Mass Casualty Triage: Mdm. Wan

Mass Casualty Triage
Mdm. Wan
Disasters
Any event that overwhelms existing
manpower, facilities, equipment and
capabilities of a responding agency or
institution.
Types of Disasters
 Internal- Hospital blackouts, power
outage, water outage, fires, explosions
 External
Natural calamities: earthquake, hurricane,
flood, fire, explosion.
Man- made- motor vehicles accidents, plane
crashes, terrorism, bioterrorism.
Disaster Nursing
 Hospitals serve as major treatment area
for victims, also referred to as casualties.
 Hospitals activates its disaster plan &
outlines specific duties for each nursing
unit and staff.
 Each nursing unit prepares for the influx
of casualties by calling off-duty staff to
report to work & by discharging non-
critical clients.
Disaster Nursing
 Each unit is designed to receive specific types of
trauma – like major trauma, burns, medical,
pediatrics, or psychiatric.
 Decision making & prioritization of client care
are guided by resources & personnel available.
 Each hospital follows a disaster response plan &
procedures to follow when interacting with
media, families, agencies & casualties.
Personnel
First Responders
1. Police
2. Fire
3. EMT/ Paramedics
4. NGO’s
First Responders
Functions
1. Scene Assessment
2. Alerting Process
3. Field Organization
4. First Triage
Second Responders
1. Medical Team from the Hospital:

Set up the Advanced Medical Post
Treat and stabilize victims before Transport to
the Hospital
2. Senior Police, Fire officers and Medical
Consultant from the Accident and Emergency
Department:
3. Set up of the Incident Command Post
Triage
 Sorting casualties for the purpose of assigning
priorities.
 ER serves as a triage & stabilization area for
casualties.
 Additional ER staff may be called to work .
 Hospital department plan may require assigning
one or more staff from each nursing unit and
non-nursing department to a specific area or task
within the ER such as triage, first aid, critical
care, burn treatment or transportation
Golden Hour
 A seriously injured  Triagehelps to support
patient has one hour in this golden hour
which they need to concept by identifying
receive Advanced the most seriously
Trauma Life Support. injured patients so that
This is referred to as the they may be
golden hour treated/transported first
Triage Categories
Colour coding tag
Red: Life-threatening but treatable injuries requiring
rapid medical attention
Yellow: Potentially serious injuries, but are stable
enough to wait a short while for medical treatment
Triage Categories Green: Minor injuries that can wait
for longer periods of time for treatment
Dead or still with life signs but injuries are
incompatible with survival in austere conditions Black:
Triage Categories
Red – Immediate
Yellow – Delayed
Green – Minor
Black –
Deceased/Non-
salvageable
Red Tag
Immediate
RPM falls outside Parameters
This is a Critical Patient
Yellow Tag
Delayed
RPM within Desired
Values
Patient has significant
Injuries
Patient can’t walk
Green Tag
Minor injury
Patient is usually ambulatory
Patient is able to leave triage
area with instruction
Black Tag
Deceased/Non-salvageable
Patient cannot breathe after opening
airway
Injuries incompatible with Life
Triage Tools
Basic Disaster Life Support MASS Triage
Move
Assess
Sort
Send
Move
Move anyone who can walk to your
minor treatment area
Tag these patients Green for Minor
Assess
General appearance
Abcd
Subjective and objective (SAMPLE)
SALT Triage
SALT Triage
Sort
Assess
Life-saving Interventions
Treatment/Transport
START
START
Simple Triage And Rapid Treatment
Why use S.T.A.R.T?
• Examines victims objectively
• Used by individuals with limited medical
training
• Takes about 30 seconds per victim
• Transformation: From EMS to the ED
• Quick access to definitive care when
resources are overwhelmed
• Prevents clogging the ED
• Most Good for the Most People
R.P.M. Assessment
The S.T.A.R.T. System is based

on the
R.P.M. Assessment:

􀂅Respirations

􀂅Pulse/Capillary Refill (Perfusion)

􀂅Mental Status (Neurological Status)
Ambulatory vs. Non-ambulatory
Ambulatory patients are considered minor
and should be moved to your minor
treatment area
Should receive a more thorough triage in the
minor treatment area: Vital signs,
Complaints, History, etc.
Non-ambulatory are assessed using the
R.P.M. assessment
R.PM. Target Values
Triage
 Because patients are categorized, “Delayed”
does not mean that they may not have serious
injuries; It just means that they are not at high
risk for death
 Delayed patients may have injuries that span a
wide range
 They may not be able to join the walking
wounded because of a broken ankle
 They may have severe internal injuries,but are
still compensating
Triage
 Itis important that the delayed patients

are frequently reassessed and further
prioritized for transport. This will usually
be done in a central treatment area
Triage
 Delayed patients have:
 Respirations under 30/minutes
 Capillary refill under 2 seconds
 Can do-follow simple commands
Triage
 Patients with minor lacerations,
contusions, sprains, superficial burns are
identified as “minor/minimal”
 These patients will not suffer significant
morbidity if no medical intervention is
performed
Triage
 Patients with whom there are signs of
impending death or massive injuries with
poor likelihood of survival are labeled as
expectant
 These are patients with penetrating head
wounds, high spinal cord injuries, second
or third degree burns with greater than 60
percent of total body surface area,
profound shock with agonal respirations
Management of the Dead
Previously
1. Responsibility of the Police.

2. Victims who died in the AMP certified by the AMP Doctor
3. Victims who died on the field should be brought to the AMP and certified by the
AMP doctor
Management of the Dead
What changed?
The Forensic Science Centre
1. Dead bodies should be certified by the DMO if the ied on the field
2. Dead bodies should be sent to the FSC under Police escort
3. All personal effects should be collected and sent to the FSC with the bodies

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Mass Casualty Triage

1. Medical Team from the Hospital:

The S.T.A.R.T. System is based

 Itis important that the delayed patients

1. Responsibility of the Police.

The Forensic Science Centre

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