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1 Mass Casualty Management System
1 Mass Casualty Management System
MANAGEMENT
SYSTEM
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QUESTION 1
GLOBAL TREND
1.
2.
Kobe Earthquake, Japan 1995
Sarin attack in Tokyo, 1995
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Overview of Mass Casualty
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Overview of Mass Casualty
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Overview of Mass Casualty
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Overview of Mass Casualty
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Overview of Mass Casualty
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Overview of Mass Casualty
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Establishing Mass
Casualty Management
System
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Establishing a Mass Casualty Management System
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Establishing a Mass Casualty Management System
Casualty Management
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Establishing a Mass Casualty Management System
Based on:
- Pre-established procedures
- Maximization of use of existing resources
- Multi-sectoral preparation and response
- Strong pre-planned and tested coordination
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Establishing a Mass Casualty Management System
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Establishing a Mass Casualty Management System
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Establishing a Mass Casualty Management System
Classical Approach
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Establishing a Mass Casualty Management System
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Establishing a Mass Casualty Management System
Field Management
Definition:
Encompass procedures used to organize the disaster area in order to
facilitate the management of victims
Components
RESCUE CHAIN---SECTORAL
Impact Zone
Command Post
*SEARCH*
Triage
Traffic Control ER
*RESCUE* Stabilization
Evacuation
Regulation of Evacuation or
*First Aid*
CP / A&ED
AMP
Field Organization
Alerting Process
Field Organization
Alerting Process
Dispatch Center:
Core of the Alerting Process
(Operation/Communication Center)
Functions:
• receives all warning messages (radio/phone)
• mobilize a small assessment team (Flying
Team) from police, fire or ambulance services
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Establishing a Mass Casualty Management System
Initial Assessment
Precise location of the event
Time & type of the event
Estimated number of casualties
Added potential risk
Exposed population
Resources needed
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Establishing a Mass Casualty Management System
Impact Zone
Command Post
Collecting Area in unstable location
Advance Medical Post Area (3-T Principle)
Evacuation Area
VIP & Press Area (Information Officer)
Access Roads (geographical presentations if
available)
Check point for resources (Staging Area)
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Establishing a Mass Casualty Management System
Safety
• Best practice technique to protect victims, responders
& exposed population: immediate/potential risk
• Measures:
Direct action:
- risk reduction - fire fighting
- contain hazardous material
- evacuation of exposed population
Preventive actions: establish field areas
- primary- impact zone
- secondary- rescue/ICP/AMP
- tertiary-“buffer zone”; tri-media 30
Establishing a Mass Casualty Management System
Safety
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Establishing a Mass Casualty Management System
Security Measures
• Non-interference of external elements:
- crowd/traffic control
• Contribute to safety:
– protect workers from external influence; additional
stress
– free flow: victims/resources
– protect general public from risk exposure
• ensured by police officers / special units (security:
airport/building/hospital/establishments, etc..)
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Establishing a Mass Casualty Management System
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Establishing a Mass Casualty Management System
Personnel
High ranking officer (government police, fire, health,
defense)
- plant manager/ airport manager/ chief security, etc…
- fire officer / police officer skilled in ICS / MCM
Identified by name/position, coordinator / commander
May depend on what type of incident
Must be familiar with each other’s roles during previous
meetings/ drills/ simulation exercises (policy)
This core group cooperate with volunteer organizations
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Establishing a Mass Casualty Management System
METHOD
The communication / coordination hub of the pre-
hospital organization. By constant re-assessment,
CP will identify needs to increase / decrease
resources:
- organize timely rotation of rescue workers exposed
to stressful/exhausting conditions in close
coordination w/ back-up system
- ensure adequate supply of equipment / manpower
- ensure welfare / comfort of rescue workers
- provide info to back-up system, other officials, and
tri-media thru an Information Officer
- release as soon as situation allows “E” staff and re-
establish normal operations
- determine termination of field operations
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Establishing a Mass Casualty Management System
MANAGEMENT OF VICTIMS
Search & Rescue
- locate victims
- remove victims from unsafe locations – collecting area
- assess victim’s status (on-site triage)
- provide first aid , if necessary (no CPR on-site in MC Event)
- transfer victims to AMP thru entry triage (medical triage)
- under supervision of the CP/ IC/ or Commander/Coordinator
- may in special situation, require medical personnel (trained)
- to stabilize/resuscitate/amputate (trapped) victim before
extrication.
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Establishing a Mass Casualty Management System
Management of Victims
• Field Care
- Pre-established capabilities / inventory: pre-
planning
- Integrated community plan: practiced w/ policy
support
- The “Golden Hour” Principle
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Establishing a Mass Casualty Management System
to the hospital……” 38
Establishing a Mass Casualty Management System
TRIAGE
On-site T: Acute
Non-acute Red: transferred as soon as
possible to tertiary facilities
in an equipped ambulance
Medical T: Red with medical escort
Yellow Yellow: after evacuation of Red,
Green without life-threatening
Black problem
Green: ‘walking wounded’-to
AS/OPD
Evacuation T - transport:
Black: to morgue Forensic Services
Red
Public Health & Psycho-Social
Yellow
Green interventions to relatives/kin
Black 40
Establishing a Mass Casualty Management System
First Aid
Personnel:
• volunteers, fire, police staff, special units, EMT’s, and
medical personnel
Location:
• on-site, before moving victim
• at collecting point/ area in an unstable environment.
• “Green Area” of “AMP”
• ambulance in transit to facility
Action:
• primarily to transfer with consideration of the ABC’s
order of priority
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Establishing a Mass Casualty Management System
Purpose:
reduce loss of life & limb - save as many as possible in
the context of existing & available resources/ situation
victim’s status; chance of survival; resources
Location:
50-100 meters from Impact Zone (walking distance )
direct access to: Evacuation Road. / Command Post
Clear Radio-Com Zone… and SAFE (Upwind)
tent / bldg / open / mobile field hospital..??
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Establishing a Mass Casualty Management System
Role:
Provide “entry” medical triage
Effective stabilization for victims of a MCI/Situation
• intubation, tracheostomy, chest drainage,
• shock mgt , analgesia , fracture immobilization
• fasciotomy, control external bleed & dressing
Convert red to yellow category as maybe possible
Organize patient transfer to designated care facility/ties
AMP 3-T principle: Tag – Treat – Transfer….
Personnel:
ER (A&ED), physicians/ nurses (trained & skilled)
support: Anesthetists / Surgeons / EMT’s / Nurses / Aiders,
etc. 43
Establishing a Mass Casualty Management System
AMP
NON-ACUTE
Red Yellow
ACUTE
C P– Collecting Point
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Establishing a Mass Casualty Management System
COLLECTION AREA
(in unstable condition)
TRIAGE AREA
(color tagging of victims)
COMMAND POST
TREATMENT AREA
(management and stabilization)
1st
3rd 2nd
T R A N S P O R T A R E A
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Establishing a Mass Casualty Management System
Working
T C
Area
r o
Triage a n
Evacuation
f t
AMP
f r
i o
c l
Impact Zone
Command Post
Strictly Restricted
Restricted
Traffic
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Access Route
Establishing a Mass Casualty Management System
Transfer Organization
Procedures used to ensure that victims of a MC
situation is safely, quickly, and efficiently transferred by
appropriate vehicles to the appropriate and prepared
facility
Preparation for Evacuation:
1. Single Reception Facility
Transfer Organization
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Establishing a Mass Casualty Management System
Transfer Organization
Evacuation Procedures: Regulation
Rules:
- victim is in most possible stable condition
- victim is adequately equipped for transfer
- receiving facility correctly informed and ready
- the best possible vehicle and escort– available
Victim Flow
- “Noria” Principle, Spanish word from Arabic--… ”wheel”
WW I Battle of Chemin de Dames, Verdun, France
* conveyor belt’ flow from first aid to the most
sophisticated care level..
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Establishing a Mass Casualty Management System
Triage Treatment
3-T
Triage Evacuation
Tag
Treat
and
Transfer
Impact Collecting
AMP TRANSFER
Zone Point
HOSPITAL
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Victim Flow
- Ambulance Traffic Control
Radio Links:
*Transport Officer at AMP
*Hospital Admission / ER Department
*Command Post
*Ambulance Headquarters
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Establishing a Mass Casualty Management System
Victim Flow
Road Control:
Police Officers ----- crowd and traffic control
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Establishing a Mass Casualty Management System
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Fallacy
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Incident Command System
Performance Objectives
Discuss the advantages of using the
Incident Command System
Discuss the two types of command
Discuss the Incident Command
Process
Discuss Incident Priorities
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Performance Objectives
Discuss the components of the
Incident Command System
Discuss the Incident Command
System organization
Discuss the use of the Incident
Command checklist
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Question 1
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Incident Command System
Framework necessary to manage
resources, personnel and equipment
Designed to be flexible and can be used in
large or small incidents
Creates a safe environment for all involved
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Benefits of Incident Command
Common terminology
Position titles and Chain of
Command for decision making
Responder accountability
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Basic Command Types
Unified Command
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Single Command
Based on first arriving emergency
units.
Initial Incident Commander begins
assessment of incident
Rescue, Triage, Treatment,
Transport
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Basic Command Structure
Single Command
IN C ID E N T
COMMANDER
RESCUE/ TR IA G E TR E A TM E N T TR A N S P O R T
E X TR IC A TIO N
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Unified Command
Incidents that involve jurisdictions or
agencies involved in the decision
making and planning process
Ensures plan is communicated and
supported by all resources assembled
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INCIDENT CO M M AND SY ST EM
INC ID E NT
COM M AND
S A F E T Y O F F IC ER L IA ISO N OF F ICE R
PU BL IC IN F OR M A T ION
OF F ICE R
S ITU ATIO N PR O CU R E M EN T
TRE ATM E N T TE AM TR IAG E TEAM G R O U N D AMB ULANC E CO M MU N ICATIO N S SU PP LY
LE AD E R LE AD ER
D O CU M E N TATIO N C O M PE NS ATIO N
AIR AM BU LAN CE M E D IC AL F AC ILITIE S
TR E ATM EN T ME MB ER S TRIAG E ME M B ER S
IMM ED IATE DE M O BILIZATIO N CO S T
FOOD G RO U N D S U P PO R T
TR E ATM EN T ME MB ER S MO R G U E MAN AG ER
D ELAYE D
TR E ATM EN T ME MB ER S
M IN O R
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Overview of Incident Command
Process
Process is based on:
Size up
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Size Up
Rapid mental evaluation of factors
influencing an incident
Must continue throughout incident
with ongoing evaluation
Incident situation, incident cause
and incident status
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Incident Situation
May be one or combination of:
Biological
Nuclear
Fire
Chemical
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Incident Cause
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Incident Status
Is the incident:
In a somewhat controlled state
or
Does it remain uncontrolled
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Setting Incident Priorities
After size up of the incident a
course of action is determined
High priority is life safety for the
public and responders
Incident stabilization
Protection of critical systems
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Estimating Potential Incident Course
and Harm
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Strategic Goals
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Incident Command System
Organization
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Command Staff
Consists of the :
Incident Commander
Safety Officer
Liaison Officer
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Incident Commander
IN C ID E N T
COMMANDER
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Incident Commander
First person on the scene with
communications capability
Remains in command until
transferred or incident is
terminated
Complete authority and
responsibility
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Incident Commander
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Incident Commander
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Transfer of Command
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General Staff
Consists of:
Operations (includes
staging)
Planning
Logistics
Administrative/Finance
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Operations Section
IN C ID E N T
COMMANDER
O P E R A TIO N S
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Operations Section
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Operations Section
Makes recommendations for changes
to plan based on incident status
Oversees and is in direct contact
with the staging manager
Task supervisors report to
Operations not Incident Command
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Planning Section
IN C ID E N T
COMMANDER
O P E R A TIO N S P L A N N IN G
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Planning Section
Responsible for collection,
evaluation, distribution and use of
information about the incident
Forecast and develop plans to
contain and resolve incident
Communicates with logistics
section
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Logistics Section
IN C ID E N T
COMMAND
O P E R A TIO N S P L A N N IN G L O G IS TIC S
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Logistics Section
Responsible for providing facilities,
services and materials in support of
incident
Includes equipment, personnel and
associated materials and tools
Support branch and Services branch
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Administrative / Finance Section
IN C ID E N T
COMMANDER
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Administrative/Finance Section
Generally not located at incident
site
Responsible for financial,
administrative and cost analysis
Divided into four units: time,
procurement, compensation/claims
and cost
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Summary
Incident Command created to deal
with any incident in an organized
manner
Manages resources, personnel and
equipment to mitigate the incident
Builds from first responder
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Summary
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Thank you
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CRITICAL INCIDENT
MANAGEMENT
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Performance Objectives
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Critical Incident Management
Characteristics
Demands a coordinated response
to prevent incident from getting
worse
This includes unresolved element
of danger such as additional bomb,
a threat to citizens and responders
or an unusual incident
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Critical Incident Management
Characteristics
Often random in nature and
disrupt normal life
Terrorist organizations use
opportunity as a tool for civil
disturbance
A mass casualty is a critical
incident
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Mass Casualty Incident
Overview
Produces several patients
As few as six or as many as
several hundred
Affects local hospitals
Patients are greater than resources
of the initial responders
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Preparation For Mass Casualty
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Functional Systems Approach
Three levels of function: strategic,
tactical and task (operation)
Management is strategic
Team leaders are tactical
Resources not involved in
supervision are task
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Critical Incident Stages
Response
Recovery Stage
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Initial Response Stage
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Initial Response Objectives
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Initial Response Objectives
As soon as possible:
Gain control of the scene
Restore order
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Incident Control Using The
Six-Step Response
The Six-Step response is based on
the Incident Command System. It
includes: Assume Command,
Situation Assessment, Identify and
Set Perimeters, establish
Command Post, assign Safety
Officer and establish Staging Area
and assign a Staging Officer
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# 1 – Assume Command
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# 2 – Situation Assessment
Size up of the incident that
includes the type of threat,
approximate number of injured,
size of threatened area and
possibility of secondary event.
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# 2 – Situation Assessment
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# 3 - Identify and Set Perimeters
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# 3 - Identify and Set Perimeters
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Inner Perimeter
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Outer Perimeter
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Perimeter Placement Illustration
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# 4 – Establish Command Post
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# 4 – Establish Command Post
The command post will ensure
support for field personnel, create a
controlled environment and improve
communications
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# 5 - Establish Safety Officer
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# 6 - Establish Staging Area
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Inter Agency Planning
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Secondary Incidents
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Recovery Stage
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Recovery Stage
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Goals in the Recovery Stage
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Post Incident Analysis
Critical for operational review.
Benefits include:
Operational performance
Organizational needs
Procedure modification
Additional training
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Summary
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Summary
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9-11-01
TRIAGE
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QUESTION 1
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Objectives
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What is Triage ?
French word meaning to “Sort”
Utilized to identify treatment priorities
Process by which a decision is made on which victim
receives treatment and which does not
Four basic priorities of patient treatment and transport
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Priorities
Highest Priority
• Patients that require immediate care and transportation
• Patients receive treatment at the scene for life
threatening injuries
• First to be sent to available medical facilities
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Priorities
Intermediate Priority
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Priorities
some point
Treatment and transport can be
delayed
Monitor patients and reassess
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Priorities
Lowest Priority
Patients have either died or are near death
ignored
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Initial Triage Officer
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Simple Triage and Rapid Transport System
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Simple Triage and Rapid Transport System
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Simple Triage and Rapid Transport System
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Simple Triage and Rapid Transport System
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Simple Triage and Rapid Transport System
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Simple Triage and Rapid Transport System
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Patient Assessment
Respiration
Assess breathing rate
• Greater than 30 per minute, patient is
priority one and tagged red
• Less than 30 per minute, move on to
assessing pulse and mental status
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Patient Assessment
Not Breathing
• Quickly make sure mouth is clear
• Open airway with head tilt method
• During mass casualty incident, cervical spine
immobilization may not be able to be done
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Patient Assessment
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Patient Assessment
Pulse Rate and Quality
• Check radial pulse
• No more than 5 second check
• Pulse is weak or irregular - Red Tag Priority One
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Patient Assessment
Pulse Rate And Quality
• If pulse is strong, move on to assess mental
status
• If there is NO pulse, black tag priority four
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Patient Assessment
Mental Status
• Breathing and pulse should have already been
checked
• Have patient respond to simple commands such as
“open your eyes” or “squeeze my hand”
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Patient Assessment
Mental Status
• If patient can perform this function, is breathing
and has a pulse, yellow tag priority two
• If patient is unresponsive and cannot follow simple
commands, red tag priority one
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all walking wounded START TRIAGE
MINOR
RESPIRATION
YES NO
Position Airway
over under
YES NO
30/min 30/min
IMMEDIATE DECEASED
IMMEDIATE
PERFUSION
Respirations 30/min
Radial Pulse Present
Radial Pulse Absent Perfusion 2 secs
Capillary Refill Mental Status can do
Over Under
2 2
Secs Secs
IMMEDIATE
Can’t Follow Can Follow
Simple Commands Simple Commands
IMMEDIATE DELAYED
THANK YOU
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