TRIAGE

Presented by Anang Arliono

 Incident
Daily triage,
triage,

TRIAGE Disaster Tactical

PHILOSOPHY triage, military triage,

Special
condition
triage.
 1. Daily triage
• A routine basis in the emergency care system.
• Goal is to identify the sickest patients to supply early evaluation and
treatment.
• The highest intensity of care is provided to the most seriously ill patients,
even if those patients have a low probability of survival.
• Optimal care is provided to all presenting patients.
 2. Incident or mass casualty
incident (MCI) triage
• When the local emergency care system becomes more stressed but is not
overwhelmed.
• The highest intensity of care is still provided to the most critically ill
casualties.
• Additional resources may be used, but disaster plans may not be activated.
• The minimal or delayed cases may wait for longer periods than they might
during daily triage function, but they will eventually receive care.
• Optimal care is still provided to all casualties.
 3. Disaster triage
• The local resources are unable to provide immediate care on a timely basis
to all casualties needing such care.
• Care to greatest good for the greatest number
• The focus shifts to identifying of seriously injured casualties who have a
good chance of survival with immediate medical interventions and
resources.
 3. Disaster triage (cont.)
• The initial goal is to sort casualties into those who are lightly injured and
who can wait for care without risk and those who are so hopelessly injured
that they will not survive
• The set of serious and critical casualties are then prioritized for
transportation and treatment based on their level of injury and the
available resources
• Casualties with hopeless injuries and little chance of survival may receive
only compassion, pain relief, and monitoring with frequent reevaluation by
triage
The focus of triage at extremes of care
 4. Tactical and military triages
• Mission-oriented perspective
• Some triage decisions may be based primarily on mission objectives rather
than on usual medical guidelines
• This philosophy still follows ‘‘the greatest good’’ approach because failure
to achieve a mission objective may have profoundly adverse results on the
health and well-being of a much greater population
 5. Special condition triage
• When additional factors are present in the population of casualties
• Examples of these include incidents involving weapons of mass destruction
(WMD) with radiation, biological, or chemical contaminants
• These casualties may suffer from the additive effects of such agents (e.g.,
increased mortality in radiation-contaminated trauma cases)
• Decontamination may be needed, and protective equipment may be
required for health care providers
 The Triage Triage
Process Categories

Minimal
TRIAGE Acceptable
Undertriage
and Overtriage
CONCEPTS Care

The Nature of
Disaster
Casualties
 The Triage Process
• Triage officer
• Simply triage
• Triage category
• Triage tag
• Cohort
 Triage Categories
In a disaster situation, resuscitative attempts should not be initiated

• Priority 1 or immediate (RED) patients

• Priority 2 or delayed (YELLOW) casualties
• Priority 3, minimal, or nonurgent (GREEN) casualties (walking wound)
• Expectant patients (BLACK)
 Minimal Acceptable Care
• the initial concern at triage is to preserve the capacity of the hospital to
treat those casualties with serious injury or illness but with a high
probability of survival
• in a disaster situation where trauma resources are limited, the only way to
provide optimal care to immediate casualties is to deliberately divert key
personnel and resources from the less seriously injured or ill casualties
 Undertriage and Overtriage
triage sensitivity

• Under triage occurs when the triage evaluation underestimates the

severity of injury and classifies the patient as noncritical
• Over triage occurs when a noncritical patient is triaged as a critical casualty
 The Nature of Disaster Casualties
• the casualties presenting from a mass casualty or disaster event are
potentially much better known before arrival than the myriad of cases
presenting to the ED during a usual work day
• The specific characteristics of the population seeking care after a disaster
will also be dependent on the location of the disaster impact
 Elements of
Organization
a Good
of Triage
Triage
Activities
Officer
PERFORMANCE
OF TRIAGE
Physical
Triage
Assessment
Mechanisms
during Triage
Elements
of a
Good
Triage
Officer
Prehospital
disaster
triage
organization
Hospital-
based
disaster
triage
organization
 Triage Mechanisms
• Triage is not a static activity
• Triage categorization of a casualty may change based on alterations in the
patient’s condition and in available resources
• After patients are triaged, they should be methodically tagged to
designate the order in which they should be cared for in the treatment
area
Basic
Operational
Policies for
Disaster
Triage
PREHOSPITAL • When a disaster occurs, prehospital
personnel triage are the first on the
MASS scene, and they usually establish the
triage and treatment areas
TRIAGE • The most commonly used system is titled
Simple Triage and Rapid Treatment
SYSTEMS (START)
START
triage
M
START
Triage
Sieve
Triage
SALT triage (Sort, Assess,
lifesaving
intervention,
Treatment/Transport)
Smart
Triage
System
ESTIMATION
• Do not transfer the disaster to the
OF HOSPITAL hospital

CAPACITY
DISASTER MEDICINE 2
ND

ED.
DAVID E. HOGAN
JONATHAN L. BURSTEIN

reference