Published on October 23, 2014
1. Off to a good s.t.a.r.t. Trauma Triage and Mass Casualty Incidents V. Bonales, M.D. RMH PreHospital Care Medical Director HCEMCC Paramedic Coordinator
2. Mass Casualty Incident Any incident that overwhelms the available resources 9/11 Two person EMS crew arriving at scene with three victims
3. Mass Casualty Incident First unit on scene declares MCI When additional units start en route, first unit starts triage Usually involves setting up an Incident Command System Triage, Treatment, Transport
4. Mass Casualty Incident Triage everyone according to START Treatment of manageable injuries Transport in order of priority and for definitive care
5. - Assess and control the accident scene - Tamponade external hemorrhage with direct pressure - Protect the spine after blunt trauma - Extricate the patient - Supplement inspired O2 - Stabilize long bone fractures
6. S.T.A.R.T. Simple Triage And Rapid Treatment/Transport
7. Triage Principles
8. Triage Principles Triage – Fr. trier = to sort Napoleon’s surgeon Larrey established the ambulance corps and a method of setting priorities for the evacuation of war casualties - he picked up the war wounded that could be saved by quick intervention (ie. amputation) - other surgeons quickly bandaged those that could go back and fight
9. Triage Principles Civil War: Formal establishment of military field ambulance service Surgeons continued the practice of collecting those who could benefit from immediate medical intervention
10. Triage Principles WWI and WWII Increased use of field medics and the “buddy system” Increased use of antibiotics Aid stations and surgical hospitals moved
11. Triage Principles Korean War MASH units and helicopters helped to further decrease the number of battlefield casualties This was further improved upon in the Vietnam conflict where death rates decreased from 30% to 24% Afghan and Iraq war casualty rates now 10%
12. Triage Principles
13. Triage Principles START Triage Team of two can assess an average of one patient every 30 seconds. 40 casualties, two triage teams will take approximately 10 minutes to accurately assess Only treatment rendered by the triage team open a patient’s airway by head tilt /neck lift by insertion of an OPA apply direct pressure to stop an obvious bleed or by elevating the extremities.
14. Triage Principles START by those who STARTed it…
15. START Triage
16. Assess, Treat, (use bystanders) When you have a color STOP - TAG - MOVE ON minor Move Walking Wounded decease d NO RESPIRATIONS after head tilt* immedia te Breathing but UNCONSCIOUS Perfusion Capillary refill > 2 or NO RADIAL PULSE Control bleeding Mental Status Unable to follow simple commands delayed Otherwise REMEMBER: Respirations < 30 Perfusion < 2 Mental Status - Can Do
17. Triage Principles · Evaluate patient using START · Tear off the bottom of the tag · Tear off a tracking slip and place it in the kit · Attach tag to the patient with a tie · Give tracking slips to the Triage Officer
18. Triage Principles A lot of GREEN helps… but goes fast.
19. Triage Principles Be like Visine… … Get the Red OUT!
20. Triage Principles Don’t let YELLOW mellow… re-assess!!
21. Triage Principles IMMEDIATE-by-mechanism Depending on their injury Age Medical history
22. Triage Principles 16 year old with bleeding scalp lac. 17 year old with no spontaneous respirations or pulse 35 year old with foreign body 47 year old with open tib-fib fracture
23. Triage Principles 30 year old with dislocated ankle 5 year old who seems confused and won’t talk 24 year old with broken finger 38 year old with no heartbeat and no spontaneous respirations
24. Triage Principles 19 year old with burns to soles of feet 29 year old with no visibile injuries 7 year old with no pulses and no spontaneous breaths after 2 rescue breaths 36 year old with penetrating trauma and a swelling belly
25. Assess, Treat, (use bystanders) When you have a color STOP - TAG - MOVE ON minor Move Walking Wounded decease d NO RESPIRATIONS after head tilt* immedia te Breathing but UNCONSCIOUS Perfusion Capillary refill > 2 or NO RADIAL PULSE Control bleeding Mental Status Unable to follow simple commands delayed Otherwise REMEMBER: Respirations < 30 Perfusion < 2 Mental Status - Can Do
Calcification Inhibitors in CKD and Dialysis Patients
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