How to save a life…
OFF TO A GOOD S.T.A.R.T.   Trauma Triage and Mass Casualty              Incidents               Veronica Bonales, M.D.    ...
Mass Casualty IncidentAny incident that overwhelms the available resources  9/11  Two person EMS crew arriving at scene wi...
Mass Casualty IncidentFirst unit on scene declares MCIWhen additional units start en route, first unit starts triageUsuall...
Mass Casualty IncidentTriage everyone according toSTARTTreatment of manageableinjuriesTransport in order of priorityand fo...
- Assess and control the accident scene- Tamponade external hemorrhage with direct pressure        - Protect the spine aft...
S.T.A.R.T.SimpleTriageAndRapidTreatment/Transport
Triage Principles
Triage Principles
Triage Principles  Triage – Fr. trier = to sort
Triage Principles                 Triage – Fr. trier = to sortNapoleon’s surgeon Larrey established the ambulance corps an...
Triage Principles                 Triage – Fr. trier = to sortNapoleon’s surgeon Larrey established the ambulance corps an...
Triage Principles                 Triage – Fr. trier = to sortNapoleon’s surgeon Larrey established the ambulance corps an...
Triage Principles
Triage Principles      Civil War:
Triage Principles                      Civil War:Formal establishment of military field ambulance service
Triage Principles                         Civil War:  Formal establishment of military field ambulance serviceSurgeons con...
Triage Principles
Triage Principles                     WWI and WWII   Increased use of field medics and the “buddy system”                I...
Triage Principles
Triage Principles                      Korean WarMASH units and helicopters helped to further decrease the            numb...
Triage Principles
Triage Principles
Triage Principles
Triage Principles
Triage Principles
Triage PrinciplesSTART Triage  Team of two can assess an average of one patient every 30 seconds.  40 casualties, two tria...
Triage PrinciplesSTART by those who STARTed it…
START Triage
START Triage
START Triage
START Triage
START Triage
Assess, Treat, (use bystanders)                      When you have a color                     STOP - TAG - MOVE ON       ...
Triage Principles· Evaluate patient using START· Tear off the bottom of the tag· Tear off a tracking slip and place it in ...
Triage PrinciplesA lot of GREEN helps… but goes fast.
Triage PrinciplesBe like Visine…… Get the Red OUT!
Triage PrinciplesDon’t let YELLOW mellow… re-assess!!
Triage PrinciplesIMMEDIATE-by-mechanism  Depending on their injury  Age  Medical history
Triage Principles16 year old with    17 year old with   35 year old with   47 year old withbleeding scalp lac. no spontane...
Triage Principles16 year old with    17 year old with   35 year old with   47 year old withbleeding scalp lac. no spontane...
Triage Principles16 year old with    17 year old with   35 year old with   47 year old withbleeding scalp lac. no spontane...
Triage Principles16 year old with    17 year old with   35 year old with   47 year old withbleeding scalp lac. no spontane...
Triage Principles16 year old with    17 year old with   35 year old with   47 year old withbleeding scalp lac. no spontane...
Triage Principles30 year old with   5 year old who   24 year old with   38 year old withdislocated ankle   seems confused ...
Triage Principles30 year old with   5 year old who   24 year old with   38 year old withdislocated ankle   seems confused ...
Triage Principles30 year old with   5 year old who   24 year old with   38 year old withdislocated ankle   seems confused ...
Triage Principles30 year old with   5 year old who   24 year old with   38 year old withdislocated ankle   seems confused ...
Triage Principles30 year old with   5 year old who   24 year old with   38 year old withdislocated ankle   seems confused ...
Triage Principles19 year old with    29 year old with     7 year old with no 36 year old withburns to soles of   no visibi...
Triage Principles19 year old with    29 year old with     7 year old with no 36 year old withburns to soles of   no visibi...
Triage Principles19 year old with    29 year old with     7 year old with no 36 year old withburns to soles of   no visibi...
Triage Principles19 year old with    29 year old with     7 year old with no 36 year old withburns to soles of   no visibi...
Triage Principles19 year old with    29 year old with     7 year old with no 36 year old withburns to soles of   no visibi...
Assess, Treat, (use bystanders)                      When you have a color                     STOP - TAG - MOVE ON       ...
Questions??
FCA 0912 MCI's and START
FCA 0912 MCI's and START
FCA 0912 MCI's and START
FCA 0912 MCI's and START
FCA 0912 MCI's and START
FCA 0912 MCI's and START
FCA 0912 MCI's and START
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FCA 0912 MCI's and START

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  • The concepts of dedicated ambulances and standardized medical equipment spread rapidly after the publication of the groundbreaking 1966 National Research Council report Accidental Death and Disability: The Neglected Disease of Modern Society.14 Victims of illness and injury in nonurban areas of the United States began to be triaged by trained, skilled medics, rather than the local hearse drivers who had provided civilian medical transportation services.\n
  • The concepts of dedicated ambulances and standardized medical equipment spread rapidly after the publication of the groundbreaking 1966 National Research Council report Accidental Death and Disability: The Neglected Disease of Modern Society.14 Victims of illness and injury in nonurban areas of the United States began to be triaged by trained, skilled medics, rather than the local hearse drivers who had provided civilian medical transportation services.\n
  • The concepts of dedicated ambulances and standardized medical equipment spread rapidly after the publication of the groundbreaking 1966 National Research Council report Accidental Death and Disability: The Neglected Disease of Modern Society.14 Victims of illness and injury in nonurban areas of the United States began to be triaged by trained, skilled medics, rather than the local hearse drivers who had provided civilian medical transportation services.\n
  • The concepts of dedicated ambulances and standardized medical equipment spread rapidly after the publication of the groundbreaking 1966 National Research Council report Accidental Death and Disability: The Neglected Disease of Modern Society.14 Victims of illness and injury in nonurban areas of the United States began to be triaged by trained, skilled medics, rather than the local hearse drivers who had provided civilian medical transportation services.\n
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  • Respirations, perfusion, mental status\n
  • Respirations, perfusion, mental status\n
  • Respirations, perfusion, mental status\n
  • Respirations, perfusion, mental status\n
  • Respirations, perfusion, mental status\n
  • Respirations, perfusion, mental status\n
  • Respirations, perfusion, mental status\n
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  • The wreckage of a Cessna 177 in which trainee pilot  Jessica Dubroff, her father and her instructor were killed while engaging in a trans-continental record attempt. The accident was caused by the instructor pilot's improper decision to take off into deteriorating weather conditions which resulted in stall. 4/96\n
  • The wreckage of a Cessna 177 in which trainee pilot  Jessica Dubroff, her father and her instructor were killed while engaging in a trans-continental record attempt. The accident was caused by the instructor pilot's improper decision to take off into deteriorating weather conditions which resulted in stall. 4/96\n
  • The wreckage of a Cessna 177 in which trainee pilot  Jessica Dubroff, her father and her instructor were killed while engaging in a trans-continental record attempt. The accident was caused by the instructor pilot's improper decision to take off into deteriorating weather conditions which resulted in stall. 4/96\n
  • The wreckage of a Cessna 177 in which trainee pilot  Jessica Dubroff, her father and her instructor were killed while engaging in a trans-continental record attempt. The accident was caused by the instructor pilot's improper decision to take off into deteriorating weather conditions which resulted in stall. 4/96\n
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  • Transcript of "FCA 0912 MCI's and START"

    1. 1. How to save a life…
    2. 2. OFF TO A GOOD S.T.A.R.T. Trauma Triage and Mass Casualty Incidents Veronica Bonales, M.D. RMH PreHospital Care Medical Director HCEMCC Paramedic Coordinator
    3. 3. Mass Casualty IncidentAny incident that overwhelms the available resources 9/11 Two person EMS crew arriving at scene with three victims
    4. 4. Mass Casualty IncidentFirst unit on scene declares MCIWhen additional units start en route, first unit starts triageUsually involves setting up an Incident Command SystemTriage, Treatment, Transport
    5. 5. Mass Casualty IncidentTriage everyone according toSTARTTreatment of manageableinjuriesTransport in order of priorityand for definitive care
    6. 6. - Assess and control the accident scene- Tamponade external hemorrhage with direct pressure - Protect the spine after blunt trauma - Extricate the patient - Supplement inspired O2 - Stabilize long bone fractures
    7. 7. S.T.A.R.T.SimpleTriageAndRapidTreatment/Transport
    8. 8. Triage Principles
    9. 9. Triage Principles
    10. 10. Triage Principles Triage – Fr. trier = to sort
    11. 11. Triage Principles Triage – Fr. trier = to sortNapoleon’s surgeon Larrey established the ambulance corps and a method of setting priorities for the evacuation of war casualties
    12. 12. Triage Principles Triage – Fr. trier = to sortNapoleon’s surgeon Larrey established the ambulance corps and a method of setting priorities for the evacuation of war casualties- he picked up the war wounded that could be saved by quick intervention (ie. amputation)
    13. 13. Triage Principles Triage – Fr. trier = to sortNapoleon’s surgeon Larrey established the ambulance corps and a method of setting priorities for the evacuation of war casualties- he picked up the war wounded that could be saved by quick intervention (ie. amputation) - other surgeons quickly bandaged those that could go back and fight
    14. 14. Triage Principles
    15. 15. Triage Principles Civil War:
    16. 16. Triage Principles Civil War:Formal establishment of military field ambulance service
    17. 17. Triage Principles Civil War: Formal establishment of military field ambulance serviceSurgeons continued the practice of collecting those who could benefit from immediate medical intervention
    18. 18. Triage Principles
    19. 19. Triage Principles WWI and WWII Increased use of field medics and the “buddy system” Increased use of antibioticsAid stations and surgical hospitals moved closer to the front
    20. 20. Triage Principles
    21. 21. Triage Principles Korean WarMASH units and helicopters helped to further decrease the number of battlefield casualties This was further improved upon in the Vietnam conflict where death rates decreased from 30% to 24% Afghan and Iraq war casualty rates now 10%
    22. 22. Triage Principles
    23. 23. Triage Principles
    24. 24. Triage Principles
    25. 25. Triage Principles
    26. 26. Triage Principles
    27. 27. Triage PrinciplesSTART Triage Team of two can assess an average of one patient every 30 seconds. 40 casualties, two triage teams will take approximately 10 minutes to accurately assess Only treatment rendered by the triage team open a patient’s airway by head tilt /neck lift by insertion of an OPA apply direct pressure to stop an obvious bleed or by elevating the extremities.
    28. 28. Triage PrinciplesSTART by those who STARTed it…
    29. 29. START Triage
    30. 30. START Triage
    31. 31. START Triage
    32. 32. START Triage
    33. 33. START Triage
    34. 34. Assess, Treat, (use bystanders) When you have a color STOP - TAG - MOVE ON Move Walking Wounded NO RESPIRATIONS after head tilt* Breathing but UNCONSCIOUS Perfusion Capillary refill > 2 or NO RADIAL PULSE Control bleedingminor decease Mental Status Unable to follow simple commands d immedi ate Otherwise delaye d REMEMBER: Respirations < 30 Perfusion < 2 Mental Status - Can Do
    35. 35. Triage Principles· Evaluate patient using START· Tear off the bottom of the tag· Tear off a tracking slip and place it in the kit· Attach tag to the patient with a tie· Give tracking slips to the Triage Officer
    36. 36. Triage PrinciplesA lot of GREEN helps… but goes fast.
    37. 37. Triage PrinciplesBe like Visine…… Get the Red OUT!
    38. 38. Triage PrinciplesDon’t let YELLOW mellow… re-assess!!
    39. 39. Triage PrinciplesIMMEDIATE-by-mechanism Depending on their injury Age Medical history
    40. 40. Triage Principles16 year old with 17 year old with 35 year old with 47 year old withbleeding scalp lac. no spontaneous foreign body open tib-fib respirations or fracture pulse
    41. 41. Triage Principles16 year old with 17 year old with 35 year old with 47 year old withbleeding scalp lac. no spontaneous foreign body open tib-fib respirations or fracture pulse
    42. 42. Triage Principles16 year old with 17 year old with 35 year old with 47 year old withbleeding scalp lac. no spontaneous foreign body open tib-fib respirations or fracture pulse
    43. 43. Triage Principles16 year old with 17 year old with 35 year old with 47 year old withbleeding scalp lac. no spontaneous foreign body open tib-fib respirations or fracture pulse
    44. 44. Triage Principles16 year old with 17 year old with 35 year old with 47 year old withbleeding scalp lac. no spontaneous foreign body open tib-fib respirations or fracture pulse
    45. 45. Triage Principles30 year old with 5 year old who 24 year old with 38 year old withdislocated ankle seems confused broken finger no heartbeat and and won’t talk no spontaneous respirations
    46. 46. Triage Principles30 year old with 5 year old who 24 year old with 38 year old withdislocated ankle seems confused broken finger no heartbeat and and won’t talk no spontaneous respirations
    47. 47. Triage Principles30 year old with 5 year old who 24 year old with 38 year old withdislocated ankle seems confused broken finger no heartbeat and and won’t talk no spontaneous respirations
    48. 48. Triage Principles30 year old with 5 year old who 24 year old with 38 year old withdislocated ankle seems confused broken finger no heartbeat and and won’t talk no spontaneous respirations
    49. 49. Triage Principles30 year old with 5 year old who 24 year old with 38 year old withdislocated ankle seems confused broken finger no heartbeat and and won’t talk no spontaneous respirations
    50. 50. Triage Principles19 year old with 29 year old with 7 year old with no 36 year old withburns to soles of no visibile injuries pulses and no penetratingfeet spontaneous trauma and a breaths after 2 swelling belly rescue breaths
    51. 51. Triage Principles19 year old with 29 year old with 7 year old with no 36 year old withburns to soles of no visibile injuries pulses and no penetratingfeet spontaneous trauma and a breaths after 2 swelling belly rescue breaths
    52. 52. Triage Principles19 year old with 29 year old with 7 year old with no 36 year old withburns to soles of no visibile injuries pulses and no penetratingfeet spontaneous trauma and a breaths after 2 swelling belly rescue breaths
    53. 53. Triage Principles19 year old with 29 year old with 7 year old with no 36 year old withburns to soles of no visibile injuries pulses and no penetratingfeet spontaneous trauma and a breaths after 2 swelling belly rescue breaths
    54. 54. Triage Principles19 year old with 29 year old with 7 year old with no 36 year old withburns to soles of no visibile injuries pulses and no penetratingfeet spontaneous trauma and a breaths after 2 swelling belly rescue breaths
    55. 55. Assess, Treat, (use bystanders) When you have a color STOP - TAG - MOVE ON Move Walking Wounded NO RESPIRATIONS after head tilt* Breathing but UNCONSCIOUS Perfusion Capillary refill > 2 or NO RADIAL PULSE Control bleedingminor decease Mental Status Unable to follow simple commands d immedi ate Otherwise delaye d REMEMBER: Respirations < 30 Perfusion < 2 Mental Status - Can Do
    56. 56. Questions??

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