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JumpSTART Training Presentation Instructor Course 2016 Final
JumpSTART Training Presentation Instructor Course 2016 Final
This slide set and all related training information provided in this
session is in accordance with current practice at the time that this
program was developed.
Acknowledgements
• This 4th edition education program was developed under the direction and
guidance of the Illinois Pediatric Preparedness Workgroup. The original
program was adapted in 2006 from a module developed by Children’s
Memorial Hospital (now Ann & Robert H. Lurie Children’s Hospital of
Chicago).
• Terrorist Events
• Arson
• Bombings
• Shootings
• Use of chemical,
biological or nuclear
agents
• Hazmat incidents
Terrorist Events and the Pediatric
Population
Myth
Kids are secondary victims
of terrorism and inadvertently
targeted
Fact
Children may be
intentionally targeted
Harsh Realities: Children as Victims of
Disasters
• 1984: Bhopal, India
– Industrial gas release (methyl isocyanate)
– Estimated 20% of victims were children
• 1999: Columbine High School
Shootings
– 12 students killed, 24 injured
• 2004: Beslan, Russia
– Three day hostage event at school
– 334 hostages killed including 186 (56%)
children
Gaps in pediatric
Critical
preparedness in
emergency care
hospitals, agencies,
interventions
communities, and on
performed
the state and federal
infrequently
levels
Equipment needs
Higher risk for vary based on
respiratory issues size
Exposure
Faster Thinner skin/
respiratory greater body Shorter stature
rates surface area
More susceptible
to:
infections
Faster Immature
effects of agents metabolism immune
system
prolonged
exposures
hypothermia
Trauma
Larger
Rib cage is higher head/higher
center of gravity
Increased exposure
and risk of injuries
May be uncooperative
Unable to help with
reunification
Long term
psychological effects
are possible
Age & developmental
level influences
response to stressful
events
Children with Special Health Care Needs
(CSHCN)/Children with Functional Access
Needs (CFAN)
• Can include those kids who
are/have:
• Technology dependent
(ventilators, G-tubes, shunts,
insulin pumps)
• Developmentally delayed or
disabled
• Chronic diseases
• Immunocompromised
• Psychiatric/behavioral illnesses
• 23% of U.S. households • Many emergency personnel
have at least 1 child that and disaster responders are
meet criteria not used to dealing with this
• 15.1% (>11.2 million) population
children in U.S. meet criteria
• Illinois: 14.3% (452,574)
Triage
Triage
• Sorting and prioritizing patients
• Looks at the medical needs and
urgency of each individual patient
• Conventional Triage
• Do the best for each individual
• Disaster/MCI Triage
• Do the greatest good for the greatest
number
• Based on physiology
• Provides an objective framework for
stressful and emotional decisions
• Helps in resource allocation
Triage
• Primary Triage
• Typically performed at the scene of the incident
• Helps prioritize patients for evacuation/transport
• Can occur at a hospital
• Secondary Triage
• Performed to re-evaluate the patient after primary triage has
been completed
• Typically done once the patient arrives at the hospital.
• Can also take place at an alternate care site or at the scene of
the incident if prolonged scene time or in casualty collection
areas
Mass Casualty Incident
(Source: newyearseve.com)
~80% of casualties self or buddy
transport to the closest hospital
MCI Triage
• All victims must have equal importance at the time of
primary triage
• Sort patients based on the need for immediate care
• IMMEDIATE = Emergent
• DELAYED = Urgent
• MINOR = Non-urgent/walking
wounded
• EXPECTANT/DECEASED =
Dead/little to no hope of survival
IMMEDIATE
Severely ill/injured but
treatable and able to be saved
with relatively quick treatment
and transport
• Examples:
• Severe bleeding
• Shock
• Open chest or abdominal wounds (Source: Optimistworld.com/anaphylaxis)
• Examples
• Minor fractures
• Minor bleeding
• Minor lacerations
EXPECTANT/DECEASED
Dead or obviously dying; May have
signs of life but injuries are
incompatible with survival
• Examples
• Cardiac arrest
• Respiratory arrest with a pulse
• Massive head injury
Triaging Expectant/Deceased Patients
• Can be psychologically difficult to tag a child as
Expectant/Deceased
Designate Treatment
Areas
• Establish areas for each triage
color category
• Triaged patients should be
moved to designated areas
MCI TRIAGE TOOLS
MCI Triage Tools
• START Algorithm
• JumpSTART© Algorithm
• SMART Triage Pacs™
START TRIAGE
START
• Simple Triage And Rapid Treatment
• Joint development by the Fire & Marine
Department and Hoag Hospital in New Port
Beach, California
• Gold standard for field adult MCI triage in U.S.
and numerous other countries
• Utilizes the standard four color triage categories
• Used for primary triage
• More information at www.start-triage.com
START Triage Algorithm
START Triage Algorithm
START Triage Algorithm
START Triage Algorithm
START Triage Algorithm
START Triage Algorithm
START Triage Algorithm
START Triage Algorithm
JumpSTART© Triage
JumpSTART© Triage
• Developed in 1995 to parallel the START Triage
system and revised in 2002
• Designed for use in MCI events
(Source: Dr. Lou Romig-slide presentation: JumpSTART Pediatric Multi-casualty Triage System)
JumpSTART© Triage
• In children, typically respiratory failure precedes
circulatory failure
EXPECTANT/DECEASED
Step 3
Next begin triaging the
remaining victims in the
order that they are
encountered.
Assess the breathing status of
each child.
• If the child is breathing
spontaneously, go on to
step 4
• If child is apneic, position
the upper airway. If they
start to breath on their
own, tag them as
IMMEDIATE
Step 3
(Continued)
If the child is still apneic
after positioning their upper
airway in Step 2 and they
have no palpable pulses,
tag as EXPECTANT/
DECEASED
Step 3
(Continued)
If the child is still apneic after
positioning their upper airway
but has a palpable pulse, give
5 rescue breaths.
• If they start breathing
spontaneously, tag as
IMMEDIATE
• If they remain apneic, tag
as
EXPECTANT/DECEASED
FOR THOSE CHILDREN WHO
REMAIN APNEIC AFTER 5
RESCUE BREATHS, DO NOT
CONTINUE TO VENTILATE THE
PATIENT
(Source: emsstaff.buncombecounty.org)
SMART Triage Pacs™
• Triage tags
• Equipment used to perform START and
JumpSTART© triage
• Have standard barcodes for tracking
patients
• Card folds to the assigned color and only
shows one color at a time
• Allows patients to be re-triaged to another
color classification without having to
replace the tag and reassessment can be
documented on the same tag
• Separate tags for Expectant/Deceased
category
(Source: emsstaff.buncombecounty.org)
SMART Triage Pacs™( Continued)
SMART Triage Pacs™( Continued)
START Triage vs. the SMART Triage
Pacs™
The START algorithm looks like The SMART Triage Pacs™
this… algorithm looks like this...
An F5 tornado has
struck within your
city/town. It occurred
at 3pm while school
was letting out. The
tornado touched down
near 3 schools and a
shopping mall.
Scenario 2 (continued)
• Fire reported on
15th floor
• Smoke to the 16th
and 17th floors.
• The building’s day
care center is
located on the 17th
floor with 30 kids
and 6 employees.
(Source: Used with permission from Paula Willoughby DeJesus, DO, MHPE)
4 y/o F RR 38 Radial pulse Knows name Facial burns,
present and recalls coughing
incident
53 y/o F RR 48 Cap refill Moaning Burns to
> 2 sec abdomen;
wheezing
3 y/o F RR 0 Weak pulse Unresponsive Found under
desk
4 y/o M RR 45 Pulse present Crying No obvious
injuries
2 y/o M RR 20 Palpable pulse Hoarse cry Soot to face
5 kids are
carried out, all
being given
CPR.
As lead triage
officer, what do
you do?
,
(Source: Used with permission from Paula Willoughby DeJesus DO, MHPE)
Recovery
Taking Care of Yourself
(Source: Pictures obtained from Flat Stanley Adventures, Stimulaid, and MCHC)
Course Preparation
For Information Purposes Only
• JumpSTART© Algorithm
• START Algorithm
• PowerPoint presentation
• Pediatric Disaster Triage
Training Scenarios: Utilizing
the JumpSTART Method
Course Materials