MassMultiple casualty Triage

PURPOSE: -

• The goal of the mass/multiple Casualty Triage protocol is to prepare for a unified, coordinated Incident Management System (IMS). The IMS can also be implemented successfully in large-scale incidents that require activation of the national emergency response plan.
• Successful management of any MCI depends upon the effective cooperation, organization, and planning among healthcare professionals, hospital administrators and out-of-hospital EMS agencies, local, and government representatives, and individuals and/or organizations associated with disaster-related support agencies.

DEFINITIONS:

Multiple Casualty Situations:

• The number of patients and the severity of the injuries do not exceed the ability of the provider to render care. Patients with life-threatening injuries are treated first. Mass Casualty Incidents.
• The number of patients and the severity of the injuries exceed the capability of the provider, and patients sustaining major injuries who have the greatest chance of survival with the least expenditure of time, equipment, supplies, and personnel are managed first.

GENERAL CONSIDERATIONS

Initial assessment to include the following:

• Location of incident.
• Type of incident.
• Any hazards.
• Approximate number of victims.
• Type of assistance required.

COMMUNICATION:

• Within the scope of a Mass Casualty Incident, the EMS provider may, within the limits of their scope of practice, perform necessary ALS procedures, that under normal circumstances would require a direct physician’s order.
• These procedures shall be the minimum necessary to prevent the loss of life or the critical deterioration of a patient’s condition.
• All procedures performed under this order shall be documented thoroughly.

TRIAGE

Utilize a triage system such as “START” (Simple Triage and Rapid Transport) to prioritize patients. START is based upon best evidence and designed to develop a national standard for mass casualty triage.

• Assess each patient as quickly and safely as possible.
• Conduct rapid assessment.
• Assign patients to broad categories based on need for treatment. (Remember: Triage is not treatment! Stopping to provide care to one patient will only delay care for others.) Standard triage care is only to correct airway and severe bleeding problems.

TRIAGE CATEGORIES

•  Immediate: Serious injuries, immediately life-threatening problems, high potential for survival (e.g., tension pneumothorax, exposure to nerve agent resulting in severe shortness of breath or seizures). Likely to survive given available resources. If no to any of the following: Has a peripheral pulse? Not in respiratory distress? Hemorrhage is controlled? Follows commands or makes purposeful movements?
•  Delayed: Serious (not minor) injuries requiring care but management can be delayed without increasing morbidity or mortality (e.g., long bone fractures, 40% BSA exposure to mustard gas). If yes to all of the following: Has a peripheral pulse? Not in respiratory distress? Hemorrhage is controlled? Follows commands or makes purposeful movements?
•  Minimal: Injuries require minor care or no care (e.g., abrasions, minor lacerations, nerve agent exposure with mild runny nose). If yes to all of the following: Has a peripheral pulse? Not in respiratory distress? Hemorrhage is controlled? Follows commands or makes purposeful movements?
•  Dead: Patient is not breathing after opening airway. (In children, if after giving 2 rescue breaths, if appropriate.) Deceased or casualties whose injuries are so severe that their chance of survival does not justify expenditure of limited resources. Tag patients to prevent re-triage. Do not move bodies unless they are hindering efforts to rescue live patients, or they are in danger of being further damaged, for example, burned by fire, building collapse, etc.

TAGGING SYSTEM

• Use water-repellent triage tags with waterproof markers and attach to the patient.
• Indicate patient’s triage priority, degree of decontamination performed, treatment and medications received.

TRIAGE IN HAZARDOUS MATERIAL INCIDENTS

Decontamination

The need for decontamination is the “first triage decision.” since decontamination can be a lengthy process; the “second decision” is which patient(s) are the first to be decontaminated. The “third decision” is based on need for treatment during the decontamination process, since only simple procedures such as antidote administration can be accomplished while wearing PPE.

Identification and Treatment

• Signs and symptoms of exposure will usually dictate the treatment required, however, at the earliest possible time, identification of the specific chemical should be made.
• Reference additional hazardous materials protocols as necessary.
• Request additional resources. Initial antidote and medical supplies may be limited to priority patients.
• Respiratory compromise is a leading factor of fatalities due to hazardous material exposure. Symptoms of chemical exposure may be delayed and occur suddenly. Constant reevaluation of respiratory status is necessary.

TRIAGE IN HAZARDOUS MATERIAL INCIDENTS

Decontamination

The need for decontamination is the “first triage decision.” since decontamination can be a lengthy process; the “second decision” is which patient(s) are the first to be decontaminated. The “third decision” is based on need for treatment during the decontamination process, since only simple procedures such as antidote administration can be accomplished while wearing PPE.

Identification and Treatment

• Signs and symptoms of exposure will usually dictate the treatment required, however, at the earliest possible time, identification of the specific chemical should be made.
• Reference additional hazardous materials protocols as necessary.
• Request additional resources. Initial antidote and medical supplies may be limited to priority patients.
• Respiratory compromise is a leading factor of fatalities due to hazardous material exposure. Symptoms of chemical exposure may be delayed and occur suddenly. Constant reevaluation of respiratory status is necessary.