Disaster and Field Triaging

Dr Selvendra

Disaster

• Incident that occurs in a sudden manner, complex in nature, resulting in the loss of lives, damages to the property or the environment as well as affecting the daily activities of the community

• Requires the handling of resources, equipment, and manpower from various agencies as well as effective coordination.

• Involves complex action, long period of duration

TYPES OF DISASTERS

• Natural disaster e.g. flood,landslide• Industrial disaster e.g. fire• Accidents of dangerous/hazardous material• Collapse of high rise buildings• Aviation accidents in public places• Railway accidents• Major fire incident• Collapse of hydroelectric dam• Nuclear and radiological accidents• Release of toxic gas in public places• Air and environmental disasters e.g. haze

Disaster management in Malaysia

• Majlis Keselamatan Negara Directive 20

• NSC formed Disaster Management and Relief Council

• Its aim is to coordinate disaster management at 3 levels – District, State, and Federal

Agencies Involved in Disaster

• PDRM• Tentera Diraja Malaysia• Special Malaysia Disaster Assistance and Rescue

Team (SMART)• Jabatan Kajicuaca• Jabatan Pengairan dan Saliran• Jabatan Kerja Raya• Jabatan Kebajikan• NGO e.g. PBSM, St. John Ambulance• JPAM• International cooperation

HIGHLAND TOWERS TRAGEDY 1993

TRIPLE TEN BUS ACCIDENT MAYHEM..

ON THE 10TH.10.10.. AT SIMPANG AMPAT, AYER KEROH, NORTH SOUTH HIGHWAY

THE GENTING TOURIST BUS ACCIDENT ~ THE GROUND ZERO

Tsunami 2004

                                                              

YET ANOTHER BUS ACCIDENT WITHIN ONE MONTH FOR GENTING BOUND PASSENGERS ~

sept 2013

Field Triage

Definition of Triage

• the process of deciding which patients should be treated first based on how sick or seriously injured they are.

Goal of Multicasualty Triage

“To do the best for the most

with the least.”

START(Simple Triage And Rapid Treatment)

Triaging < 15s

START• Triage categories:

– Green (ambulatory)– Red (immediate)– Yellow (delayed)– Black (dead or

nonsalvageable)

• Components of Assessment– Ambulation– Respirations– Perfusion– Mental status

START Triage

RESPIRATIONS

NO

YES

Non-salvageable

Immediate

Position Airway

NO YES

Over 30/min

Immediate

Under 30/min

PERFUSION

Radial PulseAbsent

ControlBleeding

Immediate

Radial Pulse Present

MENTALSTATUS

Failure to followsimple commands

Can followsimple commands

Immediate Delayed

JumpSTART

• For pediatric age group

• Reduce over and under triaging

• Achievable in 15s

The JumpSTART Field Pediatric Multicasualty Triage System ©(Patients aged 1- 8 years)

Black = Deceased/expectantRed = ImmediateYellow = DelayedGreen = Minor/Ambulatory

Identify and direct all ambulatory patients to designatedGreen area for secondary triage and treatment. Begin assessment of nonambulatory patients as you come to them.Proceed as below:

Spontaneous respirations?

NO

Open airway

Spontaneous respirations?

YES

IMMEDIATE

NO

DECEASED

YES

Peripheral pulse?

YES

Perform 15 sec.Mouth to MaskVentilations

Spontaneous respirations?

YES

IMMEDIATE

NO

DECEASED

NO

Check resp. rate

< 15/min or

> 40/minor irregular

IMMEDIATE

15 - 40/ min,regular

Peripheral pulse?

NO

IMMEDIATE

YES

Check mental status(AVPU)

AVP (appropriate)

DELAYED

P (inappropriate)U

IMMEDIATE

MINOR

© Lou Romig MD, FAAP, FACEP, 1995

JumpSTART: Breathing?

• If breathing spontaneously, go on to the next step, assessing respiratory rate.

• If apneic or with very irregular breathing, open the airway using standard positioning techniques.

• If positioning results in resumption of spontaneous respirations, tag the patient immediate and move on.

JumpSTART: Respiratory Rate• If respiratory rate is 15-40/min (roughly

one breath every 2-4 seconds), proceed to assess perfusion.

• If respiratory rate is <15 or >40/min (slower than one breath every four seconds or faster than one breath every 2 seconds) or irregular, tag patient as immediate and move on.

JumpSTART:Perfusion

• If peripheral pulse is palpable, proceed to assess mental status.

• If no peripheral pulse is present (in the least injured limb), tag patient immediate and move on.

JumpSTART: Mental Status• Use AVPU scale to assess mental status.

• If Alert, responsive to Verbal, or appropriately responsive to Pain, tag as delayed and move on.

• If inappropriately responsive to Pain or Unresponsive, tag as immediate and move on.

The “Jumpstart” Part If no breathing after airway opening, check

for peripheral pulse. If no pulse, tag patient deceased/nonsalvageable and move on.

If there is a peripheral pulse, give 15 sec of Mouth to Mask ventilations (about 5 breaths). If apnea persists, tag patient deceased/nonsalvageable and move on.

• If breathing resumes after the “jumpstart”, tag patient immediate and move on.

START/JumpSTART:Differences• Apneic children are rapidly assessed for

sustained circulation.

• Apneic children with circulation receive a brief ventilatory trial as an additional airway opening and stimulating maneuver.

• Respiratory rates are adjusted.

• Peripheral pulse is substituted for cap. refill. This is now done in START too.

• AVPU is used to assess mental status.