The document discusses triage procedures for sorting patients based on injury severity. It describes using triage tags color-coded as green (walking wounded), yellow (delayed treatment), red (immediate treatment), and black (deceased). The START method is outlined to evaluate a patient's respirations, perfusion (pulses), and mental status to determine the priority color code. The document provides guidance on establishing treatment areas and directing patients to the appropriate sector based on their triage tag for further medical assistance.

1. TTRRIIAAGGEE
EEAASSTT GGRROOUUPP
FFIIRREE DDEEPPTT’’SS
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2. TRIAGE
• TO SORT OR CATEGORIZE
• FIRST USED BY NAPOLEON
• INITIALLY USED TO IDENTFY THE
LEAST INJURED TO PREPARE THEM
TO GET BACK INTO THE BATTLE.

3. Triage?
Triage is the sorting of patients by
the severity of injury or illness so
that resources can be more
efficiently utilized to do the most
good for the most people…

4. Triage is a Dynamic Process…
• Regardless of whether patients are moved from
point of injury/illness to another location for
treatment, or if they are treated in place…triage is
repeated before treatment begins. Triage is
conducted during the initial contact and when the
patient is moved to the treatment sector.

5. Triage Tags
• Triage tags are often used to document the patient
condition and treatment received. Tags come in a
variety of different designs.
• Different colors are used to represent priority of
injury.
Red: Immediate
Yellow: Delayed
Green: Walking Wounded, Minor
Black: Deceased
12/05/14 Triage: Montgomery Fire Dept

7. What do the colors mean???
• Green: Minimal/Walking wounded- These are
patients that are ambulatory, and have only minimal
injuries and are capable of making their own way to
the casualty collection point/treatment sector.
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9. What do the colors mean???
• Yellow: Delayed- These are patients that have
wounds that require attention, but are not
immediately life threatening. These patients usually
need assistance making their way to the treatment
sector.
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11. What do the colors mean?
• Red: Immediate- critically-injured patients
with treatable life-threatening injuries or
illnesses. This might include airway and
breathing difficulties, decreased mental
status, and uncontrolled bleeding. These
patients will be treated and transported from
the scene first.
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13. What do the colors mean?
• Black: (morgue)- is used for dead and
unsalvageable patients such as someone in
cardiac arrest. These victims will be
removed from the scene, but only after all
of the living/salvageable patients.
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15. DMS Triage Tag, Instructions
The Contaminated strip running the length
of the triage tag has three functions. First to
prevent the tag from being used until
patient contamination has been considered.
Second, to identify victims who have been
exposed to a hazardous material, and third
to aid rescuers with identifying clothing
(evidence) belonging to victims.
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16. Triage Tag Instructions, Cont.
After a victim's clothing has been
removed and placed into an airtight
clear plastic bag, the long
CONTAMINATED tear off strip is
placed inside the bag face out. The
numbered tag allows for clear
identification of items for retrieval by
the owner or for investigative purposes.
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17. Triage Tag Instructions, Cont.
If contamination is not an issue, the
strip may be removed and standard
triage procedures may be initiated.
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19. Triage Tag Instructions, Cont.
Once contamination has been ruled out or
decon procedures completed, the next step will
be to follow START triage guidelines. On the
back of the tag the R.P.M. pneumonic will be
used while referring to the flow chart located
directly above. Once the patients have been
categorized they are ready to be moved to the
treatment area.
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20. Triage Tag Instructions, Cont.
The front of the tag is than used to
record injuries and their anatomical
locations, as well as vital signs and
medications.
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21. Triage Tag Instructions, Cont.
The second tear off tag from the top is
to be used for recording patient
destination. The tag may be removed
just prior to the patient leaving the
scene. Both the destination and how
the patient was transported (ambulance
number, helicopter, bus, etc.) shall be
recorded on the tag.
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23. Ok, now we know what triage is,
and how to use the tags….
LET’S GET TO WORK!!!

24. How do we determine what color
a patient gets?
• RPM
• Respirations?
• Perfusion?
• Mentation?
12/05/14 Triage: Montgomery Fire Dept

25. S.T.A.R.T.
• First arrival makes the announcement:
– ANYONE WHO CAN WALK, PLEASE GO
TO _____________________________.
You have just triaged the green category.
Those who did not leave, perform START.

26. Respirations
• Is the patient breathing?
!-If the patient is not breathing, open the
airway and reassess. If the patient is still not
breathing tag as black and move on.
!- C-Spine control may have to be
sacrificed in this situation. Do the best you
can…as quickly as you can…
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27. Respirations
• Assess the rate of respirations.
!- If >30, tag as red and move on to the
next patient.
!- As the triage officer, you do not stop
to ventilate the patient.
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28. Respirations
• If the patient requires simple airway maintenance
you will need to assign someone to this task. If no
EMS personnel are available, remember that you
have a pool of human resources in the green tag
area. If no one there is available, you will need to
improvise by placing something under the
patient’s head/neck to keep the airway open. You
may also consider placing a simple airway
adjunct.
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29. Perfusion
• Check for the presence of radial pulses.
However, note that we are not concerned
with a pulse rate at this time. If the patient
has no radial pulses, he is critical and in
immediate need of care. You apply a red tag
to the patient and move on to the next
patient.
12/05/14 Triage: Montgomery Fire Dept

30. Perfusion
• If there are no radial pulses, there is no need
to check for carotid pulses
!- If the patient is breathing, the heart is
beating…if the radial pulses are absent, the
BP is <90mmHG and requires attention
from the treatment sector.
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31. Perfusion
• Is there any immediately life threatening
bleeding?
!- Quickly address only life threatening
bleeding. Use the cleanest dressing
material available, and use green tagged
patients to provide pressure.
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32. Mentation (Mental Status)
• Unconscious patients, or patients that can
not follow simple instructions require
immediate attention from the treatment
sector. Tag these patients with a red tag
and move on.
• Patients that can follow instructions may be
tagged yellow.
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33. Putting it all together
• As soon as a patient meets any one of the
criteria for triage as critical/immediate, you
should apply a red tag, delegate someone to
provide rapid treatment (e.g. maintain an
airway or control bleeding), stop any further
assessment and move on to the next victim.
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34. Putting it all together
• Any patient who makes it through all three
assessments, without any findings that would
result in triaging as critical/immediate, is
given a yellow tag.
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35. Putting it all together
• No triage system is 100% fail safe. It is, however,
reasonable to assume, that a patient who cannot
walk, but is maintaining his own airway, breathing
at a rate less than 30 breaths-per-minute, perfusing
radial pulses, has no sign of uncontrolled bleeding
and follows commands, is in need of medical
attention at the hospital, but can wait until all of
the critical/immediate (red tags) are removed from
the scene.
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36. Summary
• Anyone who gets up and walks to the
designated area is given a green tag
• Anyone who is not breathing is given a
black tag
• Anyone who fails one of the RPM
assessments is given a red tag
• Anyone who cannot walk but passes all of
the assessments is given a yellow tag
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37. Proceed to Part 2