MAJOR INCIDENT – TRIAGE Suzan Thompson Senior Lecturer MSc – Inter-professional Practice (Civil Emergency Management) HMIMMS Instructor Where to Start? The Structured Response - CSCATTT • • • • • • • Command and control Safety Communication Assessment Triage Treatment Transport ‘Triage is the Keystone of Good Disaster Medical Management’ (Hogan and Burnstein 2002 Pg 10) Triage • The assignment of degrees of urgency to wounds or illnesses to decide the order of treatment of a large number of patients or casualties • To Sieve or to Sort Aims of Triage Timing • Dynamic Process (continuous) – At Scene – At CCS – Prior to evacuation – Hospital reception – During resuscitation – Prior to surgery – Prior to admission to ICU / Critical Care Area Trimodal Distribution of Death Triage Priorities Priority Immediate Category Casualties require immediate life-saving treatment Priority Urgent Category Casualties require significant intervention as soon as it can be given Priority (Immediate) NARU – Triage Sieve 18 MPTT - 24 Triage Sieve ©ALSG, 2012 NARU – Triage Sieve 21 Triage Sort • • Triage Revised Trauma Score Three Parameters: – Respiratory Rate – Systolic Blood Pressure – GCS • Triage Priority assigned based on score Respiratory Rate Respiratory rate 0-4 Value Score 10-29 >29 6-9 1-5 0 Systolic BP Value Score >90 76-89 50-75 1-49 0 Systolic BP 0-4 GCS Value Score 13-15 9-12 6-8 4-5 GCS 0-4 TRTS Triage priority + + = Triage sort refines the triage priority with a relevant anatomical description Triage Labelling • • • Highly visible Dynamic Easily secured 27 Triage Labelling Triage and Evacuation CCS © ALSG, 2012 Triage – Implications for ICU • • • • Evaluation of Severity of Injuries Liaison with Hospital Control Centre Develop Plan Potential Critical Care admissions need to be evaluated in context of those patients already in the unit • Re-evaluate patients on admission Any Questions? 31 Summary - Triage • • Triage Sieve (quickly assigns priorities) • • At the scene Dynamic Triage Sort (refines the priorities) • • • More detailed At the Casualty Clearing Station Dynamic – patient’s status may change 32 ... invoked in a UK Major Incident Priority (Expectant) 15 Triage - Methods • • Reliability Validity – Over -Triage – Under -Triage – Physiological v Anatomical • • Triage Sieve (primary) Triage Sort... (secondary) Triage Sieve ©ALSG, 2012 NARU – Triage Sieve 18 MPTT - 24 Triage Sieve ©ALSG, 2012 NARU – Triage Sieve 21 Triage Sort • • Triage Revised Trauma Score Three Parameters: – Respiratory Rate –. .. Sieve or to Sort Aims of Triage Timing • Dynamic Process (continuous) – At Scene – At CCS – Prior to evacuation – Hospital reception – During resuscitation – Prior to surgery – Prior to admission