Medical Triage.pptx

Medical Triage Mass Casualty Incidents (MassCal) ● Mass casualty incidents are incidents in which the number of casualties overwhelms local resources. While these incidents are infrequent, CERT volunteers can play an important role by supporting local resources in responding to the incident. ● Exa...

Medical Triage Mass Casualty Incidents (MassCal) ● Mass casualty incidents are incidents in which the number of casualties overwhelms local resources. While these incidents are infrequent, CERT volunteers can play an important role by supporting local resources in responding to the incident. ● Examples of mass casualty incidents include: ○ ○ ○ ○ ○ ○ Commuter train derailment Multi-car accident Bus accident Building collapse Natural disasters (e.g., tornadoes) Terrorist attacks In mass casualty incidents, first responder personnel ● Establish command and control of the incident area ● Conduct a scene size-up and set-up ● Send survivors with relatively minor injuries to a holding area to await treatment ● Identify deceased victims as well as survivors too severely injured to save ● Manage medical transportation for survivors who require additional treatment ● Secure the area to protect first responders, survivors, and evidence for law enforcement investigations ● Remove debris and other safety or health threats Mass Casualty Incidents ● In addition to providing critical life-saving interventions, first responders must organize a likely chaotic situation when they arrive on scene. To support first responders, CERT volunteers must understand their role during mass casualty incidents. Roles of CERT volunteers during Mass Casualty Incidents ● Whether dispatched to the scene or located nearby by coincidence, the first task of a CERT volunteer is to conduct a scene size-up. Take a moment to look around the scene and determine the appropriate course of action. ○ Call 9-1-1 and provide the operator with the information gathered during your initial size-up ○ Put on your PPE and any CERT affiliated gear, such as a hat, vest or shirt ○ Locate the nearest first responder and identify yourself as a CERT volunteer. Give them your local agency affiliation ○ If a first responder is not available, assess the situation and determine whether you can provide life-saving interventions, such as controlling bleeding or opening an airway ○ Once responders have arrived, provide them with detailed information from your size-up, and ask how you may be of assistance. Again, communicate your CERT affiliation to first responder personnel ○ For your safety, first responders may ask you to leave the area. After leaving, report the incident and your role to your CERT Team Leader and/or local agency CERT affiliation ○ Communication is key for supporting first responders. CERT volunteers can provide valuable information to support an effective response Functions of Disaster Medical Operations ● Disaster medical operations are the tasks associated with survivor treatment and support during a mass casualty incident. ● Triage/Assessment: The initial assessment and sorting of survivors for treatment based on the severity of their injuries ● Treatment: The medical services provided to survivors ● Transport: The movement of survivors from the scene to the treatment area or medical facility ● Morgue: The temporary holding area for patients who died at the scene or the treatment area ● Supply: The hub for getting and distributing supplies Treating Life-Threatening Conditions ● In emergency medicine, airway obstruction, bleeding, and shock are “killers.” The first priority of medical operations is to attend to those potential killers by: ○ Opening the airway ○ Controlling excessive bleeding ○ Treating for shock Airway Obstructed by the Tongue ● The most common airway obstruction is the tongue. In an unconscious or semiconscious victim, especially one positioned on his or her back, the tongue - which is a muscle - may relax immediately for breathing and, if necessary, the airway must be opened Head-Tilt/Chin-Lift Method for Opening an Airway Step Action 1 At an arm’s distance, shake the victim by touching the shoulder and shout, “Can you hear me?” 2 If the victim does not or cannot respond, place the palm of one hand on the forehead. 3 Place two fingers of the other hand under the chin and tilt the jaw upward while tilting the head back slightly. 4 Place your ear over the victim’s mouth, looking toward the victim’s feet, and place a hand on the victim’s abdomen. 5 Look for chest rise. 6 Listen for air exchange. 7 Feel for abdominal movement Treating Life-Threatening Conditions (Continued) ● Part of your mission is to do the greatest good for the greatest number of people. For that reason, if breathing is not restored on the first try using the Head-Tilt/Chin-Lift method, CERT members should try again using the same method. If breathing cannot be restored on the second try, CERT member must move on to the next victim. ● If breathing has been restored, the airway must be maintained. One option is to use a volunteer or walking wounded to hold the head in place. The airway also can be maintained by placing soft object under the victim’s shoulders to elevate the shoulders slightly and keeping the airway open. Controlling Bleeding ● Uncontrolled bleeding initially causes weakness. If bleeding is not controlled, the victim will go into shock within a short period of time, and finally will die. An adult has about five liters of blood. Losing one liter can result in death. ● There are three types of bleeding and the type can usually be identified by how fast the blood flows: ○ Arterial bleeding: Arteries transport blood under high pressure. Bleeding from an artery is spurting bleeding. ○ Venous bleeding: Veins transport blood under low pressure. Bleeding from a vein is flowing bleeding. ○ Capillary bleeding: Capillaries also carry blood under low pressure. Bleeding from capillaries is oozing bleeding. There are three main methods for controlling bleeding: Method Direct Pressure Procedures ● ● Place direct pressure over the wound by putting a clean dressing over the wound and pressing firmly. Maintain pressure on the dressing over the wound by wrapping the wound firmly with a pressure bandage. Elevation ● Elevate the wound above the level of the heart. Pressure Points ● Put pressure on the nearest pressure point to slow the flow of blood to the wound. Recognizing and Treating Shock ● Shock is a disorder resulting from ineffective circulation of blood. Remaining in shock will lead to the death of: ○ Cells ○ Tissues ○ Entire organs ● The body will initially compensate for blood loss and mask the symptoms of shock. Therefore, it is important to continually evaluate patients for shock and monitor their condition. The main signs of shock that CERT members look for are: ● ● ● ● Rapid and shallow breathing Capillary refill of greater than 2 seconds Failure to follow up simple commands, such as, “Squeeze my hand.” Changes in skin color Capillary refill is how long it takes for the color to return. This is called the “blanch test”. Although Victims who are suffering from shock may be thirsty, they should NOT eat or drink anything, because they may also be nauseated. Procedures for Controlling Shock Step Action 1 ● ● ● Lay the victim on his or her back Elevate the feet 6-10 inches above the level of the heart Maintain an open airway 2 ● Control obvious bleeding 3 ● Maintain body temperature (e.g., cover the ground and the victim with a blanket if necessary). 4 ● Avoid rough or excessive handling unless the rescuer and victim are in immediate danger Triage ● Triage is a French term meaning “to sort”. ● During triage, victims are evaluated, sorted by the urgency of the treatment needed, and set up for immediate or delayed treatment ● Triage was, in fact, initiated by the military and experience has shown that triage is an effective strategy in situations where: ○ There are many more victims than rescuers ○ There are limited resources ○ Time is critical ● Triage occurs as quickly as possible after a victim is located or rescued. During triage, victims’ conditions are evaluated and the victims are prioritized and labeled (tagged) into three categories: ● Immediate (I): The victim has life-threatening (airway, bleeding, or shock) injuries that demand immediate attention to save his or her life: rapid, life-saving treatment is urgent. ● Delayed (D): Injuries do not jeopardize the victim’s life. The victim may require professional care, but treatment can be delayed. ● Dead (DEAD): No respiration after two attempts to open the airway. Because CPR is one-on-one care and is labor-intensive, CPR is not performed when there are many more victims than rescuers. Triage in a Disaster Environment ● Step 1: Stop, Look, Listen and Think. Before you start, stop and size up the situation by looking around and listening. THINK about your safety, capability, and limitations, and decide if you will approach the situation and how ● Step 2: Conduct voice triage. Begin by calling out, “Emergency Response Team. If you can walk, come to the sound of my voice.” If there are survivors who are ambulatory, instruct them to remain at a designated location, and continue with the triage operation. (If rescuers need assistance and there are ambulatory survivors, then these survivors should be asked to provide assistance.) These persons may also provide useful information about the location of the victims. Triage in a Disaster Environment ● Step 3: Start where you stand, and follow a systematic route. Start with the closest victims and work outward in a systematic fashion. ● Step 4: Evaluate each victim and tag them “I” (Immediate), “D” (Delayed), or “DEAD”. Remember to evaluate the ‘walking wounded’. ● Step 5: Treat “I” victims immediately. Initiate airway management, bleeding control and treatment for shock for “I” victims. ● Step 6: Document triage results for: ○ Effective deployment of resources ○ Information on the victims’ location ○ A quick record of the number of casualties by degree of severity Step Procedures 1 Check airway/breathing. At an arm’s distance, shake the victim and shout. If the victim does not respond: ● Position the airway ● Look, listen, and feel ● Check breathing rate. Abnormally rapid respiration (above 30 per minute) indicates shock. Treat for shock and tag “I” ● If below 30 per minute, then move the step 2. If the victim is not breathing after 2 attempts to open airway, then tag “DEAD”. 2 ● ● ● ● ● ● 3 ● Check circulation/bleeding Take immediate action to control severe bleeding Check circulation using the blanch test (for capillary refill). -Press on an area of skin until normal skin color is gone. A good place to do this is on the palm of the hand. The nail beds are sometimes used. -Time how long it takes for normal color to return. Treat for shock if normal color takes longer than 2 seconds to return, and tag “I” Check mental status. Give a simple command, such as “Squeeze my hand.” Inability to respond indicates that immediate treatment for shock is necessary. Treat for shock and tag “I” Triage Procedure ● If the victim passes all tests, his or her status is “D”. If the victim fails one test, his or her status is “I”. Remember that everyone gets a tag. All victims tagged “I” get airway control, bleeding control, and treatment for shock. Sample Triage Documentation Status Location A B C D I 1 2 0 1 D 0 2 5 3 DEAD 3 7 1 0 Triage Decision Flow Chart Triage Decision Flowchart ● Time will be critical in a disaster. You will not be able to spend very much time with any single victim. ● Take advantage of local exercises as a means of maintaining your triage skills and to avoid the triage pitfalls. ● Triage pitfalls include: ○ ○ ○ ○ No team plan, organization, or goal Indecisive leadership Too much focus on one injury Treatment (rather than triage) performed