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13 Cards in this Set

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Triage
Sorting or categorizing
During a disaster, the goal is to maximize the number of survivors by sorting the treatable from the untreatable victims.
Potential for survival and available resources determine who receives immediate treatment
Primary goal during disaster
Save the greatest number of lives
Triage done at site of disaster and again at each stage of transport
Nurses and emergency personnel most often do the triage while physicians are caring for the most critically injured
Triage categories may be descriptive words, numbers or colors
Five Category-Coding for Triage
Red-Most Urgent; first priority
Yellow-Urgent; second priority
Green-Minimal; Third priority
Black-Dying, hopelessly injured or dead
Contaminated-may have a color code or Hazardous material (HAZ-MAT) tag.
3 Category triage rating system in the emergency department
Emergent
Urgent
Non-Urgent
Emergency Room triage
Who is seen first?
Chest Pain
Respiratory distress
Hemorrhage
Trauma
The necessity of triage
A surgeon can only treat one person at a time. A typical hospital has only a few surgeons available and would be overwhelmed if presented with several casualties all requiring immediate surgical care
...patients needing urgent surgical care need to be sent to a number of area hospitals including regional trauma centers to "even out the load," especially because some victims will "self-transport" to nearby facilities which are most likely to be overwhelmed, as well as possibly damaged in the disaster.
Advanced triage may become necessary when
Advanced triage may become necessary when medical professionals determine that the medical resources available are insufficient to treat all the people who need help. This has happened in disasters such as earthquakes, tsunami and civil defense situations and would happen in the event of nuclear warfare
In an extreme case like in a disaster, do people receive medical attention when they have extensive injuries-severe burns, excessive blood loss, etc
In this extreme case, any medical care given to people doomed to die is care taken away from people who might live if they had been given it. It becomes the unpleasant task of the disaster medical authorities to set aside some victims (especially burn victims) because it would take a staff of several professionals to save their one life at the expense of several others.
START (Simple Triage and Rapid Treatment)
START is an expedient triage system that can be performed by lightly-trained lay and emergency personnel in emergencies. It is not intended to supersede or instruct medical personnel or techniques. It has been field-proven in mass casualty incidents such as train wrecks and bus accidents
Triage separates the injured into four groups:
The DECEASED who are beyond help, the injured who can be helped by IMMEDIATE transportation, the injured whose transport can be DELAYED, and those with MINOR injuries—the walking wounded who need help less urgently. Other regions may use different designations.
Simple triage and evacuation
Simple triage identifies which persons need advanced medical care. In the field, triage also sets priorities for evacuation to hospitals. In START, persons should be evacuated as follows:
DECEASED are left where they fell, covered if necessary; note that in START a person is not triaged "DECEASED" unless they are not breathing and an effort to reposition their airway has been unsuccessful.
IMMEDIATE priority evacuation by MEDEVAC if available or ambulance as they need advanced medical care at once or within 1 hour.
DELAYED can have their medical evacuation delayed until all IMMEDIATE persons have been transported.
MINOR are not evacuated until all IMMEDIATE and DELAYED persons have been evacuated. These will not need advanced medical care for at least several hours. Continue to re-triage in case their condition worsens.
Advanced triage
In advanced triage systems, secondary triage is typically implemented by paramedics, battlefield medical personnel or by skilled nurses in the emergency departments of hospitals during disasters, injured people are sorted into five categories.
Blue / Expectant
They are so severely injured that they will die of their injuries, possibly in hours or days (large-body burns, severe trauma, lethal radiation dose), or in life-threatening medical crisis that they are unlikely to survive given the care available (cardiac arrest, septic shock); they should be taken to a holding area and given painkillers to ease their passing.
Red / Immediate
They require immediate surgery or other life-saving intervention, first priority for surgical teams or transport to advanced facilities, "cannot wait" but are likely to survive with immediate treatment.
Yellow / Observation
Their condition is stable for the moment but requires watching by trained persons and frequent re-triage, will need hospital care (and would receive immediate priority care under "normal" circumstances).
Green / Wait
They will require a doctor's care in several hours or days but not immediately, may wait for a number of hours or be told to go home and come back the next day (broken bones without compound fractures, many soft tissue injuries).
White / Dismiss
They have minor injuries; first aid and home care are sufficient, a doctor's care is not required.
Note that this scale is much more complex than with simple triage. Medical professionals should refer to professional texts and training references when implementing advanced triage; this listing is only for a layperson's understanding.

Some crippling injuries, even if not life-threatening, may be elevated in priority based on the available capabilities. During peacetime, most amputations may be triaged "Red" because surgical reattachment must take place within minutes—even though strictly speaking, the person will not die without a thumb or hand.
Triage should be a ________ process and categories should be checked _________ to ensure that the priority remains correct.
Triage should be a continuous process and categories should be checked regularly to ensure that the priority remains correct.