goal is to move patients away from the incident and toward resources that offer more comprehensive care.

What is mass casualty?

The World Health Organization defines mass casualty incidents as disasters and major incidents characterized by quantity, severity, and diversity of patients that can rapidly overwhelm the ability of local medical resources to deliver comprehensive and definitive medical care. They have been occurring more frequently in recent decades ...

What are the different triage systems?

Some of the more well-known algorithms include START (simple triage and rapid treatment), SALT (sort, assess, life-saving interventions, treatment/triage), STM (Sacco triage method), Care Flight Triage, and SAVE (Secondary assessment of victim endpoint). There is limited data available to support one system over another. However, it is important to choose one and adhere to its algorithm to maintain an ordered approach. [6][7][8][9][10]

How are triage colors assigned?

The triage colors may be assigned by giving triage tags to patients or simply by physically sorting patients into different designated areas. (see the algorithm below) "Green" patients are assigned by asking all victims who can walk to a designated area. All non-ambulatory patients are then assessed. Black tags are assigned to victims who are not breathing even after attempts to open the airway. Red tags are assigned to any victim with the following:

What is the sort, assess, life-saving interventions, and triage/treatment approach?

The sort, assess, life-saving interventions, and triage/treatment approach is similar to the START system; however, it is more comprehensive and adds simple life-saving techniques during the triage phase.

Why do patients switch to another category?

Patients may initially be triaged to one category but may be switched to another due to changes in their clinical status. Many of the triage tags have fold over tabs that are designed to switch patients between categories easily. However, emphasis should be placed on rapid assessment and quick movement of patients.

What happens when you tag a patient?

TREATMENT AND TRANSPORT: Once tagged, patients will be moved to the designated casualty collection point for transport by emergency management services to receiving facilities.

What is a triage system?

Triage systems are used by prehospital providers to “sort” casualties. into essentially those who are dead or will likely die despite treatment, those with injuries that don’t really require prehospital treatment, and those with injuries that are immediately life-threatening and likely to die without rapid intervention.

What is the easiest triage system to use?

What is equally obvious is that RAMP is the easiest to use as it divides casualties into only three groups by easily determined parameters. Although it is much less studied, it uses similar decision points as the Field Triage Score https://www.crisis-medicine.com/why-do-traditional-triage-systems-fail-in-actual-events/, which we have been teaching as a simpler and effective system to triage casualties in high-risk environments since its publication in 2010.

What are the three categories of casualties?

divides casualties into three categories: expectant / deceased (already dead or going to die regardless), urgent (need help now), or delayed (you don’t need help right this second). These categories are often color-coded into black (expectant or deceased), red (urgent), and green (delayed), respectively. It essentially is similar to the Field Triage Score https://www.crisis-medicine.com/why-do-traditional-triage-systems-fail-in-actual-events/. For those not familiar with RAMP triage, Brad Keating presented to the TECC committee November 2019. http://www.c-tecc.org/images/Tactical_triage_-_CTECC.pptx-compressed.pdf . Print the full-sized diagrams to follow along and triage the unfortunate gingerbread casualties over the coming week.

What happened to the SWAT officer in the second group of casualties?

In the second group of casualties, a SWAT officer suffered blast lung from over pressure, a passerby was wounded by shrapnel, and a law enforcement K9 suffered an amputated rear limb.

How many SWAT officers were injured in the first group?

In the first group of casualties, three SWAT officers are wounded, one with an isolated head injury, one with an abdominal injury, and one with massive hemorrhage secondary to an amputated leg.

What is the respiratory rate of an officer with a leg amputated?

The officer with a leg amputated: is crawling, follows commands, has a respiratory rate of 28, and a palpable radial pulse.

Does triage include pregnancy?

None of the triage systems include pregnancy as a triage modifier. Should they? The pregnant woman comprises two casualties, not just one. There isn’t any operational way to include it as a category until the pregnancy is clearly visible or verbal notification from the woman as to its presence. Also, until the pregnancy is at least twenty weeks, it isn’t viable outside the body. Based on all of this, the simple answer is no. If not anticipated as a possibility ahead of time, we could see an obviously pregnant casualty as a friction point for the rescuer’s decision-making process.

What is a mass casualty incident?

While a disaster by definition overwhelms response capabilities, a mass casualty incident (MCI) occurs more commonly and is defined as a situation that places a significant demand on medical resources and personnel 2. Local response capabilities are not overwhelmed, but there are still a large number of patients requiring triage. A commonly occurring example of an MCI in the United States is a multiple vehicle or bus collision.

What is the most commonly accepted disaster triage protocol?

Currently, two of the most commonly accepted triage protocols are START (Simple Triage and Rapid Treatment) and SALT (Sort-Assess-Lifesaving Interventions-Treatment/Transport).

What is a red triage tag?

Red Triage Tag (“Immediate” or T1 or Priority 1): Patients whose lives are in immediate danger and who require immediate treatment;

What changed the strategy of modern battlefield triage from on-scene treatment to rapid evacuation?

During the Korean and Vietnam Wars, and most recently in conflicts in the Middle East, the ability to rapidly transport wounded soldiers by ground and air to well-equipped medical facilities changed the strategy of modern battlefield triage from on-scene treatment to rapid evacuation [10, 11].

What are some examples of MCI?

A commonly occurring example of an MCI in the United States is a multiple vehicle or bus collision. Regardless of whether a situation is classified as a medical disaster or MCI, it requires rapid and effective triage methods. In order to optimize overall patient outcomes in a catastrophic situation, there is a shift from doing what is best for ...

What is the most challenging category for caregivers?

The “expectant” category can be the most challenging for caregivers from an ethical and emotional standpoint. While it is logical to help the greatest number of victims in a disaster, it is difficult to walk away from a person who is on the verge of succumbing to severe injuries.

How many people die in natural disasters?

The World Health Organization defines an event as a disaster when “normal conditions of existence are disrupted and the level of suffering exceeds the capacity of the hazard-affected community to respond to it.” In any given year, more than 100,000 people are killed in natural disasters around the globe, and millions more are injured or disabled 1. The catastrophic earthquake that struck Haiti in 2010 and the destructive tsunami in the Indian Ocean in 2004 are recent examples that show the difficulties in providing medical care in the wake of such devastation.

How many people were injured in the 911 blast?

victims, twenty-eight of them with significant injuries. Seven arrived nearly at once, starting at 3:08 P.M.  All required emergency surgery. The first to go to surgery—a patient in shock, hemorrhaging profusely, with inadequate breathing and a near-completely severed leg—was resuscitated and on an operating table by 3:25 P.M., just thirty-five minutes after the blast.  The rest followed, one after the other, spaced by just minutes.  Twelve patients in all would undergo surgery—mostly vascular and orthopedic procedures—before the evening was done.

What does green mean in a triage?

GREEN. The patient could deteriorateor you may determine a different priority when you re-triage at the scene or the ED.