START Triage

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START Triage

• During a Mass Casualty
• Gina Smith RN

Gina Smith RN Director of Emergency Management
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Presenter

• Gina Smith RN CHEP
• Team Commander MA-2 DMAT
• UMass Memorial Medical Center Program Director
• EMS
• Emergency Management
• Injury Prevention

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Disclosure Statement

• I have no actual or potential conflict of
  interest in relation to this program/presentation.
  
• Gina Smith

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Objectives

• Describe the key elements of disaster triage
• Recognize the basic principles of START Mass
  Casualty Triage
• Demonstrate options for Start Triage tagging

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MCI

• Mass Casualty Incident
• An incident which generates more patients than
  available resources can manage using routine
  procedures

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Determining Factors

• number of patients
• number of ambulances.
• number of available, qualified personnel.
• personnel efficiency.
• number of appropriate hospital beds.
• minus the number of beds occupied by patients.
• communications system capacity.

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Medical concerns

• Search and rescue
• Triage and initial stabilization
• Evacuation
• Definitive medical care

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Search and Rescue

• Local population is usually your first search and
  rescue team
• Communities are now developing specially trained
  Search and rescue teams
• Technical specialists knowledgeable in HAZMAT,
  structural engineering, and technical search and
  rescue equipment such as listening devices,
  remote cameras etc.
• May include trained canines

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START
Simple Triage And Rapid
Treatment

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START

• Developed in the early 1980s
• Rapid approach to triaging large numbers of
  casualties
• Easy to remember

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START MCI Triage

• Initial assessment and treatment should take less
  than 30 seconds for each patient

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Triage Categories

• Red (Priority 1)
• Yellow (Priority 2)
• Green (Priority 3)
• Black (Dead or death is imminent)

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TRIAGE RED

• Red

• Life threatening but treatable injuries requiring
  rapid medical care

Priority 1 Immediate
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TRIAGE YELLOW

• Yellow

• Potentially serious injury but stable enough to
  wait a short time for treatment

Priority 2 Delayed
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TRIAGE GREEN

• Green

• Minor injury that can wait longer for treatment

Priority 3 Minor
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Triage Black

• Black

• Deceased,
• Patients with irreversible injuries for which
  death is imminent

Deceased (holding)
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Triage Begins

• Clear the walking wounded from site using verbal
  instruction
• Direct them to treatment areas for detailed
  assessment and treatment
• Tag as GREEN or Priority 3

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RPM

• Respirations
• Perfusion
• Mental Status

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Assessment guide

• R
• P
• M

• 30
• 2
• Can DO

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Whats your call?

• An adult, shaking his head, non ambulatory. He
  says hes too dizzy to walk.
• RR 20
• CR 2 sec
• Obeys commands

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Whats your call?

• Adult female, had been trapped by her lower legs
  under caved-in wreckage.
• RR 24
• Cap refill 4 sec
• Moans with verbal stimulus

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Whats your call?

• A woman is carrying a crying infant. She is able
  to walk.
• RR 20
• CR 2 sec
• Obeys commands

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Whats your call?

• An adult male lies on the ground
• RR 20
• Good distal pulse
• Obeys commands but cries that he cant move his
  legs

OR
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Whats your call?

• Adult Female apparent Compound fracture, left
  femur
• Respirations over 36/minute
• Radial pulse weak
• Awake

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Triage Tag Sample
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Hospital Triage

• Secondary Triage
• Quickly reassess
• Triage should take place outside of ER dept.
• Initial hospital triage can be changed from
  initial field triage.

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Triage

• Triage is a dynamic process and is often done
  more than once for each patient.

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Triage Tagging

• Commercial product
• Ribbons
• Skin Markers
• Colored tape

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Questions

• Thank you for all that you do!