logging in or signing up triage_and_more Monhae Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 97 Category: Education License: All Rights Reserved Like it (1) Dislike it (0) Added: December 17, 2010 This Presentation is Public Favorites: 0 Presentation Description START Triage training class Comments Posting comment... By: DR_AFTAB (7 month(s) ago) THANKS A LOT. WAS REALLY HELPFUL. KEEP UP THE GOOD WORK. Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Triage and More : Triage and More Scurry County EMS August 17, 2010 Topics : Topics What is Triage? Triage Tools Triage Categories When to triage Slide 3: What is Triage? “Triage” means “to sort” Looks at medical needs and urgency of each individual patient Sorting based on limited data acquisition Also must consider resource availability Slide 4: Concepts in Triage “The needs of the many outweigh the needs of the few or the one." Star Trek Slide 5: Concepts in Triage Those with the most serious but realistically salvageable injuries are treated first Victims with clearly lethal injuries or those who are unlikely to survive even with extensive resource application are treated as the lowest priority. Slide 6: Ethical Justification This is one of the few places where a "utilitarian rule" governs medicine: the greater good of the greater number rather than the particular good of the patient at hand. This rule is justified only because of the clear necessity of general public welfare in a crisis. A. Jonsen and K. Edwards, “Resource Allocation” in Ethics in Medicine, Univ. of Washington School of Medicine, http://eduserv.hscer.washington.edu/bioethics/topics/resall.html Slide 7: Why Should Responders Care About Good Triage? Provides a way to draw organization out of chaos Helps to get care to those who need it and will benefit from it the most Helps in resource allocation Provides an objective framework for stressful and emotional decisions Slide 8: When Does Triage Begin? With Dispatch: The moment the call comes in. Initializing resources and implementing response plans is the first priority, prior to arrival at the scene. Proactive Anticipation saves lives. Reactive Response often puts you behind the 8 ball. Slide 9: Triage is Dynamic! Triage must constantly adjust to accommodate continual changes in: Patient conditions Scene Conditions Resources Environment Responder Health and Safety Slide 10: Why are Resources Important in Triage? Disaster is commonly defined as an incident in which patient care needs overwhelm local response resources. Daily emergency care is not usually constrained by resource availability. Slide 11: R Abundant resources relative to demand Do the best for each individual (P = Patient) Slide 12: R Resources challenged Do the best for each individual (P = Patient) Slide 13: Do the greatest good for the greatest number R P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P Resources overwhelmed (P = Patient) Slide 14: Primary Disaster Triage Goal: to sort patients based on probable needs for immediate care. Also to recognize futility. Assumptions: Medical needs outstrip immediately available resources Additional resources will become available with time Slide 15: Primary Disaster Triage Triage based on physiology How well the patient is able to utilize their own resources to deal with their injuries Which conditions will benefit the most from the expenditure of limited resources Slide 16: Secondary Disaster Triage Goal: to best match patients’ current and anticipated needs with available resources. Incorporates: A reassessment of physiology An assessment of physical injuries Initial treatment and assessment of patient response Further knowledge of resource availability Slide 17: Tertiary Disaster Triage Goal: to optimize individual outcome Incorporates: Sophisticated assessment and treatment Further assessment of available medical resources Determination of best venue for definitive care Slide 18: Primary Triage Secondary Triage Tertiary Triage Slide 19: Primary Disaster Triage The most commonly used adult tool in the US and Canada is the START tool. The only recognized pediatric MCI primary triage tool used in the US and Canada is the JumpSTART tool. Other tools exist but are less oriented to mass casualties than triaging smaller numbers of (adult) trauma patients. Slide 20: Triage Categories Red: Life-threatening but treatable injuries requiring rapid medical attention Yellow: Potentially serious injuries, but are stable enough to wait a short while for medical treatment Slide 21: Triage Categories Green: Minor injuries that can wait for longer periods of time for treatment Black: Dead or still with life signs but injuries are incompatible with survival in austere conditions Slide 22: START Simple Triage And Rapid Treatment Developed jointly by Newport Beach (CA) Fire and Marine Dept. and Hoag Hospital Gold standard for field adult multiple casualty (MCI) triage in the US and numerous countries around the world Slide 23: START: Step 1 Triage officer announces that all patients that can walk should get up and walk to a designated area for eventual secondary triage. All ambulatory patients are initially tagged as Green. Slide 24: START Triage RESPIRATIONS NO YES Dead or Expectant Immediate Position Airway NO YES Over 30/min Immediate Under 30/min PERFUSION Cap refill > 2 sec Control Bleeding Immediate Cap refill < 2 sec. MENTAL STATUS Failure to follow simple commands Can follow simple commands Immediate Delayed Slide 25: START: Step 2 Triage officer assesses patients in the order in which they are encountered Assess for presence or absence of spontaneous respirations If breathing, move to Step 3 If apneic, open airway If patient remains apneic, tag as Black If patient starts breathing, tag as Red Slide 26: START: Step 3 Assess respiratory rate If ≤30, proceed to Step 4 If 30, tag patient as Red Slide 27: START: Step 4 Assess capillary refill If ≤ 2 seconds, move to Step 5 If 2 seconds, tag as Red Slide 28: START: Step 5 Assess mental status If able to obey commands, tag as Yellow If unable to obey commands, tag as Red Slide 29: Mnemonic R P M 30 2 Can do Slide 30: The physiology of adults and children are not the same. Primary MCI triage is based on physiology… Slide 31: Pediatric multicasualty triage may be affected by the emotional state of triage officers. Why do we need a pediatric tool? Slide 32: JumpSTART Pediatric MCI Triage Developed by Lou Romig MD, FAAP, FACEP Now in widespread use throughout the US and Canada Being taught in Japan, Germany, Switzerland, the Dominican Republic, Africa, Polynesia Slide 33: JumpSTART: Age Initially ages 1-8 years chosen Less than one year of age is less likely to be ambulatory. The pertinent pediatric physiology (specifically, the airway) approaches that of adults by approximately eight years of age. BUT… Slide 34: I’m 10! Slide 35: JumpSTART: Age The ages of “tweens and teens” can be hard to determine so the current recommendation is: If a victim appears to be a child, use JumpSTART. If a victim appears to be a young adult, use START. Slide 36: JumpSTART: Ambulatory Identify and direct all ambulatory patients to designated Green area for secondary triage and treatment. Begin assessment of nonambulatory patients as you come to them. Slide 37: Modification for nonambulatory children All children carried to the GREEN area by other ambulatory victims must be the first assessed by medical personnel in that area. Slide 38: JumpSTART: Breathing? If breathing spontaneously, go on to the next step, assessing respiratory rate. If apneic or with very irregular breathing, open the airway using standard positioning techniques. If positioning results in resumption of spontaneous respirations, tag the patient immediate and move on. Slide 39: The “Jumpstart” Part If no breathing after airway opening, check for peripheral pulse. If no pulse, tag patient deceased/nonsalvageable and move on. If there is a peripheral pulse, give 5 mouth to barrier ventilations. If apnea persists, tag patient deceased/nonsalvageable and move on. If breathing resumes after the “jumpstart”, tag patient immediate and move on. DO NOT CONTINUE TO VENTILATE THE PATIENT. RESUME TRIAGE DUTIES. Slide 40: JumpSTART: Respiratory Rate If respiratory rate is 15-45/min, proceed to assess perfusion. If respiratory rate is <15 or >45/min or irregular, tag patient as immediate and move on. Slide 41: JumpSTART:Perfusion If peripheral pulse is palpable, proceed to assess mental status. If no peripheral pulse is present (in the least injured limb), tag patient immediate and move on. Slide 42: JumpSTART: Mental Status Use AVPU scale to assess mental status. If Alert, responsive to Verbal, or appropriately responsive to Pain, tag as delayed and move on. If inappropriately responsive to Pain or Unresponsive, tag as immediate and move on. Slide 44: Modification for nonambulatory children Infants who normally can’t walk yet Children with developmental delay Children with acute injuries preventing them from walking before the incident Children with chronic disabilities Slide 45: Modification for nonambulatory children Evaluate using the JS algorithm If any RED criteria, tag as RED. If pt satisfies YELLOW criteria: YELLOW if significant external signs of injury are found (ie. deep penetrating wounds, severe bleeding, severe burns, amputations, distended tender abdomen) GREEN if no significant external injury Slide 46: Note for Black Category Victims Unless clearly suffering from injuries incompatible with life, victims tagged in the BLACK category should be reassessed once critical interventions have been completed for YELLOW and RED patients. Slide 50: Certainties about MCI Triage Organization is a good thing in a disaster Triage tools must help match limited resources to an abundance of needs Physiologic tools should suit physiologic differences Triage tools should be kept as simple as possible and practiced often Slide 51: Triage should be done with the head, not the heart. Biggest Rule. Slide 52: The End You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
triage_and_more Monhae Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 97 Category: Education License: All Rights Reserved Like it (1) Dislike it (0) Added: December 17, 2010 This Presentation is Public Favorites: 0 Presentation Description START Triage training class Comments Posting comment... By: DR_AFTAB (7 month(s) ago) THANKS A LOT. WAS REALLY HELPFUL. KEEP UP THE GOOD WORK. Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Triage and More : Triage and More Scurry County EMS August 17, 2010 Topics : Topics What is Triage? Triage Tools Triage Categories When to triage Slide 3: What is Triage? “Triage” means “to sort” Looks at medical needs and urgency of each individual patient Sorting based on limited data acquisition Also must consider resource availability Slide 4: Concepts in Triage “The needs of the many outweigh the needs of the few or the one." Star Trek Slide 5: Concepts in Triage Those with the most serious but realistically salvageable injuries are treated first Victims with clearly lethal injuries or those who are unlikely to survive even with extensive resource application are treated as the lowest priority. Slide 6: Ethical Justification This is one of the few places where a "utilitarian rule" governs medicine: the greater good of the greater number rather than the particular good of the patient at hand. This rule is justified only because of the clear necessity of general public welfare in a crisis. A. Jonsen and K. Edwards, “Resource Allocation” in Ethics in Medicine, Univ. of Washington School of Medicine, http://eduserv.hscer.washington.edu/bioethics/topics/resall.html Slide 7: Why Should Responders Care About Good Triage? Provides a way to draw organization out of chaos Helps to get care to those who need it and will benefit from it the most Helps in resource allocation Provides an objective framework for stressful and emotional decisions Slide 8: When Does Triage Begin? With Dispatch: The moment the call comes in. Initializing resources and implementing response plans is the first priority, prior to arrival at the scene. Proactive Anticipation saves lives. Reactive Response often puts you behind the 8 ball. Slide 9: Triage is Dynamic! Triage must constantly adjust to accommodate continual changes in: Patient conditions Scene Conditions Resources Environment Responder Health and Safety Slide 10: Why are Resources Important in Triage? Disaster is commonly defined as an incident in which patient care needs overwhelm local response resources. Daily emergency care is not usually constrained by resource availability. Slide 11: R Abundant resources relative to demand Do the best for each individual (P = Patient) Slide 12: R Resources challenged Do the best for each individual (P = Patient) Slide 13: Do the greatest good for the greatest number R P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P P Resources overwhelmed (P = Patient) Slide 14: Primary Disaster Triage Goal: to sort patients based on probable needs for immediate care. Also to recognize futility. Assumptions: Medical needs outstrip immediately available resources Additional resources will become available with time Slide 15: Primary Disaster Triage Triage based on physiology How well the patient is able to utilize their own resources to deal with their injuries Which conditions will benefit the most from the expenditure of limited resources Slide 16: Secondary Disaster Triage Goal: to best match patients’ current and anticipated needs with available resources. Incorporates: A reassessment of physiology An assessment of physical injuries Initial treatment and assessment of patient response Further knowledge of resource availability Slide 17: Tertiary Disaster Triage Goal: to optimize individual outcome Incorporates: Sophisticated assessment and treatment Further assessment of available medical resources Determination of best venue for definitive care Slide 18: Primary Triage Secondary Triage Tertiary Triage Slide 19: Primary Disaster Triage The most commonly used adult tool in the US and Canada is the START tool. The only recognized pediatric MCI primary triage tool used in the US and Canada is the JumpSTART tool. Other tools exist but are less oriented to mass casualties than triaging smaller numbers of (adult) trauma patients. Slide 20: Triage Categories Red: Life-threatening but treatable injuries requiring rapid medical attention Yellow: Potentially serious injuries, but are stable enough to wait a short while for medical treatment Slide 21: Triage Categories Green: Minor injuries that can wait for longer periods of time for treatment Black: Dead or still with life signs but injuries are incompatible with survival in austere conditions Slide 22: START Simple Triage And Rapid Treatment Developed jointly by Newport Beach (CA) Fire and Marine Dept. and Hoag Hospital Gold standard for field adult multiple casualty (MCI) triage in the US and numerous countries around the world Slide 23: START: Step 1 Triage officer announces that all patients that can walk should get up and walk to a designated area for eventual secondary triage. All ambulatory patients are initially tagged as Green. Slide 24: START Triage RESPIRATIONS NO YES Dead or Expectant Immediate Position Airway NO YES Over 30/min Immediate Under 30/min PERFUSION Cap refill > 2 sec Control Bleeding Immediate Cap refill < 2 sec. MENTAL STATUS Failure to follow simple commands Can follow simple commands Immediate Delayed Slide 25: START: Step 2 Triage officer assesses patients in the order in which they are encountered Assess for presence or absence of spontaneous respirations If breathing, move to Step 3 If apneic, open airway If patient remains apneic, tag as Black If patient starts breathing, tag as Red Slide 26: START: Step 3 Assess respiratory rate If ≤30, proceed to Step 4 If 30, tag patient as Red Slide 27: START: Step 4 Assess capillary refill If ≤ 2 seconds, move to Step 5 If 2 seconds, tag as Red Slide 28: START: Step 5 Assess mental status If able to obey commands, tag as Yellow If unable to obey commands, tag as Red Slide 29: Mnemonic R P M 30 2 Can do Slide 30: The physiology of adults and children are not the same. Primary MCI triage is based on physiology… Slide 31: Pediatric multicasualty triage may be affected by the emotional state of triage officers. Why do we need a pediatric tool? Slide 32: JumpSTART Pediatric MCI Triage Developed by Lou Romig MD, FAAP, FACEP Now in widespread use throughout the US and Canada Being taught in Japan, Germany, Switzerland, the Dominican Republic, Africa, Polynesia Slide 33: JumpSTART: Age Initially ages 1-8 years chosen Less than one year of age is less likely to be ambulatory. The pertinent pediatric physiology (specifically, the airway) approaches that of adults by approximately eight years of age. BUT… Slide 34: I’m 10! Slide 35: JumpSTART: Age The ages of “tweens and teens” can be hard to determine so the current recommendation is: If a victim appears to be a child, use JumpSTART. If a victim appears to be a young adult, use START. Slide 36: JumpSTART: Ambulatory Identify and direct all ambulatory patients to designated Green area for secondary triage and treatment. Begin assessment of nonambulatory patients as you come to them. Slide 37: Modification for nonambulatory children All children carried to the GREEN area by other ambulatory victims must be the first assessed by medical personnel in that area. Slide 38: JumpSTART: Breathing? If breathing spontaneously, go on to the next step, assessing respiratory rate. If apneic or with very irregular breathing, open the airway using standard positioning techniques. If positioning results in resumption of spontaneous respirations, tag the patient immediate and move on. Slide 39: The “Jumpstart” Part If no breathing after airway opening, check for peripheral pulse. If no pulse, tag patient deceased/nonsalvageable and move on. If there is a peripheral pulse, give 5 mouth to barrier ventilations. If apnea persists, tag patient deceased/nonsalvageable and move on. If breathing resumes after the “jumpstart”, tag patient immediate and move on. DO NOT CONTINUE TO VENTILATE THE PATIENT. RESUME TRIAGE DUTIES. Slide 40: JumpSTART: Respiratory Rate If respiratory rate is 15-45/min, proceed to assess perfusion. If respiratory rate is <15 or >45/min or irregular, tag patient as immediate and move on. Slide 41: JumpSTART:Perfusion If peripheral pulse is palpable, proceed to assess mental status. If no peripheral pulse is present (in the least injured limb), tag patient immediate and move on. Slide 42: JumpSTART: Mental Status Use AVPU scale to assess mental status. If Alert, responsive to Verbal, or appropriately responsive to Pain, tag as delayed and move on. If inappropriately responsive to Pain or Unresponsive, tag as immediate and move on. Slide 44: Modification for nonambulatory children Infants who normally can’t walk yet Children with developmental delay Children with acute injuries preventing them from walking before the incident Children with chronic disabilities Slide 45: Modification for nonambulatory children Evaluate using the JS algorithm If any RED criteria, tag as RED. If pt satisfies YELLOW criteria: YELLOW if significant external signs of injury are found (ie. deep penetrating wounds, severe bleeding, severe burns, amputations, distended tender abdomen) GREEN if no significant external injury Slide 46: Note for Black Category Victims Unless clearly suffering from injuries incompatible with life, victims tagged in the BLACK category should be reassessed once critical interventions have been completed for YELLOW and RED patients. Slide 50: Certainties about MCI Triage Organization is a good thing in a disaster Triage tools must help match limited resources to an abundance of needs Physiologic tools should suit physiologic differences Triage tools should be kept as simple as possible and practiced often Slide 51: Triage should be done with the head, not the heart. Biggest Rule. Slide 52: The End