Chapter 28

Triage

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Chapter 28: Triage

• Explain the purpose, use, and benefits of the triage process.

• Describe the four-colored categories used in primary triage.

• Summarize the four steps of the START system for triage.

• Describe methods of identifying triage categories.

Objectives (1 of 2)

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Chapter 28: Triage

• Describe the sequence of emergency care for a single patient with multiple injuries.

• Given a scenario of a mass-casualty incident, perform triage correctly using the START algorithm.

Objectives (2 of 2)

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Chapter 28: Triage

Triage• Assessment of multiple injured patients• Multiple-casualty/mass-casualty incident

(MCI) refers to a situation with more than one patient.

• Incidents may overtax resources. • Safety is your primary concern!• Situations could include avalanche, lift

accident, vehicle crash, earthquake, terrorist attack, etc.

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Chapter 28: Triage

The Triage Process

• Sorting two or more patients to provide the best outcome for the greatest number

– Patients ranked by severity

– Patients marked to reflect ranking

• Triage officer assigns rescuers and equipment to priority patients.

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Chapter 28: Triage

Remote Locations• In remote locations, triage may

require modification due to:– Manpower– Weather– Equipment – Communications– Terrain, including distance from

definitive care

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Chapter 28: Triage

5 S’s of Triage 1. Safety assessment—scene safety 2. Scene size-up—MOI, patients,

injuries, access 3. Send—information to dispatcher and

request resources 4. Setting up scene—establish triage

points and obtain tags or ribbon5. START—a type of triage process

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Chapter 28: Triage

Triage Priorities: Red(Four-Color System)

• Highest or first priority, usually injuries to the circulatory or respiratory system

• Probable survival with immediate care and transport.

• Usually includes:

– Hypoxia or shock, present or imminent

– Major external or internal hemorrhage

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Chapter 28: Triage

Triage Priorities: Red(Four-Color System)

• Respiratory distress due to flail chest, sucking chest wound, pneumothorax, upper airway obstruction, or burns

• Pericardial tamponade • Head injuries with progressive

deterioration, altered mental status • Medical emergencies such as AMI,

poisoning, diabetic hypoglycemia

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Chapter 28: Triage

Triage Priorities: Yellow(Four-Color System)

• Second or delayed priority, usually with musculoskeletal or nervous system injuries

• Able to survive a wait of 45 minutes or longer

• Lesser chance of survival than RED

• Greater need of resources than RED

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Chapter 28: Triage

Triage Priorities: Yellow(Four-Color System)

• Usually includes:

– Severe burns without respiratory distress

– Spinal injuries

– Multiple fractures

– Pelvic or femur fractures without shock

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Chapter 28: Triage

Triage Priorities: Yellow(Four-Color System)

• Usually includes:

– Open fractures

– Stable abdominal injuries, including open injuries without shock

– Eye injuries

– Stable head or chest injuries

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Chapter 28: Triage

Triage Priorities: Green(Four-Color System)

• Third or lowest priority, usually “walking wounded” or with no life-threatening injuries

• Uninjured and present at an MCI scene

• Usually includes patients with minor burns

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Chapter 28: Triage

Triage Priorities: Green(Four-Color System)

• Usually includes:

– Single, closed fractures

– Localized soft-tissue injuries

– Psychological problems

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Chapter 28: Triage

Triage Priorities: Black(Four-Color System)

• Nonsalvageable patients, dead patients, patients who will die even with care

• Usually includes: –Cardiac arrest –Respiratory arrest with an open airway –Massive head, chest, or abdomen

injuries –Total body burns (>90%)

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Chapter 28: Triage

Triage Tags• Rolls of red, yellow,

green, and black surveyor’s ribbon

• Preprinted tags with tear-off sections

• Tape with color initial affixed to forehead

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Chapter 28: Triage

The START System

• Simple Triage And Rapid Treatment• Begins by having all “walking wounded”

move outside triage area to safety • Based on a 15- to 30-second assessment

of each remaining patient• Assesses “RPM”—respirations, pulse, and

mental status. • Tracks the total numbers of patients.

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Chapter 28: Triage

The START system• Step 1

– Get up and walk GREEN

• Step 2 – Open airway and

assess respirations 0/min =

BLACK > 30/min = RED < 30/min = Step 3

• Step 3 – Radial pulse check – Absent = RED – Control bleeding – Present = Step 4

• Step 4 – Assess mental status – Altered = RED – Appropriate =

YELLOW/GREEN

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Chapter 28: Triage

Secondary Triage • Move patients from a triage area to

treatment area for care and transport.• Reassess all RED patients to allocate

limited resources and personnel. • Recategorize patients as status

changes (ie, YELLOW to RED or RED to BLACK).

• Triage tags can be used to record patient information.

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Chapter 28: Triage

Triage Tags

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Chapter 28: Triage

Special Triage Situations• Injured rescuer

• Injured relative

• Injured child

• Disruptive patient or witness

• Lightning

• Hypothermia

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Chapter 28: Triage

Patients with Multiple Injuries• Golden Hour—the time from injury to definitive

care during which treatment should occur to maximize survival

• Use assessment to prioritize treatment.

• Maintain airway, support ventilations with O2, control hemorrhage, place on backboard, treat shock, and arrange timely transport.

• Seamless interface with local ALS is essential.