This document discusses triage in trauma care. It begins by defining triage as sorting patients based on need to receive the right care at the right time. The goals of triage are to rapidly identify urgent cases and ensure treatment is timely and appropriate. Patients are assessed and assigned a priority level based on factors like vital signs, injuries, and pain level. Cultural considerations must also be taken into account. The document then describes the roles of various professionals involved in trauma situations and transport of patients to facilities that can provide the necessary care.

2. TRIAGE
PRESENTER: APARNA RAY
MODERATOR: DR. HARSHA JAIN

3. CONTENTS
 INTRODUCTION
 AIM OF THE TRAUMA CARE
 LEVEL-1 TRAUMA CENTRE
 PATIENT TRANSPORT MEANS
 PREHOSPITAL
 TRIAGE:
 AIM
 GOALS
 TYPES
 TRIAGE AQUITY SYSTEMS
 BASIC COMPONENTS OF TRIAGE
 CULTURAL VALUE CONSIDERATIONS
 DETERMINE PRIORITY OF PATIENT CARE AND TRANSPORT
 TRAUMA MANAGEMENT TEAM

4. INTRODUCTION

5. AIM OF THE
TRAUMA CARE

6. LEVEL-1 TRAUMA CENTRE

7. PATIENT TRANSPORT

8. ADVANCED LIFE SUPPORT
AMBULANCE

9. PREHOSPITAL
 AMBULANCE CREW
 PARAMEDICAL CREWS

10. POLAROID CAMERA
 USED FOR TAKING VISUSAL
PICTURE OF THE SCENE
CARRYING ENORMOUS VALUE IN
ASSISTING THE INDEX OF
SUSPICION OF INJURIES WHICH
MAY HAVE OCCURRED.
 THE PHOTOGRAPH COMES
ALONG WITH THE PATIENT.

11. TRIAGE
• Triage is the sorting of patients based in the need for treatment
and the available resources to provide that treatment.
• Triage is the term derived from the French verb trier meaning
‘to sort’ or ‘to choose’
• Aids in seamless trauma care

12. AIM
 It’s the process by which patients are classified according to
the type and urgency of their conditions to get the
Right patient to the
Right place at the
Right time with the
Right care provider
 To treat the patients in the order of their clinical urgency
appropriately and timely

13. GOALS
1. Rapidly identify patients with urgent life threatening conditions
2. Assess/ determine severity and acuity of the problem
3. Ensuring that the patients are being treated in order of clinical
emergency
4. Ensuring that the treatment is appropriate and timely
5. Reevaluating the patients who are who are in waiting area

14. • Provide continued assessment and
reassessment of arriving and waiting
patients.
• Provide information and referrals to
patients and families.

15. TYPES
(a) Multiple casualties
(b) Mass casualties

16. DISASTER
 Defined as an incident, either natural or human-made,
that produces patients in numbers needing services
beyond immediately available resources. May involve
a large no. of patients or a small no. of patients
requiring significant demand on resources.
 The key to successful disaster management is to
provide care to those who are in greatest need first.
Correct triage is essential to accomplish this goal.

17. BASIC COMPONENTS OF TRIAGE
An “across-the room” assessment -
1. Chief complaint
2. Brief triage history
3. Injury/ illness
4. General appearance
5. Vital signs

18. INITIAL ASSESSMENT OF THE PATIENT

19.  DEATH AT SCENE: Brain stem injury, airway obstruction, heart
of major vessel injury
 Early death: Airway obstruction, tension pneumothorax, cardiac
tamponade, fail chest, uncontrolled blood loss/hypovolemic shock
 Late deaths: Multiple organ failure, respiratory distress, sepsis
 KEEPING ALL THE FACTORS IN MIND DURING
ASSESSMENT TRANPORT OF PATIENTS SHOULD BE
DONE TO SAVE MAXIMUM NUMBER OF LIVES

20. SCORING SYSTEMS
Prehospital trauma scoring may be helpful in
determining which patients are to be transported to
trauma center

21. GLASGOW COMA SCALE

23. ANATOMIC FACTORS RELATED WITH
HIGH MORTALITY
 PENETRATION TRAUMA TO HEAD
 PENETRATION TRAUMA TO NECK
 PENETRATION TRAUMA TO GROIN
 PENETRATION TRAUMA TO THIGH
 FAIL CHEST
 TENSION PNEUMOTHORAX
 CARDIAC TAMPONADE
 MAJOR BURNS
 AMPUTATIONS

25. Are divided into 5 levels or categories depending on following
acuity determinants:

27. High-priority patients include those with any
of the following conditions:
 Difficulty breathing
 Poor general impression
 Unresponsive with no gag or cough reflex
 Severe chest pain
 Pale skin or other signs of poor perfusion
 Uncontrolled bleeding
 Responsive but unable to follow commands
 Severe pain in any area of the body
 Inability to move any part of the body

28. Transport decisions should be made at this
point, based on:
 Patient’s condition
 Availability of advanced care
 Distance of transport
 Provide rapid transport for pregnant patients who:
Have significant bleeding and pain
Are hypertensive
Have an altered mental status

29. DETERMINE PRIORITY OF PATIENT CARE
AND TRANSPORT
The Golden Period is the time from injury to definitive care.
 Aim to assess, stabilize, package, and begin transport within 10 minutes
(“Platinum 10”).
 Rapid scan assists in determining transport priority.

30. CULTURAL VALUE CONSIDERATIONS
 Some cultures may not permit a male health care
provider to assess or examine a female patient.
 Respect these differences and honor requests from
the patient.
 A competent, rational adult has the right to refuse all
or any part of your assessment or care.

31. PREPARATION AT RECEIVING HOSPITAL
Receiving hospital must be:
 Capable of receiving victims
 Fully equipped and staffed resuscitation room with comprehensive
back up of all necessary support teams such as radiology, blood bank,
ITU etc.
 Having an ideal trauma team comprising of specialist anesthetic,
surgical and orthopedic components in addition to accident and
emergency staff
 Having maxillofacial surgeons for the early identification and
providing optimal management of craniofacial trauma

32. TRAUMA MANAGEMENT TEAM

33. TRAUMA TEAM
 All the members should put on protective clothing
 All the members should be immunized against tetanus and hepatitis B
virus
 Staff who undress the patients should initially wear more robust gloves
 Team leader should brief the team and assign specific duties about
airway and circulation

34.  No more than six people should be touching the patient at a time
 A final check on the equipments should be made by an assigned
team member
 Once the patient arrives the resuscitation room the patient should
be transferred from stretcher to the trolley in a co-ordinated
fashion to avoid injury to the spinal column and then further
assessment and management should be provided

35. CONCLUSION

36. REFERENCES
 FONSECA (ORALAND MAXILLOFACIAL TRAUMA) VOLUME -1
 PETER WARD BOOTH( FACIAL TRAUMAAND ESTHETICS)
 DAVIDONS’S PRINCILPLES & PRACTICE OF MEDICINE