® bdls is a registered trademark of the american medical association v 2.6 03/06 ® mass triage...
TRANSCRIPT
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® BDLS is a registered trademark of the American Medical AssociationV 2.6 03/06
®
MASS TriageChapter 1
Part B
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Objectives
• Define disaster triage• List components of MASS triage • Discuss importance and utilization
of triage tags• Identify victim triage categories for
simulated triage scenario
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Triage System Types
Triage systems “sort” patients for a variety of purposes and situations:
• Military Triage• Emergency Department Triage• Disaster Triage
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Disaster Triage
• Sorting patients by the seriousness of their condition and the likelihood of their survival
• To achieve the greatest good for the greatest number possible
• Dependent on resources available
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Disaster TriageFactors impacting available resources:• Volume and severity of patients• Limited providers• Infrastructure limitations• Inadequate hazard preparation
(HAZMAT, etc.)• Limited transport capabilities • Multiple agencies responding• Hospital Resources Overwhelmed
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Disaster Triage
Methods used must be: • Simple• Effective• Easily remembered• Able to sort large numbers of
patients quickly
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Disaster TriageKey Principles:• Life, Limb or Vision Threat• Medical Intervention Needed• Transportation Access
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Disaster Triage• How do I identify the most
injured victims quickly? • How do I get ambulatory or
least injured victims out of the dangerous scene quickly?
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V 2.6 03/06 9
D-I-S-A-S-T-E-R ParadigmTriage
Triage Categories:• “ID-me”! “Identify Me”
– A mnemonic for sorting patients during triage
I – ImmediateD – DelayedM – MinimalE – ExpectantD - DEAD
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V 2.6 03/06 10
D-I-S-A-S-T-E-R ParadigmTriage
M.A.S.S. Triage System
M – MoveA – AssessS – SortS – Send
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V 2.6 03/06
MASS Flow Chart
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M.A.S.S Triage
• Move • Anyone who can walk is told to MOVE to a collection area• Remaining victims are told to MOVE an arm or leg
• Assess • Remaining patients who didn’t move (help these people first)
• Sort • Categorize patients by “ID-me”• Immediate, Delayed, Minimal, Expectant, Dead
• Send• Transport IMMEDIATE patients first• Send to Hospitals and Secondary Treatment Facilities
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M.A.S.S Triage
Key Principle of MASS Triage:
• Group, then Sort!
…then Transport!
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D-I-S-A-S-T-E-R ParadigmMASS Triage Model
“MOVE” Step 1:• Goal
• Group - Ambulatory Patients
• Action:• “Everyone who can hear me and needs medical
attention, please move to the area with the green flag”
• “ID-me” Category• Minimal initial group
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D-I-S-A-S-T-E-R ParadigmMASS Triage Model
“MOVE”• Minimal group, initial screening
– Airway, breathing, and circulation intact– Mental status: able to follow commands– Not likely low blood pressure or breathing trouble– Some conditions worsen, more urgent triage
category– Must be reassessed and monitored– Limitations: not based upon individual
assessment yet• Actively managing this group will reduce self-
transports and perhaps unnecessary overburdening of nearest hospital ER’s
• Assess last, after Immediate and Delayed groups
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D-I-S-A-S-T-E-R ParadigmMASS Triage Model
“MOVE” Step 2:• Goal
– Group – can’t walk, but awake and able to follow commands to MOVE an arm or leg
• Action:– Ask the remaining victims “everyone who can hear
me please raise an arm or leg so we can come help you”
• “ID-me” Category– Delayed initial group
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D-I-S-A-S-T-E-R ParadigmMASS Triage Model
“MOVE” • Delayed group
– Airway, breathing, and circulation adequate to follow simple commands
– Mental status: Conscious & able to follow simple commands• May have low blood pressure or low oxygen level• Likely significant injuries present• Limitations: not based upon individual
assessment yet
• Assess second, after Immediate group
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D-I-S-A-S-T-E-R ParadigmMASS Triage Model
“ASSESS”• Goal
– Group – Identify location of who is left, unable to ambulate and unable to follow simple commands
• Action:– Proceed immediately to these patients and
deliver immediate life-saving interventions• “ID-me” Category
– Immediate initial group
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D-I-S-A-S-T-E-R ParadigmMASS Triage Model
“ASSESS”• Immediate group
– ABC status unknown, immediate assessment– Mental status: Unresponsive to verbal commands– Likely low blood pressure or low oxygen level– Life-threatening injuries present– Expectant and dead patients may be in this group– Minor injuries may be present due to:
• Ruptured ear drums, hearing impaired, chronically disabled– Limitations: not based upon individual assessment
• Assess these people FIRST!
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D-I-S-A-S-T-E-R ParadigmMASS Triage Model
“ASSESS” IMMEDIATE patients• Rapidly Assess ABC’s :
– Is airway open? Open it manually– Is patient breathing? If not, EXPECTANT and go on– Is uncontrolled bleeding present? Assign direct
pressure (do not hesitate to use tourniquet!) – Is likely fatal injury present? If yes, EXPECTANT
• Correct immediate life threats • Accurate count of immediate patients• Is transport available for anyone now? …Move
on!
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D-I-S-A-S-T-E-R ParadigmMASS Triage Model
“SORT” • Everyone should be able to complete the
“Move” and “Assess” steps of Triage• “Sort” requires a level of patient assessment
skills beyond basic first aid / buddy aid• If you are unable to “Sort”, then assure that
appropriate emergency medical services are enroute and continue to “move and assess”
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D-I-S-A-S-T-E-R ParadigmMASS Triage Model
“SORT” - “ID-me”:
I – ImmediateD – Delayed M- MinimalE – ExpectantD - DEAD
“SORT” them based upon individual assessment, …continue lifesaving treatment
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D-I-S-A-S-T-E-R ParadigmMASS Triage Model
“SORT” Immediate• Life or limb threatening injury• Usually persistent ABC problem• Examples:
– Unresponsive, altered mental status, severe breathing trouble, uncontrollable bleeding, proximal amputations, turning blue, rapid and weak pulse…
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D-I-S-A-S-T-E-R ParadigmMASS Triage Model
“SORT” Delayed:• Need definitive medical care, but
should not worsen rapidly if initial care is delayed
• Examples:– Deep cuts or open fractures with
controlled bleeding and good pulses; finger amputations; abdominal injuries with stable vital signs…
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D-I-S-A-S-T-E-R ParadigmMASS Triage Model
“SORT” Minimal:• “Walking Wounded”• Treated and released (preferably
without transport)• Source of “volunteer” help• Examples:
– Abrasions, contusions, minor lacerations, no apparent injury
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D-I-S-A-S-T-E-R ParadigmMASS Triage Model
“SORT” Expectant
• Severely injured with little or no chance of survival
• Care resources not utilized initially• Comfort resources used as available• Remember death could be hours or days away!• Require reassessment and transport:
– If alive after all immediate patients transported, resuscitate per available resources!
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D-I-S-A-S-T-E-R ParadigmMASS Triage Model
• How to handle the dead patients:– Dead patients should not be moved– May aid in identification of the deceased
• Evidence is important!– Finding and convicting
perpetrators....and possibly... PREVENTING future attacks!
– Excessive manipulation of human remains may destroy vital evidence
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D-I-S-A-S-T-E-R ParadigmMASS Triage Model
“SORT” is dynamic! Reassess!
• Who is left?• Expectant group could become new
Immediate group• “Most serious” injury present requires
your immediate attention!
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D-I-S-A-S-T-E-R ParadigmMASS Triage Model
• When all patients have been triaged and immediate life saving procedures complete: –Accurate count in each category–Advise incident commander/triage officer –Move all immediate to collection point –Prepare for immediate transport –Often marked with red flag/tarp
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D-I-S-A-S-T-E-R ParadigmMASS Triage Model
“SEND”• Traditional syntax
• Immediate →Delayed →Minimal →Expectant• Objective
• Transport or release ALL living patients ASAP• Mission Focused
• Send Minimal(s) with each Immediate (if unused space available in vehicle), etc…
• Resourceful• Secondary treatment facilities for minimal pts
(or on-scene treatment and release)• Utilize buses, taxis, trains, boats, etc..
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M.A.S.S Triage
Key Principle of MASS Triage:
• Group, then Sort!
…then Transport!
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Medical Record
• Triage Tags• Communication
–History & Physical–Treatment –Contact information–Personal message
Front Back
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SummaryNow you can:• Define disaster triage• List components of MASS
triage • Discuss importance and
utilization of triage tags
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Questions?
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Triage “Tabletop”
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Triage Scenario• Shooting incident at a Local
Sporting Event–Multiple gunshots were fired–You are first at the scene–10 victims
• What do you do?
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Is Need > Resources?• D- Detect
– Is this a disaster / MCI? (need>resources)• I- Incident Command
– Who is in charge? (incident commander) Who will you contact?• S- Scene Safety/Security
– Is it safe enough to enter?• A- Assess Hazards
– Active shooter? Secondary device? Further penetrating trauma• S- Support
– Law enforcement, EMS, Medical Control, Trauma Center, etc..• T- Triage/Treatment
– 10 victims• E- Evacuation
– What vehicles are available? What route is safe?• R- Recovery
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MASS Triage• Move
–Two walk–Three move
• Assess–Five do not move
• Sort– IDME categories
• Send
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MASS Triage• Move
–Two walk (Minimal Group)–Three move (Delayed Group)
• Assess–Five do not move (Immediate Group)
• Sort– IDME categories
• Send
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• 29 yr male – GSW to left chest, awake in severe respiratory distress
• 8 yr female– GSW to head (through and through) RR=4, HR=101
• 50 yr male – GSW to abdomen & chest, RR=0, HR=0, not moving
• 40 yr female – GSW to neck with gurgling respirations, marked
respiratory distress
• 16 yr male – GSW right chest, No respiratory effort, HR=130 thready
MASS: Immediate GroupUnable to “MOVE”
Immediate
Expectant
Dead
Immediate
Immediate Vs Expectant
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MASS: Delayed GroupAble to MOVE, not walk
• 14 year male–GSW to R upper arm, active massive
hemorrhage, good pulses
• 65 year male –No obvious GSW, c/o severe chest pain,
diaphoretic, and SOB
• 22 year female –GSW to R leg, good pulses, no active
bleeding, normal VS
Immediate -Delayed**
Immediate
Delayed
**after pressure dressing
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MASS: Minimal GroupAble to “MOVE” out
• 29 yr male –Superficial “scratch” wound to L
arm, no deeper penetration
• 37 yr male –GSW to left hand, exposed muscle,
tendon and bone fragments, capillary refill < 2 sec
Minimal
Delayed
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Triage Status
Category SORT
Immediate 4-5*
Delayed 2
Minimal 1
Expectant 1-2*
DEAD 1
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• 29 yr male – GSW to left chest, awake in severe respiratory distress:
Needle decompression of L chest successful, VSS • 40 yr female
– GSW to neck with gurgling respirations, marked respiratory distress: Airway management unsuccessful, profuse bleeding occurred, pt now apneic and pulseless
• 14 year male– GSW to R upper arm, active massive hemorrhage, good
pulses: Now well controlled, no active bleeding, VSS• 65 year male
– No obvious GSW, c/o severe chest pain, diaphoretic, and SOB: Symptoms continue
SORT: ImmediateDelayed
Dead
Immediate
Delayed
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SORT: Delayed• 22 year female
–GSW to R leg, good pulses, no active bleeding, normal VS: Splinted leg, VSS
• 37 yr male –GSW to left hand, exposed muscle,
tendon and bone fragments, initial capillary refill < 2 sec: Now L hand is pulseless and cyanotic
Delayed
Immediate
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SORT: Minimal• 29 yr male
–Superficial “scratch” wound to L arm, no deeper penetration: No clinical change, desires to leave and go home
Minimal
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SORT: Expectant• 16 yr male
–GSW right chest, No respiratory effort, HR=130 thready: Now no palpable pulse, no respiratory effort
• 8 yr female–GSW to head (through and through)
RR=4, HR=101: RR=6-8, HR=100
IMMEDIATE?
Dead
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Triage Status
Category SORTSORT
Immediate 4-5* 3
Delayed 2 3
Minimal 1 1
Expectant 1-2* 0
DEAD 1 3
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SummaryNow you can:• Define disaster triage• List components of MASS triage • Discuss importance and utilization
of triage tags• Identify victim triage categories for
simulated triage scenario
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Questions?