Military Coding MEDICAL TRIAGE 101 TCCC TC-3 TC3 PowerPoint Presentation on CD

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Contains the following key public domain (not copyrighted) U.S. Government publication(s) on one CD-ROM in both Microsoft PowerPoint and Adobe Acrobat PDF file formats: TITLE: TRIAGE, 67 pages (slides) SLIDE TOPICS, SUBTOPICS and CONTENTS: TRIAGE Triage “Sorting” Classifying of casualties Establish priorities for treatment / evacuation Dynamic process Triage Multiple casualties Single casualty with multiple injuries Triage Classification Systems Military/International START Simple Triage and Rapid Treatment Others Color Coding Casualties are color coded to quickly identify a casualty’s priority for medical treatment. International Color Codes (METTAG) are: Black – Expectant/Dead-Dying Red - Immediate Yellow - Delayed Green – Minimal/Minor US Military Color Code (MEDIC) Blue - Expectant Triage Categories Triage Principles Peacetime/Wartime Life over limb Bodily function over cosmetic appearance Greatest good for the greatest number Triage Officer Physician Dentist Nurse Physician Assistant Technician Triage Factors Availability of transportation Resources Facilities Continuous process Minimal/Minor Green tag Minor threat to patient’s life Classic “Walking Wounded” Easily segregated Tend to later Self-Aid, buddy care Treat and release, return to duty/manpower pool Minimal/Minor Minor lacerations Abrasions Sprains Contusions Burns under 20% BSA Rule of 9’s Combat stress casualties Immediate Red tag Threat to life is great Simple procedure will be lifesaving Reposition airway, control hemorrhaging,… Must receive urgent treatment Immediate Airway obstruction Sucking chest wounds Massive external bleeding Shock Incomplete Amputation 2nd/3rd degree burns of face or neck White phosphorus burns Delayed Injuries that are serious Delay in treatment is not life threatening Require care but no immediate life saving procedures Treatment, including surgery may be delayed several hours Delayed Open chest wounds Penetrating abdominal wound (evisceration) Severe eye injury Open wounds Non-life threatening fractures 2nd/3rd degree burns not involving the face/neck Expectant/Dead-Dying Little hope of recovery Great threat to life Treatment is complicated/time consuming Supportive vs curative treatment Only used if resources are limited Expectant/Dead-Dying Large open head wounds with loss of tissue Decapitation Massive crush injury of the chest/neck Large open chest wound Penetrating injury to trachea/neck 2nd/3rd degree burns greater then 60% BSA Multiple trauma Contaminated Not a true triage category Be alert to possibility Segregate immediately Prevent contamination of other patients, medical staff, facility Complicates management and treatment Biological, not likely to have conventional injuries Chemical, greater likelihood of combination conventional, chemical injuries Decontaminate prior to any treatment Patient Assessment ATLS/BTLS TREATMENT Primary Survey - ABC’s (Triage) Resuscitation Secondary Survey - Total Patient Evaluation Definitive Care Transfer PRIMARY SURVEY Airway maintenance / cervical spine control Breathing and ventilation Circulation with hemorrhage control Disability: Neurologic status Exposure/Environmental control: undress the patient, prevent hypothermia RESUSCITATION Management of life-threatening problems identified in the primary survey Oxygenation and ventilation Shock management - IV lines, Ringer’s Monitoring SECONDARY SURVEY Head and skull Maxillofacial Neck Chest Abdomen Perineum/rectum/ vagina Musculoskeletal Complete neurologic exam Roentgenograms, lab tests “Tubes and fingers” DEFINITIVE CARE After identifying patient’s injuries After managing life-threatening problems After obtaining special studies Definitive care begins TRANSFER If the patient’s injuries exceed the immediate treatment capabilities The process of transferring the patient is initiated as soon as the need is identified Delay may significantly increase the patient’s risk of mortality Availability of airlift PATIENT CARE DECISION TREE PATIENT CARE DECISION TREE PATIENT CARE DECISION TREE PATIENT CARE DECISION TREE Triage Exercise You are working in an ATH at a classified location in support of Operation Bellringer. At approximately 0430 hours a call comes into the command post that there are casualties lying outside the perimeter fence. You arrive on the scene and find a bus that has smashed into a large tree and then into a jeep. You are tasked to retrieve, triage, and prioritize the injuries for treatment/transport. There are six bodies with the following injuries: TRIAGE EXERCISE Bus Driver - unresponsive with a penetrating injury to the trachea region Patient One - bullet wounds to the lower legs with bright red blood spurting out Patient Two - lacerations to the face and a suspected sprain to the right foot TRIAGE EXERCISE Patient Three - conscious but somewhat confused & 3rd degree burns of the arms Patient Four - partial amputation of the right arm and signs of shock Jeep Driver - walking around the area with an open wound on his forehead TRIAGE EXERCISE Immediate - require life saving care but can be stabilized Patient One - bullet wounds to the lower legs with bright red blood spurting out Patient Four - partial amputation of the right arm and signs of shock Delayed – significant injuries required treatment, but not immediately life threatening Patient Three - conscious but somewhat confused & 3rd degree burns of the arms TRIAGE EXERCISE Minimal – minor injuries, treatment can be delayed Jeep Driver - walking around the area with an open wound on his forehead Patient Two - lacerations to the face and a suspected sprain to the right foot Expectant/Dead-Dying – life threatening injuries, attempts to stabilize may jeopardize other lives Bus Driver - unresponsive with a penetrating injury to the trachea region When a patient is triaged as expectant, what should you do with the patient? a. Transport them first so that the bystanders don’t have to see someone like this b. Move them out of sight and worry about them later c. Care for them in the same manner as you would anybody else d. Stay with them and worry about the other patients when time allows Any time you respond to a call for help, your first priority is to? a. Assure your own safety b. Do the best you can for the greatest number of casualties. c. Call medical control and ask them what you should do d. Get to the scene as fast as the ambulance will allow you to travel How often should you reassess your patient in a mass casualty situation? a. Every 5 minutes b. Every 20 minutes c. Whenever necessary d. Never, this wastes time What is the purpose of the various colors on the triage tags? a. To keep track of the number of casualties b. So that medical personnel know which casualties to treat first c. To allow the casualties to know where they stand as far as treatment goes d. To make them more interesting to look at START Triage System Hoag Memorial Hospital, Newport Beach, CA Allows rescuers to quickly identify victims at greatest risk for early death Gaining popularity US EMS Systems, Oklahoma, Trade Center bombings France, Saudi Arabia, Israel START Triage System 60 second assessment focusing on Ability to walk, walking wounded = minor pts Respiratory effort Pulses/perfusion Mental/Neurologic status Only Treatment during Triage Open airway, insert OPA Stop any visible bleeding Elevate extremities for shock START PATIENT CARE DECISION TREE START (RPM’s) TRIAGE DECISION TREE START (RPM’s) TRIAGE DECISION TREE START (RPM’s) TRIAGE DECISION TREE START Triage Summary No hard and fast rules for triage A simplified guide to help sort casualties Triage is a continuous process Accomplish the greatest good for the greatest number START TRIAGE EXERCISE Working on an ambulance Dispatched as a second unit to a bombing of an abortion clinic As you arrive you hear shouts and screams and several (19) victims lying about After assuring your own safety, what is the first action you take to begin the Triage process START TRIAGE EXERCISE Instruct all walking wounded to get up and walk to a designated area and await treatment You now have 19 patients left to triage, Establish a triage category for each patient Give your rationale for their triage category. Notes If no breathing, give triage category if respirations begin/or are still absent after airway established If radial pulse is absent, most times you can assume that bleeding can be controlled unless an obvious mortal injury is presented #1 Compound fracture of the left femur Respirations: Under 30 Pulse (radial): Absent Mental Status: A O x 4 #2 Sudden onset of chest pain, no shortness of breath Respirations: Under 30 Pulse (radial): Present Mental Status: A O x 4 #3 90% second degree burns over body Respirations: None Pulse (radial): Present Mental Status: Unconscious #4 Patient states she is a diabetic. Skin is moist and clammy Respirations: Under 30 Pulse (radial): Absent Mental Status: A O x 4 #5 Unable to move legs Respirations: Under 30 Pulse (radial): Present Mental Status: Confused #6 No apparent injuries Respirations: Under 30 Pulse (radial) Present Mental Status: A O x 4 #7 Sucking chest wound Respirations: Over 30 Pulse (radial): Present Mental Status: Unconscious #8 Dislocated right shoulder Respirations: Under 30 Pulse (radial) Present Mental Status: A O x 4 #9 No visible wounds Respirations : None Pulse: (radial): Absent Mental Status: Unconscious #10 Scalp wound with an estimated blood loss of 500 cc Respirations: Over 30 Pulse (radial): Present Mental Status: Confused #11 Significant head injury Respiration: Under 30 Pulse (radial): Absent Mental Status: Unconscious #12 Three month old Infant Respirations: Under 30 Pulse (radial): Present Mental Status: Unconscious #13 Impaled, 1 foot piece of shrapnel in RT eye Respirations: Under 30 Pulse (radial) Present Mental Status: Awake & Oriented #14 Female 6 mos. pregnant, broken left lower leg Respirations: Under 30 Pulse (radial) Present Mental Status: Awake & Oriented #15 Severe difficulty breathing, chest sinks in on inspiration Respirations: Over 30 Pulse (radial) Present Mental Status: Awake & Oriented #16 Unable to move, no verbal response Respirations: Under 30 Pulse (radial) Present Mental Status: Awake but stares into space #17 Amputated left arm, bleeding controlled Respirations: Under 30 Pulse (radial) Present Mental Status: Awake & Oriented #18 Large head wound, brain matter showing Respiration: None Pulse (radial): Absent Mental Status: Unconscious #19 Minor abrasions Respirations: Under 30 Pulse (radial) Present Mental Status: Awake & Oriented

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End Time: 2023-09-27T10:36:19.000Z

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