so, how did you do?
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So, How Did You Do?. MCI Triage:. 2006 Advanced Practice Centers for Preparedness Training Conference. Why Am I Here?. In a disaster, needs exceed resources More patients than providers Difficult choices must be made Who receives care now? Who does not? How do I decide? - PowerPoint PPT PresentationTRANSCRIPT
NACCHO 02-2006 1
So, How Did You Do?
NACCHO 02-2006 2v. 01282006
MCI Triage:2006 Advanced Practice Centers
for Preparedness Training Conference
NACCHO 02-2006 3
Why Am I Here?
In a disaster, needs exceed resourcesMore patients than providersDifficult choices must be madeWho receives care now?Who does not?How do I decide?...TRIAGE
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Triage and Public Health Competencies
CDC & CUSN-CHP (2002). Bioterrorism & Emergency Readiness:
Competencies for All Public Health Workers, p. 12
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Objectives
Define “Triage”Identify goals of MCI triageImplement “MASS” Triage Classify MCI victims by “ID-me”
categories
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In a Perfect World...
First responders respond to scenePatients are triaged in the fieldHazMat handles decon in the fieldSickest patients arrive with EMS:►Already sorted and tagged►Already decontaminated►Already partially treated
All “we” have to do is take care of them!
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What REALLY Happens...
“Chaotic” phase: 15-25 min No EMS, no scene leader 80% of minimally injured self-
transport They arrive at closest
hospitals:►NO TRIAGE►NO DECONTAMINATION►NO MEDICAL
INTERVENTION
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Another Awful Thought...
Hospital as “Hot Zone”Or....
It’s your “off “dayOr…
Flu Pandemic, Bioterrorism…
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Triage: Definition
Sorting of patients by seriousness of
condition and likelihood of
survival
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Triage: Goals
Primary Goal: ►Greatest good for the greatest
number of possible survivorsSecondary Goal:►Relief of suffering
Depend on available resources
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Triage SystemsMultiple triage systems in useVarious methods using tags, categories,
colors, symbols Familiarize yourself with your agency’s
system and PRACTICE it IDEAL = one uniform system used by all
agencies in the field & at hospitals
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“M.A.S.S.” Triage
M – MoveA – AssessS – SortS – Send
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“M.A.S.S.” Triage Developed by the militaryTested & used by the militaryAdapted for civilian disastersIt works!►Fast►Accurate (70%)►Can handle large numbers of victims
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“M.A.S.S.” Triage
1. GROUP victims first...
then....
2. ...ASSESS individual victims
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Basis of “M.A.S.S.” Triage
Ability to MOVE best predicts survival►Head Injury patients
Glasgow Coma Scale (GCS)
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“M.A.S.S.” Triage
“MOVE”: STEP 1Goal:►Group - Victims who can WALK
Action:►“Everyone who can hear me and who
can walk, please move to the area with the green flag.” MINIMAL
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Why Bother With Them FIRST?
MINIMAL group: major vital functions intact►Assess last, after more critical groups
However, actively managing this group may:►Facilitate scene management►Conserve scene resources►Reduce self-transports & overburdening of
nearest hospital ERsCaveats:
►No individual assessment, yet►Worsening conditions
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“M.A.S.S.” Triage
“MOVE”: STEP 2Goal:►Group – Victims who can’t walk, but
who can MOVEAction:►Ask the remaining victims
“Everyone who can hear me and needs help, please raise an arm or leg so we can come help you.”
DELAYED
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“M.A.S.S.” Triage“ASSESS”:Goal:►Group – Identify who is left, victims unable
to walk & unable to follow simple commands to move
Action:►Go immediately to these patients for life-
saving interventions (if medically trained)
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“M.A.S.S.” Triage
“ASSESS” IMMEDIATE patients:Goal:►Accurate count of IMMEDIATE patients
Action:►Rapidly Assess ABCs ►If not or already DEAD ►Correct immediate life threats…
EXPECTANT
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“M.A.S.S.” Triage
“ASSESS” IMMEDIATE patients:►Open Airway
►Stop Bleeding
►Give Chemical antidote
www.rk19-bielefeld-mitte.de
www.tpub.com
www.meridianmeds.com
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“M.A.S.S.” Triage“ASSESS” IMMEDIATE patients:►Open Airway
►Stop Bleeding►Give Chemical antidote
Pressure Points
Tourniquets
Whatever it takes! Be creative!
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“M.A.S.S.” Triage
“ASSESS” IMMEDIATE patients:
Question:►Is transport available?
Move on!
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Victim Group SummaryGoal Action ID-me
GroupGroup ambulatory patients
“Everyone who can hear me and needs medical attention, move to the area with the green flag”
Minimal
Group awake, can follow commands
“Everyone who can hear me, raise an arm or leg so we can come help you”
Delayed
Identify who is left
Go immediately to these patients for life-saving interventions
Immediate
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ONLY NOW Do We Assess Individuals
Having grouped victims according to their ability to move...
...The next phase entails more detailed individual assessment.
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“M.A.S.S.” Triage
“SORT”:Goal:►Sort patients based upon INDIVIDUAL
assessmentActions:►Assign to “ID-me” Categories:
IMMEDIATE, DELAYED, MINIMAL, ►Continue treatment
EXPECTANT
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“M.A.S.S.” Triage“SORT”:Start with those who could MOVE►Unless sufficient personnel for all
groups
Ideal: trained medical personnel►May not be available
Tag immediately upon triage►Including dead victims
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CERT L.A. 2003
There Are Many Different
Patient Assessment Toolswww.usmc.mil/marinelink/mcn2000
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“R”
“P”
“M”
STARTTriage
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“ID-me” CategoriesI - IMMEDIATED - DELAYEDM - MINIMAL
EXPECTANTLETHAL INJURY
E - EXPECTANT
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“M.A.S.S.” Triage
“SORT” – IMMEDIATE: Life- or Limb-threatening injury Airway, Breathing or Circulation Problem Unconscious Examples:
►Unresponsive, altered level of consciousness, severe breathing difficulty, uncontrollable bleeding, amputations above elbow or knee, blue skin color, rapid or weak pulse, open abdominal wounds, etc.
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“M.A.S.S.” Triage
“SORT” – DELAYED:Need definitive medical care, but should
not worsen rapidly, if initial care is delayedExamples:►Deep cuts or open fractures with
controlled bleeding and strong pulses, finger amputations, abdominal injuries with stable vital signs, closed head injuries without altered LOC, etc.
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“M.A.S.S.” Triage
“SORT” – MINIMAL:“Walking wounded”Group, sort & facilitate transport from
sceneVolunteer help? Risk vs. BenefitExamples:►Scrapes, bruises, minor cuts, no
apparent injuries
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“M.A.S.S.” Triage
“SORT” – :Most severely injured with little chance of
survivalThey are “expected” to die soon In a perfect world, they would receive the
most care, even though chance of survival is low
In an MCI....
EXPECTANT
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“M.A.S.S.” Triage
“SORT” – :Care resources NOT utilized initiallyComfort care as available
►Death could be hours or days away!Reassessment & transport
►Transport those still alive after all IMMEDIATE victims evacuated
►Resuscitate & treat as resources allow
EXPECTANT
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“M.A.S.S.” Triage
“SORT” – :
Examples:►Near 100 % burns►Fatal radiation doses►Absent pulse or breathing
Especially if multiple injuries►Severe open brain injury►Death “imminent”
“Judgment call”
EXPECTANT
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Triage Caveats
OVER-TRIAGE:►Tendency to classify all victims as
IMMEDIATEDefeats the purpose!
►Ruptured eardrums, chronic hearing loss, language barrier, developmental handicaps, etc.Cannot respond to “MASS” commands
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Other Triage Caveats
UNDER-TRIAGE:►Initial grouping ≠ individual assessment►Worsening patient conditions:
Internal or external bleeding, shockClosed head injuryBlast injury to lung, gut, brainAirway swelling Delayed chemical exposure symptom onsetEtc.
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“M.A.S.S.” Triage
“SORT” process is dynamic:►Resources change►Patient conditions change
Frequent reassessment▲All categories
may become IMMEDIATE
►“Most serious” injury present demands “immediate” attention!
EXPECTANT
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Tag immediately after sorting►Tie triage tag directly to patient►May need to improvise tags (tape, exam
gloves, cloth) ►May need to write on patient (lipstick, marker)
Triage Tags
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Wrapping up the SORT...
When all patients have been triaged and tagged:►Count all IMMEDIATES►Advise incident commander or
transport officer of numberTake all IMMEDIATES to collection
point for urgent transport
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“M.A.S.S.” Triage
“SEND”:Objective:►Transport or release ALL
living patients ASAPTraditional sequence:
►IMMEDIATE ►DELAYED ►MINIMAL►
EXPECTANT
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“M.A.S.S.” Triage“SEND”:Be mission-focused:►Send MINIMALS or DELAYEDS with each
IMMEDIATE, if space allowsBe resourceful:►Secondary treatment facilities for
MINIMALSBe creative: ►Buses, taxis, trains, boats, etc.
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What About The DEAD?Should NOT be moved or sent ►1 EXCEPTION?
Medical examiner / coroner:►Identification of remains►Disposition of remains
Crime scene investigation:►Evidence must be preserved►Apprehend perpetrators and prevent
future attacks
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The Need To Drill
Regardless of which triage system your agency favors...
...Practice, practice, practice!►“TRIAGE TAG TUESDAY”
Preparation will promote more efficient triage in an actual MCI
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When All Is Said and Done...
MCI Triage is NOT “business as usual”►Difficult decisions must be made►Fatalities and suffering are likely
“Gut check” for healthcare providers“Non-medical” people can participate
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Summary: Now you can
Define “Triage”Identify goals of MCI triageImplement “MASS” Triage Classify MCI victims by “ID-me”
categories
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Thank You!
Questions?