Triage 4.1.2 Version: 2017 Learning Objectives Sorting patients based on available resources Learn and know the triage systems Triage tags communicate via written word, color category, etc. to easily identify patient classification Dynamic process, attempt to right size by minimizing under and over triage 2 Which of the following triage systems requires the delivery of rescue breaths in certain patients? a) MASS b) SALT c) SORT d) JumpSTART 1
Triage (4.1.2) A process to select or sort patients in a systematic fashion Many methods to perform this process Goal: prioritize for treatment or transport Improves outcomes 4 Types of triage Traditional Sort based on injury and resources Geographic Ask patients to move to specific geographic location to assist in sorting process Common first step to many triage systems Reverse triage Military/Tactical application Patients with minor injuries are treated first in order to maintain security or meet military objectives 5 Categories Immediate Delayed Minimal Expectant/D ead Triage Categories Color Immediate Delayed Minimal Expectant/D ead 6 2
Some systems separate the expectant and dead categories. Additionally some systems/cultures do not allow an expectant category. Internationally, these may be classified as Priority 1,2 3, 4. Color coding is not universal but a common method is based on red, yellow, green, black schemes. It is presumed you have a basic understanding of these categories. If not please refer to the text for additional info. Examples of Triage Systems Start JumpStart Mass SALT Geographic 8 Many triage systems are established. There is limited evidence to determine that one system is better than the others. Be familiar with the system used by your local jurisdiction and the concepts surrounding the triage process. It is unlikely you will need to know the specifics of commercial triage systems for the testing process. The text identifies START, MASS, and SALT and provides a small discussion on each. JumpSTART is a pediatric variation of the START algorithm. 3
START Triage 10 START utilizes the geographic/ambulatory principles for initial separation. Open the airway or determine the respiratory rate for further classification. Then move to Perfusion by looking a t capillary refill. JUMP START 12 4
JumpSTART incorporates the respiratory component for pediatric patients and may require administration of 5 rescue breaths. Additionally the AVPU scale is used to determine transportation priority. Mass Triage MASS triage system (Move, Assess, Sort, Send) is described in the National Disaster Life Support Courses. The initial sorting of patients is done by asking ambulatory patients to go to a specific location and then asking those who cannot move to wave. The rescuer goes first to patients who are not able to move or wave to conduct an individual assessment. 14 15 5
The CDC developed the SALT process and proposed to use SALT as a national triage guideline. Sort, Assess, Life Saving Interventions, Treatment. It is endorsed by a number of national organizations. Global or geographic sorting is the first step. Rapid life saving interventions are performed such as control of hemorrhage, opening the airway with positioning or airway adjuncts, chest decompression if tension PTX is suspected and auto injector antidotes if appropriate. They are then assigned to one of the five categories for transport. Triage Tags Triage tags are available in a variety of different designs. Triage tags should allow for patient clinical condition changes either getting better or worsening. Triage tags are unproven in actual use Triage tags should allow for administration of medications, vital sign evaluation and recording, and some sort of identification number A marking pen can be used to identify the assigned triage category Geographic triage can also be used where casualties are simply placed in locations based on the triage category in which they been assigned. 17 Post Triage Remember that triage should be dynamic and requires reevaluation of the patient at frequent intervals Clinical status frequently changes Availability of supplies and personnel can change triage categories Remember that transportation of patients should be optimized and this may mean that minimal patients are transported in the same vehicle as critically ill patients A system for communicating with destination hospitals is Important as well as patient tracking. 18 6
Take Home Points Sorting patients based on available resources Many commercial triage systems available Triage tags communicate via written word, color category, etc. to easily identify patient classification Dynamic process, attempt to right size by minimizing under and over triage 19 Which of the following triage systems requires the delivery of rescue breaths in certain patients? a) MASS b) SALT c) SORT d) JumpSTART Which of the following triage systems requires the delivery of rescue breaths in certain patients? a) MASS b) SALT c) SORT d) JumpSTART 7