Mass Casualty Incident Triage Basics

Pediatric Triage

• Children are different from adults and require specialized consideration during triage due to immunologic, anatomic, physiologic, and psychological differences.
• Children should be reassessed frequently for changes in condition.

Pediatric MCI Triage Recommendations

• Acknowledge that children have unique needs and may require a referral.
• Increase education and training for responders.
• Group children together in the appropriate triage areas.
• Know what organizations are available to care for critically ill pediatric patients if needed.

Effects of Disasters on Children

• Children can be affected by disasters in three categories: direct, interpersonal, or indirect.
• Direct exposure occurs when children are physically present during an incident.
• Interpersonal exposure occurs when children have loved ones that are directly affected.
• Indirect exposure happens through secondary consequences of a large-scale incident, such as chaos/disruption of daily living.

JumpSTART Triage System for Children

• Expect children to be a part of an MCI.
• All patients tagged EXPECTANT or DECEASED should be reassessed once critical interventions for IMMEDIATE and DELAYED victims are completed.

SALT Triage System

• Similar to START, SALT prioritizes patients based on the severity of their injuries.
• Sort - Sort based on whether victim can walk, wave, or is still.
• Assess – Complete an individual assessment to determine need for any lifesaving interventions.
• Lifesaving interventions – Control hemorrhage, open airway, etc. and follow algorithm.
• Treatment and/or transport.

Types of Triage

• Primary triage: Performed at the first encounter with the patient.
• Secondary triage: Reevaluation of primary triage after additional assessment and/or interventions.
• Tertiary triage: Performed during ongoing definitive care.

MCI Triage

• MCI triage differs from day-to-day triage due to potential resource limitations.
• Evidence-based triage systems have been developed using documented triage basics.
• MCI triage prioritizes identification of those in need of immediate intervention.
• MCI triage must be modified for children.

START Triage System

• Intended for adults, but may also be used for older children.
• One of the most widely recognized MCI triage systems in the United States.
• Greens: Have minor injuries, MINIMAL - Casualties with minor injuries and are expected to survive even if they do not receive immediate medical attention.