Triage and Disaster: Nur Masyeerah Abdul Jalil

TRIAGE AND
DISASTER
nur masyeerah abdul jalil
Components of Comprehensive Trauma Care
1. Preparation
2. Triage
3. Primary Survey(ABCDE)
4. Resuscitation of Vital Functions
5. History of Event
6. Secondary Survey (head-to-toe examination)
6. Continued Postresuscitation Monitoring
7. Re-evaluation
8. Definitive care
TRIAGE:
meaning ‘to sort’.
A specific system of
sorting out casualties
according to the
priorities of treatment or
evacuation.
Field Triage
Perform when no of casualties overwhelms healthcare
provider
To sort victims based on their probability of survival
Triaging can be quite ‘stressful’ and ‘controversial’ at
times
Need to use an accepted method worldwide
Medico legally acceptable too
0BJECTIVES
Save maximum number of victims
Prioritizing patients
Provide immediate critical care
Do no harm
Daily Emergencies
Do the best for each individual
Disaster Settings
(Field Triage)
Do the greatest good for
the greatest number
Triage Tag or Card
1. RED- First Priority Victims

2. YELLOW - Second Priority Victims
3. GREEN - Third Priority Victims
4. WHITE - Dead Victims
FIRST UNIT ON SCENE START – Simple Triage And Rapid Treatment
What to do ?
How to begin ? 1 Call out
REMEMBER 5 S’s
Walking wounded Non Walking
&
1.SAFETY assessment Uninjured
2 RESPIRATIONS
2.SIZE UP the scene GREEN
Yes No
How big ?
How bad ? < 30/min > 30/min
3.SEND information: Position
3 PERFUSION RED Airway
4.SETUP the scene for Management

of the casualties. Capillary Refill
or Radial Pulse Yes No
5.START
Remember “RPM” Under 2 sec Over 2 sec
Or Pulse Present Or Pulse Absent RED WHITE
RESPIRATIONS
PERFUSION 4 MENTAL STATUS RED
MENTAL STATUS
Colour codes: Follows simple command Can’t follow simple command
RED -IMMEDIATE
YELLOW -DELAYED
GREEN -MINOR YELLOW RED
WHITE -DEAD
REMEMBER 5 S’s
1. SAFETY assessment
Assess the scene observing for :
- Electrical hazards
- Flammable liquids
- Hazardous materials
- Other life threatening situations
2. SIZE UP the scene:
Survey incident scene for :
- Type and/or cause of accident
- Approximate number of pt
- Severity level of injuries
- Area involved, including problems
with scene access
3. SEND information:
- Contact dispatch with the
size-up information
- Request additional resources
- Contact closest hospital
4. SETUP the scene for Mx
-Identify adequate work areas
for triage, treatment and
transportation
5. S.T.A.R.T
Simple Triage and Rapid Treatment
Transportation
 Prioritize by Triage category
 Ambulances for RED tags
 Later for YELLOW tags
 Not for GREEN tags
 NEVER for WHITE tags
JumpSTART (Patients aged 1-8 years)
Identify and direct all ambulatory patients to designated Green area.
Begin assessment of non-ambulatory pts. as you come to them Minor (Green)
Spontaneous Respirations ?
No Yes
Open Airway <15/min or

>40/min or 15-40/min
irregular and regular
Spontaneous Respirations?
Peripheral Pulse?
Yes No IMMEDIATE
(RED)
Peripheral Pulse Yes No
IMMEDIATE
(RED)
Yes No Mental status ? IMMEDIATE
(AVPUP) (RED)
Perform 15 sec. DECEASED
Mouth to mouth (BLACK)
Appropriate Inappropriate
(alert,verbal (painful stimuli,
Spontaneous Respirations ? stimuli) unresponsive)
Yes No
DELAYED (YELLOW) IMMEDIATE
IMMEDIATE DECEASED
Or MINOR (GREEN) (RED)
(RED) (BLACK)
Colour Code Category Sub Category Clinical feature
Red Critical Category 1 (R1) 1. Code arrest (cardiac/respiratory arrest or impending

arrest)
2. Hypoventilation RR<10/min
3. Shock states-SBP<90mmHg(adult or severely
shocked child or infant
4. Airway compromise
5. Severe respiratory distress. Tachypnoea and/or
dyspneoa with sPO2 <95%
6. Seizuring patients(ongoing/prolonged)
7. Coma/unconscious/respond only to pain,(GCS
<9/10)
8. Alleged poisoning/ drug overdose,impaired mental
status GCS ≤13/15
9. Exsanguinating limb injuries
10. Severe crush injuries to limbs
11. Head injury GCS ≤13/15
Red Critical Category 2 (R2) 1. Severe/moderate asthma/ COAD

2. Polytrauma/major trauma
3. Burns >25% BSA regardless the depth and or or >
20% 3rd degree burn
4. Alleged near drowning
5. Gun shot/stab wound-head, neck, trunk or
abdomen/trajectory undetermined
6. Hypertensive emergencies- SBP >220mmHg DBP
>120mmHgwith systemic symptoms /neurological
deficits
7. Chest pain- visceral, non-traumatic associated with
parasympathetic symptoms.
8. AMI/unstable angina diagnosed by referral
9. Acute abdomen, haemodynamically unstable
10. Hyperglycaemia/hypoglycaemia with altered
consciousness level
11. Baby<3 months with fever>38C
12. Obstetric emergencies, haemodynamically unstable
Yellow Semi-Critical Category Y 1. Altered consciousness level but not comatose, head
injured-GCS-14/full but pupils are unequal
2. Lower limb/pelvic fracture
3. Open fracture of upper limbs
4. Spinal injury(not in shock,no neurological deficits)
5. Eye injuries with loss/impaired vision
6. Dislocation of major joints
7. Limb amputation,total or sus total (haemodynamically
stable)
8. Burns-51-25%of BSA regardless the depth and/or10-20%
BSA of 3rd degree burn
9. Vascular injury but haemodynamically stabile
10. Acute abdomen haemodynamically stable
11. Chemical exposure involving eyes
12. Alleged poisoning/drug overdose,concious.
13. Severe pain-Trauma(8-10 pain scale) /non trauma (4-7
scale)
14. Moderate allergic reaction
15. Mild/moderate dyspneasPO2 >95%and/or RR<40/min
16. Hyperventilation and unable to maintain posture
Colour Code Category Sub Clinical feature
Category
17.Chest pain-visceral and not associated not associated with
systemic symptoms
18.Hypertyensive emergencies SBP<220 DBP<120miniml
systemic symptoms but no neurological deficits
19.Baby>3 months >38CInfant<1 month regardless symptoms
20.Per vaginal bleedingbut haemodynamically stable
21.Other medical urgencies IV intervention;
Dehydration,Diarhheoa with vomitting, Pyrexia>40
C,Dialysisi problem, signs of infection, acute psychiatric
condition
(aggressive/suicidal)
Green Non-Critical Fast lane 1. Children < 2 years old

(G1) 2. Senior citizen >65 years old
3. Acute pain(trauma) p[ain scale <4 (mild)
4. Chest pain, non visceral,musculoskeletal not assiciated
with other symptoms
5. Previous heart disease
6. Abuse,neglect,assault, stable
7. Post seizure, alert on arrival
8. POP complications
9. High blood sugar with no major symptoms
10. Mild astme
11. Closed fracture of the upper limb/ ankle with major
angulation
12. Dislocation of the smalll joints
13. Foreign body
14. Minar PV bleeding; PV spotting
Green Non-Critical Require first aid 1. Chest pain, non visceral, musculoskeletal wityh no
(G2) before seen by symptoms and previous heart disease
attending doctor 2. Minor allergic reaction
Green Non-Critical Patient can wait 1. Burns <15% BSA regardless of the depth and/or <10% 3rd
(G3) degree burn
2. Minor trauma
3. Head injury, alert, no vomiting
4. Bumps and bruises
5. Closed fracture of the upper limb
6. Controllable bleeding closed fracture
7. Nail prick
8. Simple cut
Green Non-Critical Locum/ 1. Chronic trauma>6 months

(G4) triage away to 2. Diarhhea alone
OPD/ 3. Vomiting alone
another centre 4. Abdominal pain,mild/chronic
5. Menses related complaints
6. Chronic psychiatric problem
Gre Non-Critical Not seen in ED 1. Missed appointments
en (G5) 2. Medication exhaustion
3. 2nd oppinion seeking
4. Medical certificate
THANK YOU

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TRIAGE AND

1. RED- First Priority Victims

4.SETUP the scene for Management

Open Airway <15/min or

Red Critical Category 1 (R1) 1. Code arrest (cardiac/respiratory arrest or impending

Red Critical Category 2 (R2) 1. Severe/moderate asthma/ COAD

Green Non-Critical Fast lane 1. Children < 2 years old

Green Non-Critical Locum/ 1. Chronic trauma>6 months

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