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TRIAGE SYSTEM ED m,alaysia wididjdljljpptx
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- 2. OUTLINE DEFINITION OBJECTIVESOF TRIAGE TYPES OF TRIAGE FIELD TRIAGE HOSPITAL TRIAGE CLASSIFICATION OF TRIAGE TRIAGE CATEGORIES LIMITATIONS OF TRIAGE
- 3. DEFINITION A Frenchword trier meaning ‘to separate, sort, shift or select’. Triage = establishing priorities of patient care for urgent treatment while allocating limited resources The sorting of patients according to their need for emergency treatment and evacuation.
- 4. PRINCIPLE GOAL OFTRIAGE TO DETERMINE WHO SHOULD BE SEEN FIRST
- 5. OBJECTIVES OF TRIAGE •RIGHT PATIENT • RIGHT PLACE • RIGHT TIME • RIGHT AND BEST TREATMENT OBJECTIVES
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- 7. FIELD TRIAGE HOSPITALTRIAGE Performed outside the hospital usually at the incident site. Two factors play an important role: i. The number of patients. ii. The severity of injuries of the patients. If (i) and (ii) do not exceed the capability of the facility & staff, patients with life-threatening problems are treated first. If not, patients with greater chance of survival are managed first. Sorting out patients according to the severity of injury and priority of treatment. Performed according to the hospital’s operation policy and depends on these factors: -Manpower and staffing -Availability of facilities -Zoning of the area (critical, semi- critical and non-critical)
- 8. FIELD TRIAGE DISASTER =EVENT THAT EXCEED THE CAPABILITIES OF THE RESOURCES • Save maximum number of victims • Prioritizing patients • Provide immediate critical care • Do no harm OBJECTIVES:
- 9. Why do wedo field triage? No of casualties overwhelm the healthcare provider Time constraint, limited personnel and resources Cannot possibly save everybody Standard systemic assessment Golden hour observe
- 10. Used with permission,Newport Beach Fire and Marine Dept. Used with permission, Lou E. Romig MD
- 11. START 1.Simple Triage AndRapid Treatment 2.Gold standard for field adult multiple casualty (MCI) triage in the US and numerous countries around the world 3.Utilizes the standard four triage categories 4.Used for primary triage
- 12. START Triage RESPIRATIONS NO YES Dead or Expectant Immediate Position Airway NOYES Over 30/min Immediate Under 30/min PERFUSION Cap refill > 2 sec Control Bleeding Immediate Cap refill < 2 sec. MENTA L STATUS Failure to follow simple commands Can follow simple commands Immediate Delayed Used with permission, Newport Beach Fire and Marine Dept.
- 13. START: Step 1 Triageofficer announces that all patients that can walk should get up and walk to a designated area for eventual secondary triage. All ambulatory patients are initially tagged as Green. START: Step 2 1. Triage officer assesses patients in the order in which they are encountered 2. Assess for presence or absence of spontaneous respirations 3. If breathing, move to Step 3 4. If apneic, open airway 5. If patient remains apneic, tag as Black 6. If patient starts breathing, tag as Red START: Step 3 1.Assess respiratory rate 2.If ≤30, proceed to Step 4 3.If 30, tag patient as Red
- 14. START: Step 4 1.Assess capillary refill 2.If ≤ 2 seconds, move to Step 5 3.3.If 2 seconds, tag as Red START: Step 5 4. Assess mental status 5. If able to obey commands, tag as Yellow 6. If unable to obey commands, tag as Red
- 15. Used with permission,Lou E. Romig MD
- 16. The “Jumpstart” Part If nobreathing after airway opening, check for peripheral pulse. If no pulse, tag patient deceased/ nonsalvageable and move on. If there is a peripheral pulse, give 5 mouth to barrier ventilations. If apnea persists, tag patient deceased/nonsalvageable and move on. 1. If breathing resumes after the “jumpstart”, tag patient immediate and move on.
- 17. HOSPITAL TRIAGE FACTORS CONTRIBUTING: •MANPOWER • AVAILABILITY OF THE FACILITIES • ZONING OF AREA • The triaging service counter shall be the first point of contact for all patients accessing the ETD care. • All patients presenting to ETD shall be triaged on arrival by a trained and experienced triageur(s). • The triage area shall occupy the frontage area of the ETD, be immediately visible and accessible to all categories of patients and modes of arrival. It shall also have the following functionalities and abilities:
- 18. The triagingservice counter shall be the first point of contact for all patients accessing the ETD care. All patients presenting to ETD shall be triaged on arrival by a trained and experienced triageur(s). The triage area shall occupy the frontage area of the ETD, be immediately visible and accessible to all categories of patients and modes of arrival. It shall also have the following functionalities and abilities:
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- 20. CLASSIFICATION OF TRIAGE PRIMARY TRIAGE • Proactive triage •Static triage SECONDARY TRIAGE • Vital signs • First aid • Initial treatment TERTIARY TRIAGE • Triage and rapid sequence examination done at various zone of patient management
- 21. PRIMARY TRIAGE Theprimary triage shall include the process of acquiring the main presenting complaints and rapid identification of patients with evident or potential life threatening or limb/ organ injuries or illness and/or high risk medical profile. Patients exhibiting the above shall be accorded a triage category of higher acuity immediately.
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- 23. ACROSS THE ROOM ASSESSMENT Toidentify obvious life threatening conditions GENERAL APPEARANCE AIRWAY BREATHING CIRCULATIO N DISABILITY
- 24. FIRST LOOK IMPRESSIONREQUIRED TACTILE SENSITIVTY LOOK LISTEN FEEL SMELL How patient arrive Stridor Pulse present Toxin General condition Gurgling sound Pulse volume Poisoning Bleeding In pain CRT Alcohol Muscle tone Peripheries cold and clammy Grimace Sweating Aggressive
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- 27. HOSPITAL TRIAGE RED CRITICAL SEEN IMMEDIATELY YELLOW HIGHRISK SEEN WITHIN 30MINUTES GREEN G1 REQUIRE MANY RESOURCES G2 REQUIRE MINIMAL RESOURCES G3 NON EMERGENCY
- 32. SECONDARY TRIAGE Allother patients shall be subjected to a secondary triage process which includes: vital sign, point-of-care testing and brief clinical assessment critical analysis of the above findings and integration before assigning or concluding a definitive triage category The secondary triage is a dynamic and continuous process that allows detection of changing illness or injury progression while waiting for the delivery of the care in lesser acuity areas of the department such as the waiting area of non critical zone.
- 33. TERTIARY TRIAGE Doneafter initial resuscitation and stabilisation following ETD triage. Done by specialist Goal: to optimise individual outcome To assess and allocate: - Which patient requires emergency surgery - Requires admission to ICU/specific ward - Can be discharged from their side
- 34. TRIAGE DURING COVID CRISIS SurveillanceTriage: to sort patients with risk of disease accordingly
- 36. LIMITATIONS OF TRIAGE OVERTRIAGEUNDERTRIAGE Prevent serious patient from getting appropriate care Burden of existing resources Delay in treatment
- 37. References: Emergency Medicineand Trauma Services Policy (2012) https://www.moh.gov.my/moh/images/gallery/ Polisi/EMTS_Book.pdf CDC-COVID-19: Triaging Sick Patients https://www.cdc.gov/coronavirus/2019-ncov/hcp/ non-us-settings/sop-triage-prevent-transmission.html Emergency Medicine | Jonathan Yeap
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