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TRIAGE OF MASS CASUALTIES
- C. Giannou
1 JFK Memorial Hospital, Maternity Building Improvised triage post: - - PDF document
1 JFK Memorial Hospital, Maternity Building Improvised triage post: - - PDF document
Clinical practice TRIAGE Normal clinical practice OF MASS CASUALTIES Multiple-casualty incident C. Giannou Mass casualties Hat Yai July 2012 Triage = Process The aim in a mass casualty situation is to do the best for the most, not by
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Triage Department, in use Triage cannot be organised ad hoc. It requires planning:
Preparation before the crisis Organisation of the personnel Organisation of the space Organisation of the infrastructure Organisation of the equipment Organisation of supplies Training Communication Security Convergence reaction = relatives, friends &
the curious (especially the armed ones)
Triage involves a dynamic equilibrium between needs and resources.
Needs = number of wounded and types of wounds Resources = infrastructure and equipment at hand & competent personnel present
The Triage Team
Triage team leader: co-ordinator Clinical triage officer: does not treat Head nurse, matron: chief organiser Nursing groups Follow-up medical groups
Clinical Triage Officer
No task in the medical services requires greater understanding, skill, and judgement than the sorting of casualties and the establishment of priorities for treatment.
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Triage decisions must be respected.
Discuss afterwards. Triage is a dynamic process:
begins at the point of wounding,
- ccurs all along the chain of casualty care,
- ccurs at the hospital reception,
and continues inside the hospital wards: continuous reassessment of patients.
Triage Documentation
Include basic
information
Short-form Clear Concise Complete
Triage Documentation
Reality check What really happens! During post-triage evaluation: decided to use plastic sleeve to hold the documentation.
The triage process:
Sift
Place patients in main categories:
priority Sort
Priority amongst the priorities
Sift
1) Select those most severely injured and 2) identify and remove:
the dead the slightly injured the uninjured
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Sort
Categorise the most severely injured based on:
life-threatening conditions (ABC) anatomic site of injury Red Cross Wound Score treatment available in terms of personnel and
supplies
ICRC TRIAGE CATEGORIES
I. Serious wounds: resuscitation and immediate Serious wounds: resuscitation and immediate surgery surgery II. Second priority: need surgery but can wait Second priority: need surgery but can wait III. Superficial wounds: ambulatory management Superficial wounds: ambulatory management IV. Severe wounds: supportive treatment Severe wounds: supportive treatment
Category I: Resuscitation and immediate surgery
Patients who need urgent surgery – life-saving – and have a good chance of recovery. (E.g. Airway, Breathing, Circulation: tracheostomy, haemothorax, haemorrhaging abdominal injuries, peripheral blood vessels)
Thoraco-abdominal bullet wound Distal pulse absent
Category II: Need surgery but can wait
Patients who require surgery but not on an urgent basis.
(E.g. non-haemorrhaging abdominal injuries, wounds of limbs with fractures and/or major soft tissue wounds, penetrating head wounds GCS > 8.)
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Category I for Airway; Category II for debridement Femoral vessels intact Limb salvage
Category III: Superficial wounds (no surgery, ambulatory treatment)
Patients with wounds requiring little or no surgery.
In practice, this is a large group, including superficial wounds managed under local anaesthesia in the emergency room or with simple first aid measures.
Multiple superficial fragments Multiple superficial fragments
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