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TRIAGE OF MASS CASUALTIES

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Title: PowerPoint Presentation Author: CICR Last modified by: ICRC Created Date: 9/2/2003 1:58:55 PM Document presentation format: On-screen Show Company – PowerPoint PPT presentation

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Title: TRIAGE OF MASS CASUALTIES


1
TRIAGE OF MASS CASUALTIES
  • MSF 11th Surgical Day
  • Paris, 3 December 2011
  • Marco Baldan
  • ICRC Head Surgeon

2
Al Hussein Hospital Karbala, Iraq 2 March 2004
  • First bomb attack in the city
  • Total victims 277
  • Dead 94
  • Wounded 183

3
Hospital Situation
  • Beds in ER 24
  • No place for cadavers
  • No communication with/among ambulances
  • Minimal hospital security system
  • No triage system / disaster plan
  • Medical supplies on 4th floor
  • Operating theatres on 1st and 2nd floors
  • Lifts not functioning

4
Clinical practice
Normal clinical practice
Multiple-casualty incident
Mass casualties
5
Triage Process
  • by which priorities are set for the management of
    mass casualties.

6
The aim in a mass casualty situation is to do
the best for the most, not everything for
everyone.
7
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8
JFK Memorial Hospital, Maternity
Building Monrovia 2003
9
Triage Tent
10
Inside the Triage Tent
11
JFK Memorial Hospital, Main Building
12
Main Building, Triage Department
13
Triage Department, in use
14
Triage cannot be organised ad hoc. It requires
planning
  • Preparation before the crisis
  • Organisation of the personnel
  • Organisation of the space
  • Organisation of the infrastructure
  • Organisation of the equipment
  • Organisation of supplies
  • Training
  • Communication
  • Security
  • Convergence reaction relatives, friends the
    curious (especially the armed ones)

15
Triage involves a dynamic equilibrium between
needs and resources.
  • Needs number of wounded and types of wounds
  • Resources infrastructure and equipment at hand
    competent personnel present

16
The Triage Team
  • Triage team leader co-ordinator
  • Clinical triage officer
  • Head nurse, matron chief organiser
  • Nursing groups
  • Follow-up medical groups

17
Clinical Triage Officer
  • No task in the medical services requires greater
    understanding,
  • skill,
  • and judgement
  • than the sorting of casualties
  • and the establishment of priorities for treatment.

18
Triage decisions must be respected.
  • Discuss afterwards.

19
Triage is a dynamic process
  • begins at the point of wounding,
  • occurs all along the chain of casualty care,
  • occurs at the hospital reception,
  • and continues inside the hospital wards
  • continuous reassessment of patients.

20
Triage Documentation
  • Include basic information
  • Short-form
  • Clear
  • Concise
  • Complete

21
Triage Documentation
  • Reality check
  • What really happens!
  • During post-triage evaluation
  • decided to use plastic
  • sleeve to hold the documentation.

22
The triage process
  • Sift
  • Place patients in main categories priority
  • Sort
  • Priority amongst the priorities

23
Sift
  • 1) Select those most severely injured and
  • 2) identify and remove
  • the dead
  • the slightly injured
  • the uninjured

24
Sort
  • Categorise the most severely injured based on
  • life-threatening conditions (ABC)
  • anatomic site of injury
  • Red Cross Wound Score
  • treatment available in terms of personnel and
    supplies

25
ICRC TRIAGE CATEGORIES
  • I. Serious wounds resuscitation and immediate
    surgery
  • II. Second priority need surgery but can wait
  • III. Superficial wounds ambulatory management
  • IV. Severe wounds supportive treatment

26
Category I Resuscitation and immediate surgery
  • Patients who need urgent surgery life-saving
    and have a good chance of recovery.
  • (E.g. Airway, Breathing, Circulation
    tracheostomy, haemothorax, haemorrhaging
    abdominal injuries, peripheral blood vessels)

27
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28
Distal pulse absent
29
Category II Need surgery but can wait
  • Patients who require surgery but not on an urgent
    basis.
  • A large number of patients will fall into this
    group.
  • (E.g. non-haemorrhaging abdominal injuries,
    wounds of limbs with fractures and/or major soft
    tissue wounds, penetrating head wounds GCS gt 8.)

30
Category I for Airway Category II for debridement
31
Femoral vessels intact
32
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33
Category III Superficial wounds (no surgery,
ambulatory treatment)
  • Patients with wounds requiring little or no
    surgery.
  • In practice, this is a large group, including
    superficial wounds managed under local
    anaesthesia in the emergency room or with simple
    first aid measures.

34
Multiple superficial fragments
35
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36
Category IV Very severe wounds (no surgery,
supportive treatment)
  • Patients with such severe injuries that they are
    unlikely to survive or would have a poor quality
    of survival.
  • The moribund or those with multiple major
    injuries whose management could be considered
    wasteful of scarce resources in a mass casualty
    situation.

37
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38
War Wounded in the Field
WW in the field
(GSW, mine, blast)
100 wounded
30 - 40
60 - 70
No surgery
Hospital care
First Aid
90 Surgery
10 NO Surgery
Dressing
12-15 Head
Small wounds
10 Chest
Paraplegia Quadriplegia
10 Abdomen
60-65 Limbs
Observation
39
Epidemiology of Triage short evacuation time
  • Category I 5 - 10
  • Category II 25 30
  • Category III 50 - 60
  • Category IV 5 - 7

40
Triage in Monrovia 2003 3 June 22 August
  • Total patients triaged 2588
  • Total admitted 1015 (40 of triaged)
  • War wounded 88.5 of admissions
  • Operations 1433
  • Admitted but not operated 296
  • All category 1 patients triaged, admitted and
    operated within 24 hours

41
Patients triaged by date three peaks
42
Summary of triage theory philosophy sorting
by priority
  • A simple emergency plan personnel, space,
    infrastructure, equipment, supplies system
  • "Best for most" policy
  • Priority patients are those with a good chance of
    good survival.
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