TRIAGE AND

VICTIM
E VA C U AT I O N

SUSAN FITRIYANA, DR., MMRS

 GENERAL SPECIFIC
OBJECTIVE OBJECTIVE

Alghorithm of triage
perform triage
for patient in
Disaster Rapid identification of patients
Setting requiring immediate stabilization

Identification of patients who can

be saved by surgery

To reduce casualties and

disability
 the sorting of patients based on the
resources required for treatment and the
resources that are actually available.

the sorting of patients in the field to help

determine the appropriate receiving
medical facility.
DEFINITION

a method used to assess the severity of

patients’ condition, determine the level
of priority, and mobilize the patients to
the suitable care unit.
 C AT E G O R I Z AT I O N T R I AG E
S I T UAT I O N S

Multiple Mass
Casualties Casualties
Multiple-casualty incidents are those in which the
In mass-casualty events, the number of patients and the
number of patients and the severity of their injuries do
severity of their injuries does exceed the capability of
not exceed the capability of the facility to render care.
the facility and staff.
In such cases, patients with life-threatening problems
In such cases, patients having the greatest chance of
and those sustaining multiple-system injuries are treated
survival and requiring the least expenditure of time,
first.
equipment, supplies, and personnel are treated first.
D I F F E R E N T I AT I O N O F D I S A S T E R
TRIAGE AND CONVENTIONAL TRIAGE

Conventional Disaster Triage

Trauma Triage
 This Photo by Unknown Author is licensed under CC BY-SA

Q S A L M A I DA H AYAT 3 2
01 Field
Medical Triage
Field medical triage involves
rapidly categorizing disaster
victims who potentially need
immediate medical care
“where they are lying” or at a
casualty collection center.
LEVEL OF DISASTER TRIAGE
02 Medical
Triage
Medical triage is the rapid
categorization of patients by
experienced medical
providers at a casualty
collection site or at the
hospital (fixed or mobile
medical facility).
03 Evacuation
Triage
Evacuation triage assigns
priorities to disaster victims
for transfer to medical
facilities. The goal is
appropriate evacuation (by
land or air) of victims
according to severity of
injury, likelihood of survival,
and available resources.
COLOUR CODE SYSTEM
• Minimal or no medical care is needed, or the patient has psychogenic
casualties
Green • The walking wounded who have suffered only minor injuries.

• Immediate lifesaving interventions are not required Third Priority

• Injuries that may become life- or limb-threatening if care is delayed beyond
Yellow several hours
Second Priority
•a)Lifesaving
fraktur minor;
interventions (airway, breathing, circulation) are required.
•b) Life-threatening
luka minor, luka bakar
injury minor;
that requires immediate intervention or operation
Red c) korban dalam kategori ini, setelah pembalutan luka dan atau pemasangan bidai
dapat dipindahkan pada akhir operasi lapangan; First Priority

• Victims dead.
Black
Zero Priority
COLOUR CODE SYSTEM
• Minimal or no medical care is needed, or the patient has psychogenic
casualties
Green • The walking wounded who have suffered only minor injuries.

• Immediate lifesaving interventions are not required

• Injuries that may become life- or limb-threatening if care is delayed beyond
Yellow several hours

Second Priority
• Lifesaving interventions (airway, breathing, circulation) are required.
•a) Life-threatening
korban dengan risiko
injurysyok
that (korban
requiresdengan gangguan
immediate jantung,ortrauma
intervention abdomen);
operation
Red b) fraktur multipel;
c) fraktur femur/pelvis;
First Priority
d) luka bakar luas;
e) gangguan kesadaran atau trauma kepala;
• Victims dead.
f) korban dengan status yang tidak jelas
Black
Zero Priority
COLOUR CODE SYSTEM
• Minimal or no medical care is needed, or the patient has psychogenic
casualties
Green • The walking wounded who have suffered only minor injuries.
Third Priority
• Immediate lifesaving interventions are not required
• Injuries that may become life- or limb-threatening if care is delayed beyond
Yellow several hours
Second Priority
• Lifesaving interventions (airway, breathing, circulation) are required.
• Life-threatening injury that requires immediate intervention or operation
Red

a) syok oleh berbagai kausa; First Priority

•b)Victims dead.
gangguan pernapasan;
Black c) trauma kepala dengan pupil anisokor;
d) perdarahan eksternal masif. Zero Priority
COLOUR CODE SYSTEM
• Minimal or no medical care is needed, or the patient has psychogenic
casualties
Green • The walking wounded who have suffered only minor injuries.
Third Priority
• Immediate lifesaving interventions are not required
• Injuries that may become life- or limb-threatening if care is delayed beyond
Yellow several hours
Second Priority
• Lifesaving interventions (airway, breathing, circulation) are required.
• Life-threatening injury that requires immediate intervention or operation
Red
First Priority

• Victims dead.
Black
Zero Priority
METODE TRIAGE

MODIFIED SIMPLE SECONDARY

TRIAGE AND RAPID ASSESSMENT
TRANSPORT (M- VICTIM
START) ADULT ENDPOINT
TRIAGE (SAVE)
 Is Patient Breathing?

ALGORITHM
OF Open
Patient’s
MODIFIED Airway
SIMPLE
TRIAGE AND
RAPID
TREATMENT
(MSTART) x
 patients who will die no
SECONDARY matter what treatment is
rendered,
ASSESSMENT
VICTIM
ENDPOINT
(SAVE) patients destined to survive
whetheror not care is given,
and

patients for whom significant

benefit will be obtained from
“austere field interventions.
 Abdominal
Crush Injury
Head Injury Injury with
Burn Injury to Lower
(adults) refractory
Extremity
hypotension
Less than 50%
chance of survival → Mangled Extremity
comfort care only GCS Severity Score
(MESS) No data guide
evaluation

START 70% TBSA burn

Score 8 or above :
treat
Score of 7 or more :
amputate
Age> 60 with
inhalation injury or
with 35% TBSA Burn 4 ml/kg hypertonic
saline (two times) →
if no response,
Score 7 or less : Score less than 7 :
Age <2 with 50% comfort care only
comfort care only attempt limb savage
TBSA Burn

SECONDARY ASSESSMENT
VICTIM ENDPOINT (SAVE)
 Abdominal
Crush Injury
Head Injury Injury with
Burn Injury to Lower
(adults) refractory
Extremity
hypotension
Less than 50%
chance of survival → Mangled Extremity
comfort care only GCS Severity Score
(MESS) No data guide
evaluation

START 70% TBSA burn

Score 8 or above :
treat
Score of 7 or more :
amputate
Age> 60 with
inhalation injury or
with 35% TBSA Burn 4 ml/kg hypertonic
saline (two times) →
if no response,
Score 7 or less : Score less than 7 :
Age <2 with 50% comfort care only
comfort care only attempt limb savage
TBSA Burn

SECONDARY ASSESSMENT
VICTIM ENDPOINT (SAVE)
All patients with chance of survival below 50% using available resources
send to observation (red color)
Burn injury with 70%
Crush injury to lower TBSA or age >60 with
Head injury with GCS 7 Abdominal injury with
extremity with MESS inhalation injury or age
or less (adults) refractory hypotension
score 7 or more <2 with 50% TBSA or
age >60 with 35% TBSA

Chest trauma with Adults with pre-existing Non Traumatic

Spinal trauma
abnormal vital signs diseases Emergencies

SECONDARY ASSESSMENT
VICTIM ENDPOINT (SAVE)
 Referensi :
1. ATLS Edisi 10
2. Oxford American Handbook of Disaster
Medicine, 2012
3. Buku Kurikulum Perhimpunan Tim Bantuan
Medis Mahasiswa Kedokteran Indonesia
4. Bazyar, Z., Farrokhi M, Khankeh H. Triage
System in Mass Casualty Incidents and
Disaster: A Review Study with a Worldwide
Approach, 2019
5. Emergency Severity Index, A triage Tool for
Emergency Department Care

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