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Disaster and Multi-Casualty Triage: DR - Ramanujam.S Assistant Proffesor Care
Disaster and Multi-Casualty Triage: DR - Ramanujam.S Assistant Proffesor Care
Multi-Casualty Triage
DR.RAMANUJAM.S
ASSISTANT PROFFESOR
CARE
COMMON FEATURES OF MAJOR
DISASTERS
• MASSIVE CASUALTY
• DAMAGE TO INFRASTRUCTURE
• A LARGE NUMBER OF PEOPLE REQUIRING
SHELTER.
• PANIC AND UNCERTAINTY AMONG THE
POPULATION
• LIMITED ACCESS TO THE AREA
• BREAKDOWN OF COMMUNICATION
FACTORS INFLUENCING RESCUE
AND RELIEF EFFORTS
• STATUS OF COMMUNICATIONS
• LOCATION, WHETHER RURAL OR URBAN.
• ACCESSIBILITY OF THE LOCATION.
• TIME-FRAME IN WHICH DISASTER
OCCURS.
• ECONOMIC STATE OF DEVELOPMENT OF
THE AREA
Sequence of relief efforts after a
disaster
• Establishing Chain Of Command
• Damage Assessment
• Mobilising Resources
• Rescue Operation
– First priority to prevent further damage
– Type of injuries ~ Time of rescue
• Coordination with relief agencies
• Safety of the helpers.
• Dealing with media.
Sequence of relief efforts after a
disaster
• TRIAGE
• EVACUATION OF CASUALTY.
• FIELD HOSPITALS AND ON FIELD
MANAGEMENT.
• DEFINITIVE MANAGEMENT
Triage
• Importance :
– Only 10-20% have serious injuries
requiring hospitalisation.
– It lessens the immediate burden on
medical facilities
Triage
• Pitfalls:
– a daunting process.
– senior doctors have tendency to believe that
services better utilised in actual management of
patients rather than in triage.
– important to remember the changing clinical
picture of an injured person.
– Time factor – to keep pace triage to be
undertaken at various levels.
Triage
• Components :
– Triage area – all injured brought to one
location : - which should have
• Good space for patient holding, emergency
treatment, decontamination and morgue and
• Good water supply.
– Practical triage – Emergency life saving
measures alongside triage.
Triage
• Components :
– Documentation of triage –
basic patient data,
vital signs with timing,
brief details of injuries (diagrammatic) and
treatment given
• Complements
Triage
• Rapid Identification
of patient
• Color Coded / Bar
Coded system
• Plastic “bands”
can substitute tags
Noji
Nojiet
etal,
al,NEJM
NEJM
START SYSTEM
• Respiratory
• Perfusion
• Mental status evaluation
START First Step
YES NO
Evaluate
Green Ventilation
(Minor) (Step-2)
START Step-2
Ventilation Present?
NO YES
Open Airway
Control Hemorrhage
Evaluate Level of
Consciousness
Red/ Immediate
START Step-4
Level of Consciousness
• Level of consciousness
• Stability of patient’s condition
• Mechanism of injury
• Identified injuries
Priority Interventions
• Patent airway
• Maintaining adequate ventilation
• Adequate gas exchange
• Then:
• Control hemorrhage, replace
circulating volume, restore tissue
perfusion
Maintain Airway Patency
• Essential to trauma management
• EVERY trauma patient has potential for
airway obstruction
• Most common obstruction: Tounge
• Other common causes: blood or vomitus,
secretions, structural impairment,
depressed sensorium, absent gag reflex
How to open the airway?
• Jaw thrust or chin lift!!!
• These maneuvers do not hyperextend
the neck or compromise the integrity
of the C-spine
Maintaining the airway
• Simple, simple!!
• Nasopharyngeal airway
• Oropharyngeal airways
Definitive Nonsurgical
Airway
• Endotracheal intubation-Complete control
of the airway
• Nasotracheal intubation—INDICATED for
the spontaneously breathing
patient..CONTRAINDICATED in the
patient with facial, frontal sinus, basilar
skull or cribriform plate fractures.
Choice of Airway
management
• Familiarity of procedure
• Clinical condition of the patient
• Degree of hemodynamic stability