This document provides an overview of triage in mass casualty incidents. It begins with definitions of terms like triage, medical disaster, and mass casualty incidents. It then outlines the basic principles of triage, including prioritizing those who can be helped most quickly. The document details the five triage categories from immediate/critical care to expectant/pending care. It also discusses triage tools like START/JumpSTART and considerations around tagging versus geographic sorting of patients. Success factors include pre-planning, appointing a triage officer, and following the KISS-U principle of keeping triage methods simple and understandable.
This document provides an overview of triage in mass casualty incidents. It begins with definitions of terms like triage, medical disaster, and mass casualty incidents. It then outlines the basic principles of triage, including prioritizing those who can be helped most quickly. The document details the five triage categories from immediate/critical care to expectant/pending care. It also discusses triage tools like START/JumpSTART and considerations around tagging versus geographic sorting of patients. Success factors include pre-planning, appointing a triage officer, and following the KISS-U principle of keeping triage methods simple and understandable.
This document provides an overview of triage in mass casualty incidents. It begins with definitions of terms like triage, medical disaster, and mass casualty incidents. It then outlines the basic principles of triage, including prioritizing those who can be helped most quickly. The document details the five triage categories from immediate/critical care to expectant/pending care. It also discusses triage tools like START/JumpSTART and considerations around tagging versus geographic sorting of patients. Success factors include pre-planning, appointing a triage officer, and following the KISS-U principle of keeping triage methods simple and understandable.
This document provides an overview of triage in mass casualty incidents. It begins with definitions of terms like triage, medical disaster, and mass casualty incidents. It then outlines the basic principles of triage, including prioritizing those who can be helped most quickly. The document details the five triage categories from immediate/critical care to expectant/pending care. It also discusses triage tools like START/JumpSTART and considerations around tagging versus geographic sorting of patients. Success factors include pre-planning, appointing a triage officer, and following the KISS-U principle of keeping triage methods simple and understandable.
Level II Delayed, Acute or Nonambulatory Care Serious but stable Delay of few hours: no impact Secondary degree of urgency Disposition: depends on patient condition vs. resources
II
II
Examples
Open thoracic wound
Penetrating Abdominal wound Severe eye injury Avascular limb Significant burns other than the face, neck or perineum Moderate bleeding Conscious patients with head injuries Anxiety states Multiple fractures
Level III Ambulatory or Primary Care Victims who do not require hospitalization Delay: no impact Much delayed degree of urgency Disposition: depends on space availability
III
III
Examples
Minor bleeding Minor soft tissue injuries Contusions, sprains Superficial burns Partial-thickness burns of <20% BSA
Level IV
Expectant or Pending Care
Dead and Dying Delay: no impact Much delayed degree of urgency Disposition: custodial care
IV
IV
When to Classify a Victim as
Dead and Dying? Know Disaster Response Level 1: < 2 hours 2: 2-12 hours 3: 12-24 hours 4: >24 hours
IV
< 2 Hours (Disaster Response Level I) Advanced neurological deficits (GCS<8) Injuries to the torso and a BP of < 50 mmHg systolic and below despite initial resuscitation Massive burns (>85% BSA)
IV
2 - 12 Hours (Disaster Response Level II) Disaster Response Level 1 victims Deteriorating neurovital signs Second or third degree burns involving more than 50% of total BSA
IV
12 - 24 Hours (Disaster Response Level III) Disaster Response Level 2 victims Those requiring formal surgical care Those requiring prolonged life support in an intensive care unit
IV
24 Hours (Disaster Response Level IV) Triage Level I victims
Level V
No Care Unaffected persons Delay: no impact No degree of urgency Disposition: Safe evacuation
Examples
Evacuees Relatives of victims Onlookers Press
Color Coding Triage Category
Color Code
Level I
Red
Level II
Yellow
Level III
Green
Level IV
Black
Level V
White
TRIAGE TOOLS
Casualty Scene SAFE AREA OUTER PERIMETER
INNER PERIMETER HELICOPTER LANDING ZONE
PRIMARY COLLECTION POINT
1 SCENE COMMAND CENTER
WIND DIRECTION
STAGING AREA
TEMPORARY MORGUE
2 HOSPITALS
EVACUATION CENTER
SECONDARY COLLECTION POINT
EOC
PRIMARY
SECONDARY
TERTIARY
SITE
Inner Perimeter
Outer Perimeter/Safe Outer Perimeter/Safe
GOAL
Basic Disaster Life Support or M.A.S.S. Triage
Patient needs vs.
available resources
TOOLS
Available
None. More complex and demand more
sophisticated resources
RECOMMEMDATIONS
START / JumpSTART
Common Sense and Experience
VALIDATION
No MCI primary triage tool has been validated by outcome data.
Not applicable
IMPLEMENTATION SYSTEM
Tagging
Geographical Sorting
Optimize Individual outcome
Geographical Sorting
S.T.A.R.T. Simple Triage And Rapid Treatment
START Triage All ambulatory patients are initially tagged as Green.
RESPIRATIONS NO
Over 30/min
Position Airway NO Dead or Expectant
Under 30/min
YES
YES Immediate
Immediate
PERFUSION Cap refill > 2 sec Control Bleeding Immediate
Cap refill < 2 sec.
MENTAL STATUS
Failure to follow simple commands
Can follow simple commands
Immediate
Delayed
Mnemonic
R P M
30 2 Can do
JumpSTART Triage
Special Considerations
AGE: If a victim appears to be a child, use JumpSTART. If a victim
appears to be a young adult, use START.
NON-AMBULATORY CHILDREN: Evaluate using the JS algorithm If any RED criteria is satisfied, tag as RED. If patient satisfies any YELLOW criteria: YELLOW if significant external signs of injury are found (i.e., deep penetrating wounds, severe bleeding, severe burns, amputations, distended tender abdomen) GREEN if no significant external injury
Initial patient assessment and treatment should take less than 30
