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Start triage-training-presentation
- 1. Disaster Triage START/JUMPSTART Finger LakesRegional TrainingFinger Lakes Regional Training CenterCenter Kathee Tyo, MS, RNKathee Tyo, MS, RN Coordinator/EducatorCoordinator/Educator
- 2. Objectives: Define aMass Casualty Incident and the unique challenges of an MCI Understand the differences between day- to-day triage and triage during an MCI Increase the region’s healthcare providers’ awareness of disaster triage
- 3. What is theGoal of MCI Management?
- 4. GOAL: TO SAVE THELARGEST NUMBER OF SURVIVORS FROM A MULTIPLE CASUALTY INCIDENT
- 5.
- 6. Considerations During anMCI Response Supply vs. Demand Resource Allocation Coordination Medical Management Ethics
- 7.
- 8. What Could Bean MCI For You? Transportation Accident Fire Hospital Overloading Hospital Evacuation February 2008: 390 Pile Up January 2005: 390 Bus Accident
- 9. What Could Bean MCI For You?What Could Be an MCI For You? Sporting EventSporting Event Hazmat IncidentHazmat Incident Loss of PowerLoss of Power Severe WeatherSevere Weather Watkins Glen Speedway
- 10. Managing Hospital Incidents Would any of those situations lead to shortage of personnel & equipment resources? Would decisions and changes need to be made in how you do business? Altered Standards of Care
- 11. Incident Command System EmergencyDept. TreatmentTriage Transport Immediate Delayed Minimal Expectant
- 12.
- 13. Types of Triage Primary On scene prior to movement or at hospital (self transports) Secondary Incident dependent, probably prior to or during transport or upon arrival to hospital
- 14.
- 15. Triage Coding Immediate 1 Urgent 2 Delayed 3 Dead 0 RED Yellow Green Black ColorColorPriorityTreatmentPriority Treatment
- 16.
- 17. Primary Triage The firstattempt at balancing resources and casualties/injured
- 18. PRIORITY 3 Notinjured or “Walking wounded” Have motor, respiratory, mental function DELAYEDDELAYED
- 19. Example Patient walks overto you and has an obvious broken arm Respirations are 22 Pulse is 124 (Radial) He is awake, alert, and crying
- 20. Primary TriagePrimary Triage Determiningwhether there is an airway and breathing
- 21. Primary TriagePrimary Triage Ifbreathing, at what rate & is it good enough?
- 22. Primary TriagePrimary Triage Theyhave an airway, are breathing. Are they circulating blood sufficiently?
- 23.
- 24.
- 25. PRIORITY 1 Immediate • Openingairway, starts to breatheOpening airway, starts to breathe • Breathing is greater than 30 or less than 10Breathing is greater than 30 or less than 10 • Delayed capillary refill time (> 2 seconds)Delayed capillary refill time (> 2 seconds) • Absent radial pulsesAbsent radial pulses • Bleeding that needs to be controlledBleeding that needs to be controlled • Does not follow instructionsDoes not follow instructions
- 26. Example Patient has anopen head Wound, bleeding controlled Respirations are 16 Pulse is 88 (Radial) He is unconscious
- 27. PRIORITY 2 Urgent • Didnot move out, when askedDid not move out, when asked • Airway OKAirway OK • Breathing within 11 and 29Breathing within 11 and 29 • Capillary refill less than 2 seconds or radial pulses presentCapillary refill less than 2 seconds or radial pulses present • Can follow instructions to move unaffected limbCan follow instructions to move unaffected limb
- 28. Example Patient states hecan’t move or feel his legs Respirations are 26 Pulse is 110 (Radial) He is awake and oriented
- 29. EXPECTANT/DEAD Still requireresources Focus of care is comfort Psychologically most challenging for healthcare providers
- 30. Examples Patient gurgles butcan’t maintain an open airway and Is not breathing Weak Carotid Pulse She is unresponsive
- 31. Secondary Triage Generallyused when there is an extended duration event After initial color coding triage Healthcare professionals who respond to the scene or PH/Hospital response teams may be utilized to further determine who gets transported from scene first
- 32.
- 33. PediatricPediatric TriageTriage •Children areinvolved in mass 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
- 34.
- 35. SMART Tag TriageSystem
- 36. SMART Triage PackContents Dynamic Tags (20) Dead Tags (10) Pencils Cylume Sticks Patient Count Card/Protocol SMART Pediatric Tape
- 37. When Patients Arriveat Your Door Transition from the EMS patient to hospital patient Dealing with self presenting patients
- 38. Transportation Distribution Patient transport- Oklahoma BombingPatient transport - Oklahoma Bombing Private carEMS On foot Other Injury prevention database, OK Dept of Health Patient Transport - 29 US DisastersPatient Transport - 29 US Disasters EMS Private car Police Other On foot Bus Taxi Quarantelli, Delivery of Emergency Services in Disasters, Assumptions and Realities
- 39. ””As bad asthe scene was 20 minutesAs bad as the scene was 20 minutes after the blast, it only got worse.after the blast, it only got worse. Patients who could self-evacuatePatients who could self-evacuate generally had relatively minorgenerally had relatively minor injuries. They arrived on foot, byinjuries. They arrived on foot, by taxi and by motorcycle, and theytaxi and by motorcycle, and they were treated as they came in”.were treated as they came in”. ““But then the ambulances started toBut then the ambulances started to arrive with the most serious patientsarrive with the most serious patients —the burn victims”.—the burn victims”. ““By then, though, theBy then, though, the operating rooms wereoperating rooms were completely full. They had tocompletely full. They had to wait”.wait”. Dr. Tjakra WibawaDr. Tjakra Wibawa Sanglah Trauma CenterSanglah Trauma Center BALI NIGHT CLUB BOMBING October 12, 2002
- 40.
- 41. Scenario #1 An improvisedexplosive device is detonated at a large outdoor sporting event. At least 50 people are confirmed injured. EMS is on scene, but patients begin to arrive at your hospital before EMS. Triage and “Tag” the following patients.
- 42.
- 43.
- 44. Patient #2 Eviscerated bowel Multiplepenetrating wounds to chest & head Brain matter exposed Unresponsive to tactile stimuli
- 45. Patient #2 Eviscerated bowel Multiplepenetrating wounds to chest & head Brain matter exposed Unresponsive to tactile stimuli
- 46. Patient #3 Abd. Tendernessand minor penetrating trauma Ambulating A & O x 3 RR 24 Strong radial pulse
- 47. Patient #3 Abd. Tendernessand minor penetrating trauma Ambulating A & O x 3 RR 24 Strong radial pulse
- 48. Patient #4 Multiple penetrating injuries,blood in ears Responds only to pain Airway clear RR 20 Strong Radial pulse
- 49. Patient #4 Multiple penetrating injuries,blood in ears Responds only to pain Airway clear RR 20 Strong Radial pulse
- 50. Patient #5 Extremity fractures, bloodin ears A & O x 3 RR 26 Strong radial pulse
- 51. Patient #5 Extremity fractures, bloodin ears A & O x 3 RR 26 Strong radial pulse
- 52. Patient #6 Child, screaming Minorlacs, blood in ears RR 30 Moving all extremities
- 53. Patient #6 Child, screaming Minorlacs, blood in ears RR 30 Moving all extremities
- 54. Patient #7 Amputated fingers, headinjury A & O x 3 Dizzy RR 24 Smells like beer
- 55. Patient #7 Amputated fingers, headinjury A & O x 3 Dizzy RR 24 Smells like beer
- 56. Patient #8 Chest pain,SOB No trauma noted RR 34 Shallow Weak radial pulse
- 57. Patient #8 Chest pain,SOB No trauma noted RR 34 Shallow Weak radial pulse
- 58. Patient #9 Blood innose, mouth and ears Not breathing
- 59. Patient #9 Blood innose, mouth and ears Not breathing What would you do?
- 60. Patient #9 Blood innose, mouth and ears Not breathing RR 10 with manual opening
- 61. Patient #10 Some penetrating trauma Unresponsive Apneic Noradial pulse Carotid 130/min
- 62. Patient #10 Some penetrating trauma Unresponsive Apneic Noradial pulse Carotid 130/min
- 63. Patient #11 Arterial bleedfrom leg Responsive to pain RR 34 No radial pulse Carotid 130/min
- 64. Patient #11 Arterial bleedfrom leg Responsive to pain RR 34 No radial pulse Carotid 130/min
- 65.
- 66.
- 67. Patient #13 Deviate trachea RR40 Weak radial pulse +JVD Cyanosis
- 68. Patient #13 Deviate trachea RR40 Weak radial pulse +JVD Cyanosis
- 69. Patient #14 Open fractureof RUE Non-ambulatory A & O x 3 RR 26 Strong radial pulse
- 70. Patient #14 Open fractureof RUE Non-ambulatory A & O x 3 RR 26 Strong radial pulse
- 71. Patient #15 100% TBSburns (partial and full) A & O x 2 RR 36 Coughing Strong radial pulse
- 72. Patient #15 100% TBSburns (partial and full) A & O x 2 RR 36 Coughing Strong radial pulse
- 73. Patient #16 CP, SOB Slurredspeech R sided weakness A & O x 1 RR 24 Strong radial pulse
- 74. Patient #16 CP, SOB Slurredspeech R sided weakness A & O x 1 RR 24 Strong radial pulse
- 75. Patient #17 Avulsion RUE Arterialbleed A & O x 2 RR 30 “I’m thirsty”
- 76. Patient #17 Avulsion RUE Arterialbleed A & O x 2 RR 30 “I’m thirsty”
- 77. Patient #18 Open fracturesBLE Blood in ears A & O x 3 RR 28 Strong radial pulse
- 78. Patient #18 Open fracturesBLE Blood in ears A & O x 3 RR 28 Strong radial pulse
- 79. Patient #19 Hysterical, screaming Blood inears A & O x 3 RR 36 Strong radial pulse
- 80. Patient #19 Hysterical, screaming Blood inears A & O x 3 RR 36 Strong radial pulse
- 81. Patient #20 Child Cyanotic fromnipple line up Apneic
- 82. Patient #20 Child Cyanotic fromnipple line up Apneic
- 83. Increase familiarity/proficiencyof the START and Jump START triage methodologies Increase familiarity with the SMART Tag Triage System Train with a standardized methodology and system What is the goal of Disaster Triage training?
- 84.
- 85. Thank You! Kathee Tyo,MS, RNKathee Tyo, MS, RN 585-758-7640585-758-7640 Kathee_tyo@urmc.rochester.eduKathee_tyo@urmc.rochester.edu