Triage
• Definition
– French word meaning to sort
(Sorting – the act of separating
things and putting them in a
particular order)
Triage
• Purpose
– technique for assigning treatment priorities
– separates MCI victims into easily identifiable
groups
– determine required resources for treatment,
transportation and definitive care
– prioritization of patient distribution &
transportation
Triage
• Benefits
– identifies patients who require rapid medical care
to save life & limb
– by separating out the minor injuries, reduces the
urgent burden on medical facilities &
organizations
– provides a rational distribution of casualties
Triage
• Problems
– some triage systems rely on specific injuries &
physical findings in order to categorize & prioritize
patients
– in depth assessment requires more time than may
be available in the beginning of the MCI
Ideal Triage System
• Should be simple
• Does not require advanced assessment skills
• Does not rely on specific diagnosis
• Should be easy to perform
• Should provide for rapid & simple life - saving
interventions
• Should be easy to teach & learn
Triage Ribbon Concept
• Universal colors are used
– system depends on advanced assessment &
specific injuries to classify & prioritize patients
Triage Ribbon Concept
• Red - immediate
(highest priority)
– patients with
airway, breathing,
perfusion, or
neurologic problems
– airway burns also fit
in this category
Triage Ribbon Concept
• Yellow - delayed ( second
priority)
– burn patients without
airway problems
– major or multiple bone or
joint injuries
– back & spine injuries
Triage Ribbon Concept
• Green -
minor
(third
priority)
– walking
wounded
Triage Ribbon Concept
• Black - dead ( lowest
priority)
– non - salvageable patients
including cardiac arrest
patients
START
• S - Simple
• T - Triage
• A - and
• R - Rapid
• T - Treatment
START
• This system meets the criteria for an ideal
triage system
• Easy to learn
• Simple
START
• Begin where you stand
• Ask all those that can walk to move to a
designated area
– away from immediate danger
– outside initial triage area
START
• Move through the patients in an orderly
fashion
• Assess each casualty you come to and mark
the category using triage ribbons
START
• Maintain count of casualties
– mark on 2 - 3” tape on thigh
– save small piece of triage ribbon
• Give only minimal treatment
– airway
– gross hemorrhage control
START
•KEEP MOVING
TRIAGE COLOR
• D - DEAD OR EXPECTANT = BLACK
• I - IMMEDIATE = RED
• M - MINOR OR MININAL = GREEN
• E - EXPECTANT/DELAY = YELLOW
START Triage
RESPIRATIONS YES Under 30/min
NO
PERFUSION
Over 30/min
Cap refill Cap refill
Position Airway Immediate > 2 sec < 2 sec.
Control
NO YES Bleeding
MENTAL
STATUS
Dead or Immediate Immediate
Expectant
Failure to follow Can follow
simple commands simple commands
Immediate Delayed
Used with permission, Newport Beach Fire and Marine Dept.
START
R espiratory A ssessm en t
N o B reath in g N o B reath in g B reath in g
O pen A irw ay O pen A irw ay > 3 0 bpm < 3 0 bpm
N o B reath in g B reath in g R ed N ext C h eck
B lack R ed
START
Perfusion Assessm ent
Radial Pulse
Absent Present
Red Next Check
START
M ental Status Assessm ent
Follow Sim ple Com m ands
No Yes
RED Yellow or G reen
Routine
Priority M
Urgent
Urgent Surgical
Traffic Flow
Triage Area
D/E D
TRANSPORT PRIORITY
• What is the EVACUATION PRIORITY?
– PRIORITY I – URGENT EVACUATION WITHIN 2 HOURS
– PRIORITY IA - URGENT SURGICAL EVACUATION TO
NEAREST SURGICAL FACILITY WITHIN 2 HOURS
– PRIORITY II – PRIORITY EVACUATION WITHIN 4 HOURS
– PRIORITY III – ROUTINE EVACUATION WITHIN 24 HOURS
– PRIORITY IV - CONVENIENCE
START - Respiratory
Assessment
• Check for respiratory compromise
– none? Open airway! Still none? - BLACK
– none? Open airway! Breathing? - RED
– > 30 bpm? - RED
– < 30 bpm? - Next check
– * Maintain airway however possible*
START - Perfusion Assessment
• Check for perfusion compromise
– radial pulse absent? - RED
– radial pulse present? - next check
– *Stop gross hemorrhage*
START - Mental Status Assessment
• Ask patient to follow simple commands
– does not follow command? - RED
– if able to follow command? - YELLOW or GREEN
Treatment Function
• Secondary Triage
• Purpose
– identify specific injuries/illnesses
– to categorize patients & render appropriate care
– to prioritize for transportation
Treatment Function
• START depends only on three simple
observations ( RPM)
• A more in depth assessment must be
performed (secondary triage)
Treatment Function
• Secondary triage can be
done:
– on a stretcher on the
way to a treatment
sector
– in the treatment sector
– in an ambulance on the
way to the hospital
Treatment Function
• Reassessment done in secondary triage is
more subjective than the START triage
• Some of the patient priority distinctions may
become blurred
• Adherence to general guidelines will insure
the best matching of patient conditions with
available resources
What’s your call?
• Toddler found outside the bus, lying on the
ground in a heap.
• Apneic
• Remains apneic with jaw thrust
• Faint distal pulse palpable.
• RED OR BALCK
What’s your call?
• A school aged girl lies among the wreckage.
• RR 40
• Absent distal pulse
• Withdraws from painful stimulus
• RED
What’s your call?
• A screaming infant is found among the bushes
at the side of the road.
• RR 38
• Good distal pulse
• Focuses and reaches for you.
• Has a partial amputation of the foot without
active bleeding.
• YELLOW
What’s your call?
• An adult male lies inside the bus.
• Apneic
• Remains apneic with jaw thrust
• BLACK
What’s your call?
• A youngster is up and walking
around but is limping
• Alert, crying hysterically for his
mother
• GREEN
What’s your call?
• A school aged boy lies close to the bus.
• RR 36
• Absent distal pulse
• Sluggishly looks at you when you talk to him
• RED
What’s your call?
• A young teen girl lies among the wreckage,
crying for someone to help her up. A man with
her says she needs her wheelchair.
• RR 22
• Palpable distal pulse
• Alert
• Has minor cuts and bruises
• GREEN
What’s your call?
• An adult male lies on the ground
• RR 20
• Good distal pulse
• Obeys commands but cries that he can’t move
his legs
• YELLOW OR RED
What’s your call?
• An older school aged child is found sitting
outside the bus.
• RR 28
• Good distal pulse
• Groggy, confused and slowly follows
commands but won’t get up and walk.
• YELLOW
Advantages
• JumpSTART provides a rapid triage system
specifically designed for children, taking
into consideration their unique physiology.
• The algorithm is modified from an existing
system widely accepted for adult triage.
• For most patients, triage can be
accomplished within the 30 second goal.
Advantages
• Objective triage criteria for children will
help to eliminate the role of emotions in
the triage process.
• Objective triage criteria will provide
emotional support for triage personnel
forced to make life or death decisions for
children in the MCI setting.
• THE END
“Ready to Serve, Ready to Save”
‘…so that others may live’
Thank you for listening..
