This requires identifying potentially salvageable patients with life-threatening con- ditions who require immediate treatment and transport.
1.The first EMS personnel to arrive on scene initiate mass casualty triage. Providers first ensure scene safety and relay basic information regarding the incident to dis- patchers, so additional resources can be mobilized and hazards mitigated. The responsibility for patient triage is assigned to more experienced personnel when they arrive. Field triage works best when victims are limited to a small geographic area. Large disaster sites (such as earthquakes and floods) or disasters with geo- graphically distinct areas (such as either side of a train crash, when mobility between and access to the two sides is limited by the wreckage) can require mul- tiple triage sites.
2.Principles.While it is generally taught that the most critically injured patients are transported first, empiric data are lacking to support this principle. Triage is a continuous process, with frequent reassessment of patient status and resources.
Patients are typically re-triaged on arrival at the hospital.
3.Simple triage and rapid treatment (START)is the most commonly used mass casualty triage system in the United States. Patients who are ambulatory are first removed from the area. Next, patients are classified as “expectant” if obviously dead or if not breathing after one attempt to reposition the airway.
Remaining patients are categorized as “immediate” or “delayed,” on the basis of the evaluation of respiratory rate, perfusion, and mental status. An abnormality
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B A
Danger area Danger area
Danger area – do not approach
Danger area –
do not approach Approach to load
on this side
Approach area
Approach area Approach area
Approach area
Figure 9-2.The same safety standards should be practiced whether the helicopter’s engines are running or shut down.
■Do not approach the helicopter unless signaled to do so by a flight team member.
■Remain clear of the helicopter at all times unless accompanied by a flight team member.
■When approaching the helicopter, always approach from the front of the aircraft and move away in the same direction (Panel A).
■When approaching the helicopter on a slope,neverapproach
from the uphill side. Always approach from the downhill side because the main rotor to the ground clearance is much greater. Always be aware of the blade clearance.
■Neverwalk around the tail rotor area (Panel B).
■No unauthorized personnel are allowed within 100 ft of the aircraft.
■No IV devices or other objects should be carried above the head, and long objects should be carried parallel to the ground.
Chapter 9 rPrehospital and Air Medical Care 87
TABLE 9-2 START Triage Guidelines
All walking Wounded
RESPIRATIONS
MINOR NO
IMMEDIATE
Position Airway Under 30/min.
PERFUSION
Over 30/min.
YES
Radial Pulse Present Radial Pulse Absent
OR
IMMEDIATE
IMMEDIATE
NO Respirations Respirations
DECEASED
Control Bleeding Over 2 Seconds
MENTAL STATUS
DELAYED IMMEDIATE
CAN’T Follow Simple Commands
CAN Follow Simple Commands Under 2 Seconds
Capillary Refill
in any one parameter places the victim in the “immediate” category (Table 9-2).
4.Triage tagsare often used to identify needs in both large and small multi-victim incidents.
a.Problemsthat can occur with triage tags include:
i. Separation of the tag from the victim ii. Contamination by blood or body fluids iii. Limited space for documentation
iv. Inability to “upgrade” a patient’s triage category, since many tags use color- coded strips that are torn off (leaving the patient’s categorization attached) and cannot be reattached if a patient’s status worsens
b.Color codesare traditionally used to identify patient categorization by injury severity and need for transport:
i. Red “immediate”or the most critically injured. This includes patients with major injuries to the head, thorax, and abdomen for which immediate surgical or specialty care is required.
ii. Yellow “delayed”or less critically injured. This includes patients who are less seriously injured, who still likely require in-hospital treatment, but whose clinical condition permits a delay of several hours without endan- gering life.
iii. Green “ambulatory”with no life- or limb-threatening injury identified.
Ideally, medical personnel will reassess all of the ambulatory patients who are initially moved away from the disaster scene, to identify injuries.
iv. Black “expectant”or dead. Patients who would be triaged to “red”
under certain circumstances might be triaged to “black” when resources are limited.
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