10. Triage

TRIAGE CONCEPTUAL CATEGORYSUMMARY/DESCRIPTION1.Daily



Performed by nurses on a routine basis every day in the emergency department.


The highest intensity of care is provided to the most seriously ill patients, even if they have a low probability of survival.
2.Mass casualty incident (MCI)


Emergency department is stressed by a large number of patients but remains functional; seriously ill still receive highest intensity of care.


Additional resources are used but disaster plans have not been activated.
3.Disaster


Local emergency services are overwhelmed to the point that immediate care cannot be provided to everyone who needs it.


“Do the greatest good for the greatest number.”


Identify injured patients who have a good chance of survival with immediate care.


Four categories exist: lightly injured (can safely wait for care without risk), seriously injured, critically injured, and hopelessly injured.
4.Tactical-militaryMilitary mission objectives rather than traditional nursing guidelines drive the triage and transport decisions.5.Special conditionsUsed when patients present from incidents involving weapons of mass destruction (WMD) such as radiation, biological, or chemical contaminants; mandate personal protective equipment (PPE) for all healthcare personnel, and decontamination capabilities at the facility.



SUCCESSFUL DISASTER TRIAGE PRINCIPLES

The following successful disaster triage principles have been derived from historical experience:


1. Never move a casualty backward (against the flow).


2. Never hold a critical patient for further care.


3. Salvage life over limb.


4. Triage providers do not stop to treat patients.

Never move patients before triage except in the following cases: risks exist because of bad weather or impending or existing darkness; there is a continued risk of injury; medical facilities are immediately available; or a tactical situation dictates movement.


TRIAGE SYSTEMS

The following are three well-known triage systems:


• Simple triage and rapid treatment (START) system (for triaging adults)


• JumpSTART system (for triaging pediatric patients)


• Start/Save


SIMPLE TRIAGE AND RAPID TREATMENT (START) SYSTEM

The START system is a triage system used for prehospital triage. Emergency medical service (EMS) providers are normally the first responders to the scene of a disaster and are very experienced in triage and the START system.

The START system is easy to learn and simple to use. It is based on the respiratory system and mental status of the patient. All patients who can walk (walking wounded) are categorized as delayed (GREEN) and are asked to move away from the incident area to a specific location.

The next group of patients is assessed quickly (30 to 60 seconds per patient) by evaluating RPM:


• Respiration (position upper airway or determine respiratory rate)


• Perfusion/blood circulation (check capillary refill time)


• Mental status (determine patient’s ability to obey commands)

The RPM components are assessed in order. For example, if the victim is not breathing, CPR is not performed—the patient is categorized as expectant (BLACK) and the assessor moves on to the next victim.

Table 10-2 summarizes the classifications based upon the patient’s RPM findings.










TABLE 10-2 Using RPM to Classify Patients
CATEGORY (COLOR) RPM INDICATORS
Critical (RED)
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