TRIAGE - Worshipful Society of Apothecaries · 2020-04-03 · •Who gets the urgent emergency...
Transcript of TRIAGE - Worshipful Society of Apothecaries · 2020-04-03 · •Who gets the urgent emergency...
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TRIAGE
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Wg Cdr Ankur Pandya
MBBS, MS, MCh(Plast), Dip.Nat.Board(Gen)(Plast), FRCS(Ed),
FRCS(G), Eur.Dip.Hand.Surg, FRCS(Plast), DMCC, O.St.J.,RAF
Consultant Plastic, Reconstructive & Hand Surgeon
Mountbatten Dept of Plastic & Reconstructive Surgery
Consultant Advisor in Plastic surgery to Head RAF Medical Services
Assoc Dean(S) Defence Deanery
Hon. Senior Clinical LecturerSouthampton Univ. School of Medicine
University of Portsmouth
Vounteer Operation Smile &
The Swinfen Trust
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Mass Disaster – Madrid
Bombing
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London Tower Fire
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London Bombings
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Bomb Blast
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Refugee camp in Yemen
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Ebola in the Congo
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ScreeningPatients on a humanitarian mission awaiting
surgery in Ethiopia
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What is common amongst all
these slides?
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Disaster
• All of these fulfill the definition of a
disaster
• “When any social,care or health system
is overwhelmed” by large numbers of
patients or casualties, either in terms of
• Capacity
• Infrastructure
• Expertise
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What is the most important
response when there has
been a disaster?
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Timely Response
Timely Aid
Targeted Aid
Do Maximum Good with what
is available, to maximum
people even at the expense of
some
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To Whom????
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This is the basis of Triage
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Considerations
• There should be no considerations in
Triage apart from the basic tenet of
doing as much good to those who need
it with what is available
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Considerations
• However there is the scope that being
humans we will bring in
• Human Factors
• Ethical Considerations
• In this equation
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This is wrong and has the
potential to do great harm
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Triage
• Triage, derived from the French verb
trier, and is the process by which
treatment and transport priorities are
allocated to patients
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Triage
• The aim of triage is to get the right
patients to the right care in the right way
at the right time
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Triage directed by a priority
system
P1 immediate/life saving
P2 within a few hours
P3 can wait
P4 (expectant or dead)
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Triage Systems
• Physiological
• Anatomical
• Both
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Triage Variants
• Resuscitation Triage
• Surgical Triage
• Transfer (Evacuation) Triage
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Triage
• Multiple casualties
• Mass casualties
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Personal factors in medical
management
• Fatigue / hunger / nutrition
• Emotional stress and disruption at work
• Situational awareness
• Teamworking (or lack of it)
• Multi-tasking when doing complex tasks
• Briefing/debriefing
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Ethics
These are the moral principles that
govern a person's behavior or the
conducting of an activity.
Ethics should be absolute
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Ethics
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However
• Ethics are influenced by the morality of
the times
• Religion
• Race
• Nationality
• Ethnicity
• Education
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Daily routine….
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Child Burns Afghanistan
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• She was two years old and beautiful
• 43 % burns
• Also inhalationl injury
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She was medically retired
• Pain relief..morphine drip
• Tube removed
• Passed away in 30 minutes
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Ethics or Triage
Military and the Taliban were the cause in
this war
Innocent bystander (Collateral Damage)
Ethical Responsibility versus Triage
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Ethics or Triage?
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Taliban father and son
• Father strapped son with explosives
• Loaded hand cart with explosives
• Later the son approached a check point
and the father remotely exploded the
device
• Taliban father also brought in along with
UK soldiers
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Daily routine….
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External fixators and the ICRC
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Ethics
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Ethics or Triage?
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Daily Triage
• Rounds in a hospital
• ITU beds
• Who to discharge
• Who gets the one appointment for an
urgent MRI scan
• Who gets the urgent emergency
surgical slot
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Medical Retirement
• Who to take off life support?
• Who to provide optimum treatment to?
• What is the interplay here between
human factors, ethics and triage??
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Who does one operate on?
• This old man?
• This young child?
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Never Too Old
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Which of these would you
operate upon first?
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Screening
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World Health Programme…….Screening
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In the Triage of a true disaster
pure triage systems need to
come into play for the
maximum good
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Human factors, ethics and
triage require to come
together with a human touch
in cold humanitarian triage
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Finally
• Civilian bombing
• 5 victims for a two capacity ambulance
• 1) Pregnant Lady
• 2) A Young immigrant youth
• 3) A poicewoan
• 4) The Bomber
• 5) A Child
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Thank You