Triage: Hospital Emergency Awareness and Response Training

Hospital Emergency Awareness and Response Training
Triage
Learning Objectives
At the end of the session, the participant
should be able to :
1. Define the meaning of triage
2. Discuss the importance of triage at its
different levels
3. Describe the procedures of triage at different
levels

HEMS HEART 2010, Module 3, Triage
TRIAGE
French word meaning to sort
Utilized to identify treatment priorities
Process by which a decision is made on
which victim receives treatment and
which does not

Levels of Triage
There are four levels of Triage :
first level during search and rescue
second level at the advance medical post
third level during transport
fourth level at the emergency room of
receiving hospital

First Level of Triage
period - during search and rescue
location - at the impact site or ground
zero
categories - acute or non-acute

Second Level of Triage
period - during stabilization or
treatment
location - at the Advance Medical
Post
categories - as first, second, third,
fourth and last priority

Immediate Priority (First Priority)
patients that require immediate
care and transportation
patients receive treatment at the
scene for life threatening injuries
first to be sent to available medical
facilities

Priorities during Field Care

Intermediate Priority (Second Priority)

patients treatment and transport can
be delayed for up to one hour

Priorities
Delayed Priority (Third Priority)

referred to as walking wounded
injuries require medical care at some point
treatment and transport can be delayed for
up to three to six hours
monitor patients and re-assess
Priorities cont.
Low Priority (Fourth Priority)

patients who are near death
if still alive they have suffered severe or
serious injuries with little chance of survival
when resources are limited, these patients
must be ignored
Priorities cont.
No Priority (Last Priority)

patients who are dead
brought to a temporary mortuary for
identification
Priorities cont.
System requires first responders to have
tags, ribbons or tape in four colors

Immediate Priority (First Priority)
- Immediate care : life
threatening
injuries is highest priority
Intermediate Priority (Second Priority)
- Urgent care: may delay
treatment and transport for up to one hour

Delayed Priority (Third Priority)
- walking wounded : may delay
treatment and transport for up
to three to six hours

Low Priority (Fourth Priority)
Blue - patient is near death or sustained
injuries so severe that the chance
of survival is very small

No Priority (Last Priority)
Black /White - patient is dead

Simple Triage and Rapid
Treatment System
Initial Triage Officer
must size up situation
ensure safe approach and scene survey
activate additional resources
number of victims
size of the incident
better off requesting more equipment and
personnel than not enough at all
first step is to make an announcement for
all people able to get up and walk to
proceed to a specified area
allows responder to focus on injured
people who successfully move should be
tagged Green
tell people to look out for each other and
notify responders of any significant changes
in their conditions
Simple Triage and Rapid Treatment System cont
second step is to conduct an orderly survey
of remaining victims
decide how to move through the area
perform quick assessment on each person
and label or tag
no more than 10 seconds per patient
correct life threatening : airway or breathing
problem and profuse bleeding
the objective is to locate, identify and tag
first priority patients who require
immediate care and transportation
Simple Triage and Rapid Transport
System
This system focuses on three areas :
1. respirations
2. pulse rate and quality or capillary refill
3. mental status

Patient Assessment
Respiration
assess patients breathing, if none :
quickly make sure mouth is clear
open airway with head tilt method
if patient does not start to breath with this
simple airway maneuver, tag the patient
black
note : during mass casualty incident,
cervical spine immobilization may not be
able to be done

Respiration
if breathing is more than 30 per
minute, tag the patient red
if breathing is less than 30 per
minute, move on to assess the
quality and rate of the pulse or the
capillary refill
Patient Assessment cont.
Pulse rate and quality
check radial pulse for no more than 5
seconds
if there is no pulse, tag the patient black
if pulse is weak or irregular, tag the patient
red
if pulse is strong, move on to assess patients
mental status
Pulse rate and quality (another method)
check the capillary refill
if more than 2 seconds, tag the patient red
and control any bleeding
if less than 2 seconds, move on to assess the
patients mental status
Mental status
have patient respond to simple commands
such as open your eyes or squeeze my
hand
if the patient is unresponsive or can not
perform this function, tag the patient red
if patient can perform this function, tag
the patient yellow
START TRIAGE
MINOR
all walking wounded
RESPIRATION
IMMEDIATE
YES NO
Position Airway
YES NO
IMMEDIATE DECEASED
over under
30/min 30/min
PERFUSION
Radial Pulse Present
Radial Pulse Absent
Capillary Refill
Over Under
2 2
Control
Bleeding
IMMEDIATE
Secs Secs
Respirations 30/min
Perfusion 2 secs
Mental Status can do
MENTAL STATUS
Cant Follow Can Follow
Simple Commands Simple Commands
IMMEDIATE DELAYED
/Weak
you may change the
tag of black victims to
blue, if still alive
period - during evacuation or
transport
location - on the way to health facility
priorities- red, yellow, green, blue,
black / white
Third Level of Triage
period - definitive care
location - in the emergency room of
the receiving hospital
priorities - red, yellow, green, blue,
black/white
Fourth Level of Triage
Triage levels by Period, Location and Categories
Triage Period Location Categories
FIELD CARE
HOSPITAL CARE
First
Second
Third
Fourth
During Search
and Rescue
Stabilization
or Treatment
Evacuation
Definitive Care
Impact site
(Ground Zero)
Advance Medical
Post
Transport
Emergency Room
Acute
Non-acute
Red
Yellow
Green
Blue
Black/White
Red
Yellow
Green
Blue
Black/White
Red
Yellow
Green
Blue
Black/White
Use of Color Tag for Prioritization
Color Tag
Field Care (On Scene) Hospital Care
Priority for
evacuation
Medical needs Priority Conditions
Red 1
st
immediate care 1
st
life-threatening
Yellow 2
nd
urgent care 2
nd
not life
threatening
Green 3
rd
delayed need for care 3
rd
minor injuries

Blue 4
th
no need for care 4
th
near dead

Black / last dead last dead
White
Priority for In-Hospital Care
Red immediate, priority one (life threatening
condition)
obstruction or damage to airway
disturbance of breathing (resp. > 30/min)
disturbance of circulation
does not follow command or altered level of
Consciousness
need for life-saving measures and urgent
hospital admission
Injuries demand definitive treatment in hosp.
intermediate, urgent, priority two
needs to be treated within one hour otherwise
will become unstable
severe burns, burns involving hands, feet or
face (excluding resp. tract), burns complicated
by major soft tissue trauma
hospital admission is required
moderate blood loss; back injuries, head
injuries with normal level of consciousness
Priority for In-Hospital Care cont.
Green delayed, priority three
minor injuries not threatened by airway,
breathing and circulatory instability
minor fractures, minor soft tissue injuries,
minor burns
may or may not be admitted
Blue near dead, priority four
victims who are clinically dead
to be returned for re-triaging when time and
physical conditions allow

Black / dead, last priority
patient is dead
those who die while awaiting treatment

In Summary
We are able to:
1. Define the word triage
2. Discuss the importance of triage at its
different levels
3. Describe the procedures of triage at different
levels


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