Mass casualty incident triage: Difference between revisions
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==Classification<ref name="lerner">Lerner EB, Schwartz RB, Coule PL, et al. "Mass Casualty Triage: An Evaluation of the Data and Development of a Proposed National Guideline." ''Disaster Medicine and Public Health Preparedness'' 2(Suppl. 1) 2008, pp S25-S34.</ref>== | ==Classification<ref name="lerner">Lerner EB, Schwartz RB, Coule PL, et al. "Mass Casualty Triage: An Evaluation of the Data and Development of a Proposed National Guideline." ''Disaster Medicine and Public Health Preparedness'' 2(Suppl. 1) 2008, pp S25-S34.</ref>== | ||
*Walking wounded/minor (green) | |||
*Delayed (yellow) | |||
*Immediate (red) | *Immediate (red) | ||
*Deceased/expectant (black) | *Deceased/expectant (black) | ||
==Simple Triage and Rapid Treatment (START)== | ==Simple Triage and Rapid Treatment (START)== | ||
[[File:Flowchart START.jpg|thumb|START triage | [[File:Flowchart START.jpg|thumb|START triage algorithm]] | ||
*Able to walk relocate to a certain area (green) | *Able to walk relocate to a certain area '''(green)''' | ||
*Non-ambulatory patients are then assessed | *Non-ambulatory patients are then assessed | ||
**No respirations - | **No respirations → re-position airway | ||
***No respirations ( | ***No respirations '''(deceased/expectant)''' | ||
***Respirations (immediate) | ***Respirations '''(immediate)''' | ||
**Yes respirations | **Yes respirations | ||
***>30/min (immediate) | ***>30/min '''(immediate)''' | ||
***<30 | ***<30 → check perfusion | ||
****Radial pulse absent OR | ****Radial pulse absent OR capillary refill >2 seconds '''(immediate)''' | ||
****Radial pulse present OR capillary refill <2 seconds → check mental status | |||
****Radial pulse present OR | *****Unable to follow simple commands '''(immediate)''' | ||
***** | *****Follows simple commands '''(delayed)''' | ||
***** | |||
==JumpSTART (Pediatric Patients)== | ==JumpSTART (Pediatric Patients)== | ||
[[File:JumpSTART Triage 3.gif|thumb|JumpSTART triage | [[File:JumpSTART Triage 3.gif|thumb|JumpSTART triage algorithm]] | ||
*Able to walk relocate to a certain area (green) | *Able to walk relocate to a certain area '''(green)''' | ||
*Non-ambulatory patients are then assessed | *Non-ambulatory patients are then assessed | ||
**No respirations - | **No respirations → re-position airway | ||
***Respirations (immediate) | ***Respirations '''(immediate)''' | ||
***No respirations | ***No respirations → check pulse | ||
****No pulse (expectant) | ****No pulse '''(deceased/expectant)''' | ||
****Yes pulse | ****Yes pulse → 5 rescue breaths | ||
*****Still no respirations (expectant) | *****Still no respirations '''(deceased/expectant)''' | ||
*****Respirations (immediate) | *****Respirations '''(immediate)''' | ||
**Yes respirations | **Yes respirations | ||
***<15 or >45/min (immediate) | ***<15 or >45/min '''(immediate)''' | ||
***15-45/min | ***15-45/min → check perfusion | ||
****Pulse absent or CRT >2 seconds | ****Pulse absent or CRT >2 seconds | ||
*****Control bleeding (immediate) | *****Control bleeding '''(immediate)''' | ||
****Pulse present or CRT <2 seconds | ****Pulse present or CRT <2 seconds → check mental status | ||
*****Inappropriate (immediate) | *****Inappropriate '''(immediate)''' | ||
*****Appropriate (delayed) | *****Appropriate '''(delayed)''' | ||
==Secondary Assessment of Victim Endpoint (SAVE)== | ==Secondary Assessment of Victim Endpoint (SAVE)== | ||
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**Those who will survive whether or not they receive care | **Those who will survive whether or not they receive care | ||
**Those who will benefit from limited immediate field interventions | **Those who will benefit from limited immediate field interventions | ||
==See also== | ==See also== | ||
*[[Disaster medicine]] | *[[Disaster medicine]] | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:EMS]] | [[Category:EMS]] | ||
Revision as of 09:55, 11 July 2015
Background
- Used by first responders to quickly classify victims during a mass casualty incident (MCI) based on the severity of their injury
Classification[1]
- Walking wounded/minor (green)
- Delayed (yellow)
- Immediate (red)
- Deceased/expectant (black)
Simple Triage and Rapid Treatment (START)
- Able to walk relocate to a certain area (green)
- Non-ambulatory patients are then assessed
- No respirations → re-position airway
- No respirations (deceased/expectant)
- Respirations (immediate)
- Yes respirations
- >30/min (immediate)
- <30 → check perfusion
- Radial pulse absent OR capillary refill >2 seconds (immediate)
- Radial pulse present OR capillary refill <2 seconds → check mental status
- Unable to follow simple commands (immediate)
- Follows simple commands (delayed)
- No respirations → re-position airway
JumpSTART (Pediatric Patients)
- Able to walk relocate to a certain area (green)
- Non-ambulatory patients are then assessed
- No respirations → re-position airway
- Respirations (immediate)
- No respirations → check pulse
- No pulse (deceased/expectant)
- Yes pulse → 5 rescue breaths
- Still no respirations (deceased/expectant)
- Respirations (immediate)
- Yes respirations
- <15 or >45/min (immediate)
- 15-45/min → check perfusion
- Pulse absent or CRT >2 seconds
- Control bleeding (immediate)
- Pulse present or CRT <2 seconds → check mental status
- Inappropriate (immediate)
- Appropriate (delayed)
- Pulse absent or CRT >2 seconds
- No respirations → re-position airway
Secondary Assessment of Victim Endpoint (SAVE)
- Applies after patients have been triaged with START/jumpStart
- Designed for appropriation of limited resources for most gain in immediate on-scene care situations
- Three categories:
- Those who will die regardless of care
- Those who will survive whether or not they receive care
- Those who will benefit from limited immediate field interventions
See also
References
- ↑ Lerner EB, Schwartz RB, Coule PL, et al. "Mass Casualty Triage: An Evaluation of the Data and Development of a Proposed National Guideline." Disaster Medicine and Public Health Preparedness 2(Suppl. 1) 2008, pp S25-S34.