LECTURER: SIR ABANG
BSN 4 | SEC. SEM | BATCH 2022 | TOPIC: DISASTER TRIAGE & MANAGEMENT
DISASTER TRIAGE AND MANAGEMENT
Learning Outcomes
1. Define triage
2. Describe the differences between daily hospital
triage, multiple or mass casualty incident (MCI)/
disaster triage, and population-based triage.
3. Understand the situations in which each model of
disaster triage is used.
4. Discuss how objective disaster triage tools are
beneficial not only to the victims themselves but also
to those tasked with performing triage.
5. Explain the criteria for each of the five basic primary
disaster triage levels.
6. Describe the different styles of disaster leadership
and when to use each one.
7. Describe the five phases of disaster management.
8. Implement the hospital incident command system
during disaster management.
9. Discuss the role of interagency coordination and
collaboration during disaster planning and response.
DISASTER TRIAGE
Triage means a process to place the patient on the right place,
right time, right level of care. The word triage is derived from a
French word “trier” which means to sort or to choose to form
the most important patient.
RIGHTS
1. Right patient - triage is basically a process of
prioritizing which patients are to be treated first and
is the cornerstone of disaster and management in
terms of judicious use of medical resources.
2. Right place
3. Right time
4. Right level of care
It is believed that disaster triage will always be difficult and a
daunting task. Previous triage experience in the emergency
department is an excellent preparation for disaster triage.
BIRKEL (1984) IDENTIFIED A VARIETY OF PERSONAL ABILITIES THAT
ARE ESSENTIAL TO BE A TRIAGE OFFICER DURING A DISASTER:
 Clinically experienced
o It is important to have experience in the
clinical area before becoming a triage
nurse/personnel
 Good judgement and leadership
 Calm and cool under stress
o Have a good coping mechanism
 Decisive
o Make decisions in a very short amount of
time
 Knowledgeable of available resources
o Important to be knowledgeable on where
to locate the resources and how to get the
resources needed
 Sense of humor
 Creative problem solver
o Must have an innovative mind and
resourceful in making sure that resources
are being given.
 Available
NOREEZA, PRILUNGS & PIATHEBAKER
 Experienced and knowledgeable regarding
anticipated casualties.
o As a triage nurse you need to be
experienced enough when it comes to how
to anticipate possibilities of presence of
surge of casualties in the unit.
PHILOSOPHIES OF DIFFERENT TYPES OF ACUTE MEDICAL TRIAGE
1. Daily triage
o Performed by nurses in ED on a routine basis
o Often utilizing a standardized approach
augmented by clinical judgement.
o GOAL: to identify the sickest patient to
assess and to be treat first before providing
treatment to others who are less ill.
2. Incident triage
o Occurs when the ED has a large number of
patients due to acute incident or outgoing
medical crisis. (e.g., COVID-19 pandemic)
o But still be able to provide care for all the
patients utilizing existing agency resources
3. Disaster triage
o A general term employed when a local
emergency medical system and hospital
emergency services are overwhelmed to
the point that immediate care cannot be
provided
o Sufficient resources are not immediately
available,
o MulticausaltY / multiple casualty / mass
casualty triage (MCI)
DURING A DISASTER, PATIENTS ARE USUALLY SORTED INTO ONE
OF THE FOLLOWING CATEGORIES:
1. Minimal or minor (Green)
o patients who are physiologically well
compensated and likely to remained well
for an extended period of time
o require only basic immediate care and
probably wait for a considerable period of
time w/ minimal risk of deterioration.
o E.g., minor lacerations
2. Delayed (Yellow
o patients with compensated physiology but
are potential for deterioration and morbidity
if there are long delays before care can be
provided
o E.g., stable pxs w/ possible spine or head
injury, significant bleeding, acute
neurologic deficits, orthopedic injuries w/
signs of neurovascular compromised
3. Immediate (Red)
o Patients with uncompensated physiology
and injuries that are life-threatening but
probably amenable to rapid interventions
that do not require consumptions of an
inordinate amount of resources
o E.g., pxs w/ poorly controlled external
bleeding, moderate burns, penetrating
trauma.
4. Deceased (Black)
o Patients with no detectable vital signs
o Typically identified as victims not breathing
on their own.
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BSN 4 | SEC. SEM | BATCH 2022 |
o In everyday practice setting, resuscitation
will be attempted but in disaster situation,
simple designate the victim as dead
5. Expectant (Gray)
o Still alive but due to their injuries and/or
medical conditions are unlikely to survive
with available resources.
o E.g., exposure events with vomiting and
diarrhea soon after exposure
o GI symptoms are lethal signs of radiation
poisoning.
FIVE POPULATION-BASED TRIAGE CATEGORIES (SEIRV
CLASSFICATIONS)
It is important to take in consideration exposure of induvial to
contamination to infectious disease. Containment strategies
such as: Isolation, social distancing and quarantine are the first
line of management under state public health law. And in this
model, every population falls in to one of the five population-
based triage categories.
A. Susceptible individuals
o Individuals that are unexposed but are
susceptible
B. Exposed individuals
o Susceptible individuals who have been in
contact with the disease and may be
infected and incubating but still
noncontagious
C. Infectious individuals
o Persons who are symptomatic and
contagious
D. Removed individuals
o Persons who no longer can pass the disease
to others because they have survived and
have developed immunity from that illness.
E. Vaccinated or on prophylactic antibiotics
o Individuals that are critical source for the
essential workforce
PHASES OF DIASTER TRIAGE
1. Primary triage
o Similar to trauma primary survey in which
physiology is the focus rather than
identification of specific injuries.
o Sort patients into categories
2. Secondary triage
o Or called as second patient assessment
o May be performed on scene if transport is
delayed for any reason or the hospital itself
o Through physical assessment
o Each patient information is obtained
through more thorough physical assessment
and history when there is a need.
3. Tertiary triage
o Resources are overwhelmed
o Hospital personnel’s determine if what
facility can provide appropriate care or if
the px will require stabilization and transfer
to facility capable of higher level of care.
NOREEZA, PRILUNGS & PIATHEBAKER
LECTURER: SIR ABANG
TOPIC: DISASTER TRIAGE & MANAGEMENT
HOSPITAL TRIAGE CATEGORIES
I. Three-tier system - classify patients based on
emergent need
1. Emergent (Class 1)
­ a condition that requires
immediate attention within 15-30
minutes
­ e.g., respiratory distress, cardiac
arrest, airway obstruction
2. Urgent (Class 2)
­ Patient w/serious illness that must
attended to as soon as possible
but can wait up to 2 hours.
­ E.g., bone fracture, bleeding-
controlled w/pressure dressings,
acute psychiatric problems
3. Non-urgent (Class 3)
­ Patients who can wait for >2hrs to
be seen without the likelihood of
deterioration.
­ E.g., minor lacerations, throat pain,
rash
NOTE: Time element is important
II. Four-tier system – identify those conditions that must
be treated immediately
1. Emergent (Class 1A)
­ Requiring immediate treatment
­ E.g., cardiac arrest, respiratory
failure, airway obstruction
2. Emergent (Class 1B)
­ Treatment within few minutes
­ E.g., moderate-severe respiratory
distress, cardiac dysrhythmias,
heavy bleeding w/o hypotension
or tachycardia
3. Urgent (Class 2) up to 2 hrs
- same with 3-tier system
4. Non-urgent Emergency Department Care
(Class 3) up to > 2 hrs
- same with 3-tier system
III. Five-tier system
1. Emergent (Class 1A)
­ Requiring immediate treatment
­ E.g., cardiac arrest, respiratory
failure, airway obstruction
2. Emergent (Class 1B)
­ Treatment within few minutes
­ E.g., moderate-severe respiratory
distress, cardiac dysrhythmias,
heavy bleeding w/o hypotension
or tachycardia
3. Urgent (Class 2)
- same with 3-tier system
4. Non-urgent Emergency Department Care
(Class 3)
- same with 3-tier system
- Involves condition that are non-
acute but require technology of
the emergency department to
diagnose or treat the condition
5. Non-urgent Ambulatory Care (Class 4)
- Used to classify conditions that are
non-urgent in nature and can
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BSN 4 | SEC. SEM | BATCH 2022 |
routinely be provided in the
ambulatory care setting
- Example: medication refills, sutures
or staples removal, or there’s a
chronic condition that are stable
such as pre-existing skin rashes
TRIAGE TEAM
 Emergency physician
o Triage officer
o Responsible for the tagging and coding of
the patient
 Emergency nurse 1
o Evaluates the patients
o Evaluate the patient and reports findings to
the officer and at the same time she
supervises the clerk, nursing aid and also the
transporter
 Emergency nurse 2
o Records assessment
o Records all assessment especially done in
the secondary triage
 Nurse’s aide/clerk
o Applies identification
o Responsible in applying pre-numbered
identification band for the tagging of the
patient
 Transporter
o Moves patient to assigned areas
o Moves patient from triage to assigned areas
in the emergency department
PRIMARY TRIAGE TOOLS
 These tools are used especially when we are going to
intervene our patients
 SALT (Sort-Assess-Lifesaving Interventions-Treatment)
 START (Simple Triage and Rapid Treatment)
o Focus on sort, assess, lifesaving interventions
and treatment
o The model of SALT triage
o Here, a CDC sponsored expert panel
developed this SALT triage and it is actually
non-propriety and meets the modeled
uniform core criteria for mass triage
o Begins with the first step, SORT, which
includes sorting whether the patient can
walk, have purposeful movement, or
whether the patient has obvious life-
threatening condition that would have to
be assessed first
NOREEZA, PRILUNGS & PIATHEBAKER
LECTURER: SIR ABANG
TOPIC: DISASTER TRIAGE & MANAGEMENT
o Second step will be the individual
ASSESSMENT, so you need to take into
consideration here if there’s a need for you
to control hemorrhage, whether there’s
breathing, if yes then that would be
minimal and in terms of breathing if it is a no,
you proceed with “dead”
 If the patient cannot obey
commands if no, then label as
likely to survive given current
resources then that’s gonna be a
yes and if no, then it is actually
“expectant”
o If you are talking about SALT triage, this
covers priority for treatment and transport.
Once any life saving intervention are
performed, the responders should evaluate
the patient and prioritize him for treatment
and transport.
o We consider these classifications:
 dead those who are not breathing
even if life saving interventions
were attempted
 immediate these are patient with
difficulty breathing, uncontrolled
hemorrhage, absence of
peripheral pulses and or inability to
follow commands who are likely to
survive given the available
resources
 expectant these are patient with
difficulty breathing, uncontrolled
hemorrhage, absence of
peripheral pulses and also or
inability to follow commands who
are unlikely to survive given the
available resources
 delayed these are patients who
are alert and follow commands,
have palpable peripheral pulses,
no signs of respiratory distress or
bleeding is controlled, with injuries
or illness that is classified by the
rescuer as more than minor
 minimal those are the patient
whoa re alert and follow
commands, have peripheral
pulses, no signs of respiratory
distress and bleeding is controlled
with injuries that with the opinion of
the rescuer are considered to be
minor
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 LECTURER: SIR ABANG
BSN 4 | SEC. SEM | BATCH 2022 | TOPIC: DISASTER TRIAGE & MANAGEMENT
o A tool that is commonly used in adult MCI
primary triage that’s developed in
California and it was a device used only for
adults with arbitrary lower application limit
of a patient weighs 100 lbs.
o According to your START triage, you have to
base your assessment on the following
classifications:
 Respiratory rate
 Capillary Refill
 Mental status
o You have your respirations, perfusions, and
also your mental status
o So we are classifying the patient whether
urgent, emergent, expectant, or minor o You can also include your simple triage and
 Emergent, if RR is more than 30, rapid treatment
capillary refill is > 2 seconds, and Examples of disaster tags:
mental status does not obey
commands. Therefore, the px has
to be tagged as red
 if the patient is tagged yellow, the
RR is <30, the capillary refill is <2
seconds, and mental status shows
patient can obey commands
 for expectant, that would be
colored black, that is expected to
be dead or dying when
respirations or not breathing after
jaw thrust
 Green, this is specific for minor, the
o These triage tags are very important because this will
patient is able to walk
be of help especially when communicating the color
o The indicator included here are respiration,
coding of this patient
perfusion, and mental status
o When you talk about triage tags, it has to contain the
 JUMPSTART (Pediatric MCI Tool)
name, address, hospital treatment, whether the color
is black, red, yellow or green. These are examples of
typical color bands with perforated color bars which
can help in tagging the patient based on its
classification.

DISASTER MANAGEMENT
o This is a review of the phases of disaster
o If we are taking into consideration the disaster
management, we need to make sure that we are
knowledgeable about classifications of disaster.
When we say classification of disaster it means that
we are trying to provide a technical distinction
among types of disasters may have little meaning to
individuals attempting to respond to a sudden surge
in patient, collapse of infrastructures, or overlap of
criminal behavior in a deliberately caused disaster
that might actually be useful for thinking about
strategic and contingency plan
o This is specific for pediatric MCI tool
o This evaluates infants in the first and CLASSFICATIONS OF DISASTER
secondary triage using the entire 1. INTERNAL DISASTER
JUMPSTART algorithm o Within an organization/facility
o Just follow the arrow, if yes, then to the right, o Occurs where there is an event in an
if no, then going down up until the patient is organization that poses a threat to disrupt
being managed properly the environment of care including here is
o Additionally, this is another algorithm of your the loss of utilities because of fire so that is a
jumpstart triage and in here you are going labor strike, that would be an internal
to utilize the AVPU: alert, responding to disaster
voice, responding to pain, and 2. EXTERNAL DISATER
unresponsive o Service demands exceeds the usual
o This external disaster becomes a problem in
the facility when the consequences of the

NOREEZA, PRILUNGS & PIATHEBAKER 4


BSN 4 | SEC. SEM | BATCH 2022 |
event created a demand for services that
exceeds the usual amounts of resources so
there is an overwhelming stressful situations
that might actually happen and an
example of this might be an arrival of
victims because of hazardous material
incident who needs decontamination
specially in the emergency department
3. COMBINED EXTERNAL/INTERNAL DISASTER
o External event triggers internal impact
o There are many circumstances that are
external to health organizations that can
trigger an internal disaster as well
o Example: weather conditions such as
earthquake or probably when there is fire
that might actually happen specially on
that specific organization
DISASTER MAGNITUDE
 It is important to classify the magnitude of the disaster
because it is an opportunity for us on when or where
our health is actually needed
 LEVEL I
o Able to contain the event
o The organization is able to contain the
event and respond effectively utilizing its
own resources
o In that case, the community is capable of
answering the specific disaster because of
emergency preparedness and there is
adequate search capacity within its
organization therefore, there is no big
problem at all
 LEVEL II
o Requires assistance from external source
o Assistance can be obtained by adjacent
communities
o Example: Sendong, assistance from Mis. Or
were given because it is an adjacent
community
 LEVEL III
o Requires assistance from state level
o The disaster is in a magnitude that exceeds
the overall capacity of the local community
or region and requires assistance from state
level and even federal resources or the
national resources are actually being
required specifically when it comes to
rehabilitation of this specific community
 When we talk about disaster, it is also important that
we are going to talk about the roles of leadership.
 Strong leadership is critical in disaster situations when
patient surge challenge the hospital’s capacity to
respond and normally acceptable patterns of care
are disrupted. Therefore, there is an activation of the
emergency operation plan triggers an emergency
command system structure for leadership decision
making
 These are an example of work to identify the critical
competencies of leaders that’s basically developed
and this is the list of activities that needs to be
repaired
ROLES OF LEADERSHIP
 L- leads the mission of hospitals response
 E-emergency hazard analysis regularly
 A-active implementation of response plan
NOREEZA, PRILUNGS & PIATHEBAKER
LECTURER: SIR ABANG
TOPIC: DISASTER TRIAGE & MANAGEMENT
 D- describe collaborative relationship
 E- establish emergency key elements
 R-response activities are communicated
 S-strong communications skills with others
 H- has expertise in use of PPE & other supplies
 I-institute flexible thinking & resources use
 P-prepare to evaluate response effectiveness
. List of activities that need to be prepared
 Leaders or individuals must lead the hospital response.
This includes the disaster response, chain of command
and emergency management system.
 Emergency Hazard Analysis Regularly. It is important for
us to have a regular review or revision of the hospital
emergency plan
 Active implementation response plan. During drills or
emergencies within your assigned function or chain of
command
 Describe collaborative relationship. It’s important to have
a collaborative relationship with your hospital or other
facilities or agencies in your local emergency response
system
 Establish emergency key elements. Key elements of a
hospital emergency preparedness rules and policies to
other agencies and community partner. Response
agency are also communicated, communication with
other community is appropriate for your management.
 Strong communication skills with others .This include
communicating with others, patients, families, media,
general public, your family or demonstrate them during
drills or actual emergency. Has expertise in using PPE and
other supplies, institute, flexible thinking and resource use
and prepare to evaluate response effectiveness.
. Disaster Management Process
1. Preparedness/Risk Assessment
- used to evaluate the likelihood of emergencies or
disaster for the specific institution. So there’s an issue
to consider weather, patterns, locations, expectations
to public events and gatherings and also with
location and condition of a facility.
2. Mitigation
-includes all steps that are taken to lessen the impact
of a disaster, should one occur and coonsider to be
preventive measures. Examples include installing,
maintaining and testing back-up generator to
mitigate the effects of power failure.
3. Response
- implementation of a disaster. There’s a
establishment of incident command system
A. Infrastructure - capacity of an organization to respond
to a disaster
B. Staff Competency - ensuring all levels of staffs are
competent to perform during disaster response. There is
a need to have for consistent training.
C. The plan - staff in any healthcare should be fully
conversal with any emergency responnse plan. Ther is a
need for a well-verse of plan of the organization.
D. Relationships & Partnerships - important to have
connections or network especially if there is a need for
assistance during the rehabilitation recovery period.
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BSN 4 | SEC. SEM | BATCH 2022 |
4. Recovery
- this include the rehabilitation program. Let the
community go back to there better level
5. Evaluation &Follow-through
- evaluate what has been done, what were the
interventions did work or didn’t work.
. Hospital Incident command System
 Predictable, responsibility oriented chain of command. In
the incident command system, one incident
commander has the overall responsibility for the
management of incident and employees knows who
reports to them or to whom they should have report
 Use of common nomenclature, so all agencies utilizing
the command system on responding to the same event
use the same titles and functional role for the command
staff position. Use of common terminologies
 Modular flexible organization.only those positions that
are needed for the response are activated or expanded
according to the situation.
 Unified command structure. This allows all agencies
involved in the response to coordinate effort by
establishing a unifies set of incident objectives and
strategies.
 Incident action plan (IAP). plan or event develop for the
overall command center when multiple agencies are
involved in response to emergency. It enables that all
agencies are working toward the same goal within the
same time frame.
 Facility action plan (FAP). Describes the purpose, goal
and objectives for the hospital response. All responders in
the same hospital work for the same goal and objectives.
This plan would be develop in an internal event when no
organizations involved in a response.
 Unity of command. Each person only reports to one
individual. Staff training will emphasize that this individual
is filling an assigned role within a structure and may not
be workers day to day supervisor.
 Manageable span of control. Each manager has a
defined number of human resource, limited to what
experience and can realistically manage. The ideal
range is 5-7 people for supervisor. However, tasks are
relatively simple, the personnel possess a high level of
expertise or the management team is on close proximity
to those supervise this number can supervise higher than
7.
 Used off Job action Sheet (JAS). define for each involved
staff member. Specific function role to be carried out
during the disaster response. So these are important fr the
individuals assigned for leadership roles within the
incident command system structure as the areas of
responsibilities in line for the reporting may be quite
different for the person’s usual assignment.
. Specific HICS Functional Roles
 Incident commander. Organize or direct the operations
of the incidents. The highest ranking executive if the
organization appoint the incident commander based on
the experience of disaster management, knowledge of
the organization and the nature of the incident.
 Safety and Security Officer. Ensures the safety of the staffs,
facility and environment during the disaster operation.
NOREEZA, PRILUNGS & PIATHEBAKER
LECTURER: SIR ABANG
TOPIC: DISASTER TRIAGE & MANAGEMENT
The safety officer has the final authority to make decision
in terms of safety
 Liaison Officer. Function as a contact for external
agencies protecting the incident commander from the
request from outside of the organization. All
communications from the hospital or agencies should go
to the liaison officer
 Public information officer. Responsible for providing
information to the news media. So when the media are
handled appropriately, they can be an asset for the
disaster response
 Medical/Technical Specialist. Needed for activation to
provide guidance in the facilities in the variety of special
situations. Positions may include specialist from the
biological and infectious diseases, legal affairs, chemical
exposures, medical staff, pediatric care, administrator,
hospital administration and medical ethics.
Sections Staff Chief
 Planning Section Chief. They collect and distribute any
information available within the organization required for
the planning and development. Responsible for ensuring
appropriate report that are generated or adapted by
the facility. Also responsible to ensure adequate staffing
including oversight of any labor resource
 Operation Section Chief. Direct all activities during
disaster response. When a typical patient care activities
during disaster response, in a typical health care or
hospital setting, this is the largest section and engages
the most with personnel with multiple branches and unit
within the section
 Logistic Section. Ensures all resources and support require
by the other section are readily available.responsibilities
include the maintenance of the environment,
equipments and foods
 Finance or Administrative Section Chief. Responsible for
monitoring and utilizing the assets, authorize the
acquisition of resources essential for the emergency
response. So this position is frequently charged with
ensuring that human resources policy, procedure and
consultation are available to the incident commander.
Guidelines
 Focus on disaster planning, comprehensive
management, legal framework and possible
consideration with circumstances. It is also important to
include before disaster, during disaster and after the
disaster. It is also important to have the facility
responsibilities regarding adapting care. So during the
pre-event specifically required requirement includes
develop description of potential reconfigurations of the
clinical teams or physical resources. And during the vent
it distributes information about staffing expectation
including roles of volunteers and lastly during the post
event that return to pre-event status as quickly as
smoothly as reasonable and that participates in the post
event evaluation and do a psychosocial need
responding or additional assistance if there’s a need.
And evaluation. This will guide us for the succeding
management of a disaster
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