Mass Casualty Incidents and Triage

Mass Casualty Incidents (MCI)

• In a mass casualty incident, local resources may be overwhelmed, requiring Mutual Aid from neighboring systems.
• Response to an MCI varies depending on location and patient distribution.
• Incident can be classified as open (unknown number of casualties, ongoing) or closed (known number of patients, no further casualties expected).

Triage

• Triage is the process of sorting patients by severity of condition and prioritizing them for care.
• Goal of triage is to do the greatest good for the greatest number.
• Primary triage is used to rapidly categorize patients, focusing on speed and locating all patients.
• Secondary triage is a re-triage process in the treatment area, where patient categories can be upgraded or downgraded.

Triage Categories

• Immediate (red): patients needing immediate care or transportation, with life-threatening conditions such as airway, breathing, or circulation problems.
• Delayed (yellow): patients needing care and transport, but can be delayed, with non-life-threatening conditions such as bone or joint injuries.
• Minimal (green): patients needing little to no treatment, with soft tissue injuries.
• Expectant (black): patients who are already dead or have minimal chance of survival.
• Optional: intermediate (orange) category for patients who require prompt evaluation and treatment for medical comorbidities.

Triage Tags

• Triage tags should be weatherproof, easy to read, color-coded, and clearly show the category.
• Tags can be used to track patients' locations and identify them if they're unresponsive.
• Digital photos and barcode scanners can be used for patient identification and tracking.

START Triage

• Uses a limited assessment of a patient, analyzing their ability to walk, respiratory status, hemodynamic status, and neurologic status.
• Steps:
  1. Call out to patients who can hear and guide them to an identifiable landmark (walking wounded).
  2. Evaluate non-ambulatory patients, checking respiratory status, hemodynamic status, and neurologic status.

JumpSTART Triage (Pediatric)

• Used for pediatric patients under 8 years old or weighing less than 100 lbs (45 kg).
• Steps:
  1. Check for pulse, and if absent, categorize as expectant.
  2. Open airway and give five rescue breaths if the patient isn't breathing.
  3. Check respiratory rate, and if outside the range of 15-45 breaths/min, categorize as immediate.
  4. Check hemodynamic status, and if no distal pulse, categorize as immediate.
  5. Assess neurologic status, and if the patient is unresponsive, categorize as immediate.

SALT Triage

• Sort, Assess, Life-Saving Interventions, and Treatment Andor Transport.
• Prioritizes patients who need immediate attention, including those who are unable to walk, have life-threatening injuries, or demonstrate purposeful movement.

Special Considerations

• Patients who are hysterical or disruptive to rescue efforts may need to be prioritized and transported out of the disaster site.
• Patients who may be contaminated or exposed to hazardous materials require special handling.
• Walking wounded can assist with simple tasks, such as moving patients.
• Injured or sick responders should be prioritized and transported away from the scene.

Destination Decisions

• Consider the American College of Surgeons' field triage decision scheme to refer patients to Trauma Centers.
• Factors to consider include physiologic criteria, anatomic criteria, mechanism of injury, and special considerations such as age or underlying health conditions.
• Patients may need to be transported to a hospital that is not ordinarily capable of accepting a trauma patient.

Critical Incident Stress Management

• Incidents can be emotionally stressful, and responders may need debriefing and support.
• Participation in critical incident stress management is encouraged, but not required.
• Resources should be available for responders to access, including Employee Assistance programs, mental health professionals, and peer counselors.
• Post-incident evaluation should include consideration of the psychological impact on responders.

Mass Casualty Incidents (MCI)

• Local resources may be overwhelmed in a mass casualty incident, requiring Mutual Aid from neighboring systems.
• Response to an MCI varies depending on location and patient distribution.
• Incidents can be classified as open (unknown number of casualties, ongoing) or closed (known number of patients, no further casualties expected).

Triage

• Triage is the process of sorting patients by severity of condition and prioritizing them for care.
• The goal of triage is to do the greatest good for the greatest number.
• Primary triage is used to rapidly categorize patients, focusing on speed and locating all patients.
• Secondary triage is a re-triage process in the treatment area, where patient categories can be upgraded or downgraded.

Triage Categories

• Immediate (red): patients needing immediate care or transportation, with life-threatening conditions such as airway, breathing, or circulation problems.
• Delayed (yellow): patients needing care and transport, but can be delayed, with non-life-threatening conditions such as bone or joint injuries.
• Minimal (green): patients needing little to no treatment, with soft tissue injuries.
• Expectant (black): patients who are already dead or have minimal chance of survival.
• Optional: intermediate (orange) category for patients who require prompt evaluation and treatment for medical comorbidities.

Triage Tags

• Triage tags should be weatherproof, easy to read, color-coded, and clearly show the category.
• Tags can be used to track patients' locations and identify them if they're unresponsive.
• Digital photos and barcode scanners can be used for patient identification and tracking.

START Triage

• Uses a limited assessment of a patient, analyzing their ability to walk, respiratory status, hemodynamic status, and neurologic status.
• Steps:
• Call out to patients who can hear and guide them to an identifiable landmark (walking wounded).
• Evaluate non-ambulatory patients, checking respiratory status, hemodynamic status, and neurologic status.

JumpSTART Triage (Pediatric)

• Used for pediatric patients under 8 years old or weighing less than 100 lbs (45 kg).
• Steps:
• Check for pulse, and if absent, categorize as expectant.
• Open airway and give five rescue breaths if the patient isn't breathing.
• Check respiratory rate, and if outside the range of 15-45 breaths/min, categorize as immediate.
• Check hemodynamic status, and if no distal pulse, categorize as immediate.
• Assess neurologic status, and if the patient is unresponsive, categorize as immediate.

SALT Triage

• Sort, Assess, Life-Saving Interventions, and Treatment Andor Transport.
• Prioritizes patients who need immediate attention, including those who are unable to walk, have life-threatening injuries, or demonstrate purposeful movement.

Special Considerations

• Patients who are hysterical or disruptive to rescue efforts may need to be prioritized and transported out of the disaster site.
• Patients who may be contaminated or exposed to hazardous materials require special handling.
• Walking wounded can assist with simple tasks, such as moving patients.
• Injured or sick responders should be prioritized and transported away from the scene.

Destination Decisions

• Consider the American College of Surgeons' field triage decision scheme to refer patients to Trauma Centers.
• Factors to consider include physiologic criteria, anatomic criteria, mechanism of injury, and special considerations such as age or underlying health conditions.
• Patients may need to be transported to a hospital that is not ordinarily capable of accepting a trauma patient.

Critical Incident Stress Management

• Incidents can be emotionally stressful, and responders may need debriefing and support.
• Participation in critical incident stress management is encouraged, but not required.
• Resources should be available for responders to access, including Employee Assistance programs, mental health professionals, and peer counselors.
• Post-incident evaluation should include consideration of the psychological impact on responders.

Learn about the response to mass casualty incidents, including the importance of Mutual Aid and triage, a process of prioritizing patients by severity of condition.