Unit 2-Lesson 4.pdf

Unit 2 Respond to a Medical Emergency Lesson 4 Mass Casualty Incidents and Triage Lesson Goal At the end of this lesson, you will be able to respond to a mass casualty incident as the first officer on the scene and participate in triage and a multiple agency response. You may respond to an...

Unit 2 Respond to a Medical Emergency Lesson 4 Mass Casualty Incidents and Triage Lesson Goal At the end of this lesson, you will be able to respond to a mass casualty incident as the first officer on the scene and participate in triage and a multiple agency response. You may respond to an incident that involves multiple casualties or multiple patients with severe injuries, also known as a mass casualty incident (MCI). Events such as traffic crashes involving multiple vehicles, severe weather events, and active threat/shooter incidents can quickly become an MCI. You may be the first person to arrive on the scene of an MCI, and should be able to priori- tize patients for care based on the severity of their injuries before providing emergency first aid. ✅ HL224.1. Describe the role of the first officer on the scene of a mass casualty incident Assuming there are no active threats, your role as the first responder involves conducting a scene size-up, establishing command of the scene, and communicating with other first responders through dispatch. Ideally, you accomplish these tasks simultaneously. ✅ HL224.2. Describe how to triage during a mass casualty incident Once additional resources are available, your next step is to begin triage. Triage is the process of sorting and categorizing patients, and it is used to determine the order in which patients receive medical attention. The goal of triage is to do the most for the most, rather than to provide extensive treatment to a single patient. Immediate life-saving interventions, particularly tourniquet applica- tion, can be performed, but the focus is on rapidly evaluating all patients to determine the order that patients will receive future medical attention based on the severity of their injuries. Check local protocol and department policy to determine if your agency uses a specific model. Although triage models differ slightly, the basic principles remain the same. Triage Processes Simple Triage and Rapid Treatment (START) The START method of triage can be used to assess many patients rapidly, and personnel with limited medical training can use it effectively. 1. Use BSI and appropriate PPE. 2. Locate and remove all the walking wounded into one location away from the incident, if possible. Do not forget these patients. Someone should triage them as soon as possible. Chapter 2 First Aid for Criminal Justice Officers / 81  Say “Everyone who can hear my voice and can walk, come to this area.” Now move quickly through the remaining patients. 3. If available, triage and tag the remaining injured patients with triage ribbons (color-coded plastic strips) by tying them to an upper extremity in a visible location (wrist if possible). 4. Classify patients according to the START protocols.  RED—immediate  YELLOW—delayed  GREEN—ambulatory (minor)  BLACK—deceased (non-salvageable) 5. Remember the mnemonic RPM: respiration, perfusion, mental status.  Assess respirations: a. If respiratory rate is 30 or fewer breaths per minute, assess perfusion. b. If respiratory rate is more than 30 breaths per minute, tag RED. c. If the patient is not breathing, open the airway, remove obstructions if seen, and assess for (a) or (b) above. d. If the patient is still not breathing, tag BLACK.  Assess perfusion: a. Perform by palpating a radial pulse or assessing capillary refill time. b. If no radial pulse is present or the capillary refill time is greater than two seconds, tag RED. c. If radial pulse is present or capillary refill time is two seconds or less, assess mental status.  Assess mental status or LOC: a. Assess the patient’s ability to follow simple commands and their orienta- tion to time, place, and person. b. If the patient follows simple commands, tag YELLOW. c. If the patient does not follow simple commands, is unconscious, or disori- ented, tag RED. d. Note: Depending on injuries (burns, fractures, bleeding) it may be neces- sary to tag YELLOW. 82 / Florida Basic Recruit Training Program (HL): Volume 2  6. Make independent decisions for each patient. Do not base triage decisions on the percep- tion of having too many patients in a single category. 7. If you encounter borderline decisions, always triage to the most urgent priority (GREEN/ YELLOW patient, tag YELLOW). 8. Direct the movement of patients to proper treatment areas, if necessary. 9. Provide appropriate medical treatment to patients before you move them and as incident conditions dictate. 10. The first assessment that produces a RED tag stops further assessment of that patient. During triage, only manage the correction of life-threatening problems, such as airway obstruction or severe bleeding. 11. The triage priority determined in the treatment phase should be the priority used for transport. 12. If you identify a patient in the initial triage phase as a RED and transport is available, transport right away. Sort, Assess, Life-Saving Interventions, Treatment/Transport (SALT) The SALT method of triage combines many approaches from other triage processes. SALT uses the same categories as START, but also adds another category, “GRAY,” meaning the patient is expected to die, but is not yet deceased. This signals to responders to focus their efforts on more immediate patients that have a higher chance of survival. 1. Begin with patient categorization: global sorting for patients that can walk, wave, or are still, with the goal of prioritizing patients based on severity of injuries. 2. Patients are further classified into categories of immediate (RED), expectant (GRAY), delayed (YELLOW), minimal (GREEN), and deceased (BLACK). 3. Perform individual patient assessments and rapid life-saving interventions, such as control- ling massive hemorrhage or severe bleeding and addressing airway obstructions. 4. In general, the order of treatment or transport should be immediate patients first, then delayed, then minimal. Expectant patients should be provided with treatment or trans- port when resources allow. Multiple Agency Response ✅ HL224.3. Describe the officer’s role when assisting in a multiple agency response to a mass casualty incident In a multiple agency response, your role depends on your arrival time, department policies, and local protocol. Florida implements the incident command system (ICS) for multiple agency response Chapter 2 First Aid for Criminal Justice Officers / 83 in times of disaster. If necessary, the original ICS commander will relinquish command by provid- ing a situation report. An MCI can overwhelm anyone who reaches the scene first. Understanding the role of the first officer on the scene can reduce the stress of the situation. Taking control of the scene, getting information such as the number and category of patients to responding personnel, and beginning triage helps make the combined response successful. 84 / Florida Basic Recruit Training Program (HL): Volume 2