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Mci smart triage
- 1. Objectives: • What isan MCI ? • Review Incident Management from EMS perspective • Review Triage & Practice START
- 2. What is theGoal of MCI Management?
- 3. EMS GOAL: TO SAVETHE LARGEST NUMBER OF SURVIVORS FROM A MULTIPLE CASUALTY INCIDENT
- 4. What is anMCI Scene?
- 5. What are someCommon things affecting your MCI response? • Typical staffing of your ambulance service? • What does EMS routinely do daily? • How do you handle the following? – 4 victims in a two car “head-on” – 17 victims in a “team” van – 43 victims on a school bus – 350 victims on a train
- 6. So what doyou have to think about? TREATMENT IMMODIUM COMMAND TRIAGE STAGING COMMUNICATIONS SAFETY ASSESSMENT
- 7. THE INITIAL PROBLEMON SCENE Casualties Resources
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- 15. BUT - HOWIS EMS TRAINED? • BLS, ALS • CPR, ACLS, PALS • PHTLS, BTLS • CFR, EMT, EMT-I, EMT-CC, EMT-P How many patients are you taught to treat at one time?
- 16. WHAT CHANGES WHENYOU HAVE AN MCI ? • What are my resources? • Who is a Patient? • Which Patient do I treat first? • Who can be salvaged? • Who gets transported first? • Who needs a Trauma/Specialty Center? • Who can help care for others?
- 17. ARRIVAL OF REQUESTED RESOURCES TIMEIS IMPORTANT
- 18. THE GOLDEN HOUR “Thecritical trauma patient has only 60 minutes from the time of injury to reach definitive surgical care, or the odds of a successful recovery diminish dramatically”. Pre-Hospital Trauma Life Support, Second Edition, Patient Assessment and Management, page 42. 1990. TIME IS VERY IMPORTANT
- 19. Balancing Act Casualties Resources TimeManagement Management
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- 22. Scene Management • Command Whois in Charge? Who is in charge of what? Who is going to do what? Who else needs to be here? EMS is generally in Operations (Ops) • Safety Is there a hazard or threat? Should I be here? Am I protected? What should I worry about?
- 23. Scene Management • Assessment Whatis going on? How big is this, how many people? What do I need? How does what I do affect others? What are they doing that can affect me? • Communications Who needs to know? What do they need to know? Does Command & Ops know? Do the other players know?
- 24. Scene Management • Triage Whois doing it? Where are they doing it? What are they finding? • Treatment What the typical EMS provider comes “preloaded” with… How to organize? How much can we do?
- 25. Scene Management Transport • Whois doing it? • From where are they doing it? • Where are the patients going? • How many patients going where?
- 26. “Large scale triageis the hardest job anyone in pre-hospital care will ever do”. A.J Heightman, Mass Casualty Incident Management. A practical approach to solving complex operational dilemmas. TRIAGE
- 27. Casualties exceed thenumber of skilled rescuers. TRIAGE WHEN ?
- 28. Types of Triage •Primary – On Scene prior to movement • Secondary – Incident dependant, probably prior to or during transport
- 29. TRIAGE CODING Immediate 1 Urgent2 Delayed 3 Dead 0 RED Yellow Green Black ColorPriority Treatment
- 30. TRIAGE TAGS What isthe same ? What is improved ? What is different ?
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- 33. PRIMARY TRIAGE The firstattempt at balancing EMS resources and casualties / injured
- 34. PRIMARY TRIAGE Determining whetherthere is an airway and breathing
- 35. PRIMARY TRIAGE If breathing,at what rate & is it good enough?
- 36. PRIMARY TRIAGE They havean airway, and are breathing. Are they circulating blood sufficiently?
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- 39. PEDIATRIC TRIAGE Children areinvolved in multiple casualty incidents. The over prioritizing of children will take valuable resources away from more seriously injured adults. Triage systems based on adult physiology will not provide accurate triage.
- 40. SMART Pediatric Tape •Developed by Pediatricians to use the existing START protocol but modified to reflect appropriate values for pediatric respirations and circulation.
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- 43. START EXERCISE • Female,30’s, walking • Female, teens, walking, pale, complaining of severe abdominal pain • Male, teens, walking, confused • Male, teens, you open airway, does not breathe • Male, 20’s, unconscious, breathing, RR 36, radial pulse absent • Male, 20’s, holding left ankle, cannot walk, RR 20, CRT 1, responds to instructions 1
- 44. START EXERCISE • Female,30’s, walking • Female, teens, walking, pale, complaining of severe abdominal pain • Male, teens, walking, confused • Male, teens, you open airway, does not breathe • Male, 20’s, unconscious, breathing, RR 36, radial pulse absent • Male, 20’s, holding left ankle, cannot walk, RR 20, CRT 1, responds to instructions 1 A
- 45. START EXERCISE • Female,60’s, fracture LL leg, cannot walk, RR 25, CRT 1, obeys commands • Male, 30’s, you open airway, does not breathe • Male, 30’s, lying on ground, breathing, gurgling sounds, RR 37, pulse absent, unresponsive • Male, 50’s, you open airway, does not breathe • Male, child, 75 cm, not alert, breathing, RR 30, CRT 2.5, pulse 100 • Male, child, 130 cm, not walking, breathing, RR 24 CRT 1 2
- 46. START EXERCISE • Female,60’s, fracture LL leg, cannot walk, RR 25, CRT 1, obeys commands • Male, 30’s, you open airway, does not breathe • Male, 30’s, lying on ground, breathing, gurgling sounds, RR 37, pulse absent, unresponsive • Male, 50’s, you open airway, does not breathe • Male, child, 75 cm, not alert, breathing, RR 30, CRT 2.5, pulse 100 • Male, child, 130 cm, not walking, breathing, RR 24 CRT 1 2 A
- 47. START EXERCISE • Female,child, 145 cm, lying on ground holding chest, breathing with gurgling sounds, RR 37, CRT 3 • Female, child, 47 cm, breathing, crying, pulse 160 3
- 48. START EXERCISE • Female,child, 145 cm, lying on ground holding chest, breathing with gurgling sounds, RR 37, CRT 3 • Female, child, 47 cm, breathing, crying, pulse 160 3 A
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- 50. SECONDARY TRIAGE • Purpose –Determine among like priority category, higher priority patient • When does it happen? – Generally on extended duration events – If treatment areas are established, there will likely be a need for Secondary Triage before transport
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- 53. Tools to helpmanage • Use of ICS • FOGs and SOGs – Field Operations Guides – Standard Operations Guides • Command Boards • Communications – Radios / Cellular, etc – Verbal – Documentation • Scribes/Runners
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- 57. SMART COMMANDER ™ •Organization for: – Command, Control, Coordination • Provides: – Overall Incident Management Team – EMS Operations Specifics – Incident Communications – Weather – Hazards – Primary Triage Status – Destination Capability & Patient Distribution
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- 64. Triage Team & CasualtyStatus
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- 66. SUMMARY MCI’s require: • Changeof EMS provider’s approach – Single Pt. vs. Multiple Pts. • Applying limited resources effectively & timely – Incident & Time Management • Organizing, Coordinating & Communicating in EMS Operations • Accountability of resources & patients – Who is doing what & how many patients do you have • Appropriate distribution & destinations – Where are they going & why? • After Action – Lessons Learned & Review of Existing plans
- 67. From Triage toTreatment Areas Incident Triage Treatment Search & Rescue Triage Team(s) Urgent Immediate Morgue Delayed
- 68. From Treatment toDefinitive Care Treatment Transport Definitive Care Urgent Immediate Delayed Ambulances, Ambulettes, Buses, etc Ambulances Appropriate Facility H H H