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Marien H.

Receno BSN IV-4
1. Define Triage.

NCM 201 SKILLS JUNE 21, 2013

Triage is the sorting of and allocation of treatment to patients and especially battle and disaster victims according to a system of priorities designed to maximize the number of survivors. It is the sorting of patients (as in an emergency room) according to the urgency of their need for care. http://www.merriam-webster.com/dictionary/triage 2. Research an updated American Heart Association CPR 2010/2011

CPR Guidelines for American Heart Association and American Red Cross In 2010 the American Heart Association (AHA) and the American Red Cross (ARC) adopted new CPR guidelines. This article examines the similarities and differences between both organizations’ CPR guidelines. ADULT CPR What follows is my paraphrasing of the AHA and ARC’s Adult CPR guidelines. They are meant as a point of comparison for this article, not to be taken as either organizations’ stated guidelines. Visit the AHA and ARC websites or buy their course manuals to compare their nomenclature and exact guidelines. American Heart Association 1) 2) 3) Make sure the scene is safe before approaching the victim. Check to see if the person responds by tapping the victim and shouting, “Are you OK? If the person doesn’t respond, get help. Have you and someone else call 911 and get an AED (automated

external defibrillator) if available. 4) Check for breathing. The breathing should be normal, not gasping. If the person is not breathing or only

gasping, they need CPR. 5) Begin CPR with 30 chest compressions. Push down at least 2 inches. The rate of compressions is at least 100

compressions a minute. After each compression let the chest come back up to its normal position. 6) 7) Open the airway with a head tilt-chin lift and give 2 breaths. Continue giving 30 compression and 2 breaths until the person starts to respond, you are too exhausted to

continue, the scene becomes unsafe, an AED arrives or EMS (Emergency Medical Services) arrives. American Red Cross 1) 2) 3) Make sure the scene is safe before approaching the victim. Check to see if the person responds by tapping the victim and shouting, “Are you OK?” If the person doesn’t respond, get help. Have you and someone else call 911 and get an AED (automated

external defibrillator) if available. 4) Check for breathing by performing a head tilt-chin lift. Look, listen and feel for breathing for no more than 10

seconds. Occasional gasps are not breathing. 5) Quickly scan for severe bleeding.

Then scan for bleeding. breathing) sequence for infants and children who don’t respond and aren’t breathing normally. The rate of compressions is at least 100 compressions a minute.heart. Continue giving 30 compression and 2 breaths until you find an obvious sign of life. INFANT AND CHILD CPR Rather than include a list of both organizations’ sequences for infant and child CPR. the scene becomes unsafe.Marien H. CPR always begins with chest compressions no matter who the victim is and whether you witnessed their collapse or not. “look. Differences: The primary difference is how breathing is assessed. but how this is done is not specifically stated. The responder checks for breathing. I’m only going to discuss the differences in their guidelines. After each compression let the chest come back up to its normal position. airway. However. you are too exhausted to continue. The ARC still uses this approach as part of their guidelines for infants and children. “look. The method was developed in 1983 by the staff members of Hoag Hospital and Newport Beach Fire Department located in California. begin CPR with the CAB sequence. if you witnessed the child or infant collapse you would use the CAB sequence – the 2 initial rescue breaths are not given. listen and feel for breathing” from its guidelines. The ARC still instructs. If the victim still isn’t breathing normally. an AED arrives or EMS (Emergency Medical Services) arrives. the free encyclopedia Simple triage and rapid treatment (START) is a triage method used by first responders to quickly classify victims during a mass casualty incident (MCI) based on the severity of their injury. listen. and feel” for breathing in the assessment for infants and children. The ARC continues to include the step of quickly scanning for severe bleeding after checking for breathing. 2013 Begin CPR with 30 chest compressions. Push down at least 2 inches for an adult.pdf 3. and is currently widely used in the United States. . 1) The AHA follows the CAB (compressions. give 2 rescue breathes. REFERENCES:http://inhomecpr.com/in_home_cpr_news/cpr-guidelines-for-american-heart-associationand-american-red-cross/ http://www. The AHA does not include this step. START SYSTEM Simple triage and rapid treatment From Wikipedia. The AHA has eliminated. 2) The AHA has also eliminated “look. The ARC takes a different approach if you did not witness the infant or child collapse: if there is no response and breathing is not normal. Receno BSN IV-4 6) NCM 201 SKILLS JUNE 21. 7) 8) Open the airway with a head tilt-chin lift and give 2 breaths.org/idc/groups/heartpublic/@wcm/@ecc/documents/downloadable/ucm_317350. listen and feel” for breathing.

No further interventions or therapies are attempted on deceased patients until all other patients have been treated. followed by the walking wounded.Marien H. thereby identifying the ambulatory. START is not a system for determining resource allocation. Receno BSN IV-4 Classification NCM 201 SKILLS JUNE 21. the START classifications are used to determine the order in which victims should undergo secondary triage.More detailed secondary triage systems such as SAVE may also be used: in this case. patients. One early proposed modification substituted the presence of a radial pulse for capillary refill in classifying patients as immediate. The classification algorithm used in START does not depend on the number of victims or on the number of resources available to treat them. capillary refill greater than two seconds. followed by delayed victims. Treatment and Evacuation After all patients have been evaluated. [3] Responders arriving to the scene of a mass casualty incident may first ask that any victim who is able to walk relocate to a certain area. or walking wounded. responders use the START classifications to determine priorities for treatment or evacuation to a hospital. 2013 First responders using START evaluate victims and assign them to one of the following four categories:     Immediate (red) Delayed (yellow) Walking wounded/minor (green) Deceased/expectant (black) The colors correspond to triage tags. Non-ambulatory patients are then assessed. nor does using START alone provide any prioritization of patients within any of the four triage classes. Modifications to START and Similar Triage Systems Numerous agencies have developed modifications to START or new triage systems similar to START. although physical tags are not necessary if patients can be physically sorted into different areas. The Fire Department of New York uses a modified version of START with an orange or "urgent" classification intermediate in severity between immediate and delayed. Any patient who is not breathing after this attempt is classified as deceased and given a black tag. The only medical intervention used prior to declaring a patient deceased is an attempt to open the airway. unresponsive (unable to follow commands) [1][2] All other patients are classified as delayed. Patients who are breathing and have any of the following conditions are classified as immediate:    respiratory rate greater than 30 per minute. . Therefore. significant differences in implementation of treatment and evacuation may exist across different agencies using START. which are used by some agencies to indicate each victim's status. The most basic way to use the START classifications is to transport victims in a fixed priority manner: immediate victims.

is also a major limitation. look around.Marien H. As you prepare to give the first vital report. including the potential number of patients involved. request seven ambulances. its simplicity. START suffers from implementation problems such as substantial amounts of overtriage One of the major strengths of START. and so forth. is to request one ambulance for every five patients. The key points to communicate are: Location of the incident Type of incident Any hazards Approximate number of victims Type of assistance required Note: Be as specific with your requests as possible. you are focusing your activities in the middle of a chaotic and confusing environment. and do not shout. you should be preparing yourself mentally for what you may find. Receno BSN IV-4 Modification for Pediatric Patients NCM 201 SKILLS JUNE 21. These visual surveys give you an initial impression of the overall situation. JumpSTART assigns the immediate classification on the basis of respiratory rate only if the child's respiration is under 15 or over 45 per minute Similar Triage Systems Other triage systems that are variations of or similar to START include Triage Seive. En route Even while you are responding to the scene of an incident. consensus has emerged that triage should be more sophisticated. be concise. by incorporating resource limitations and capacity in determining how to prioritize patients.org/wiki/Simple_triage_and_rapid_treatment Simple Triage and Rapid Treatment (START) By using a casualty sorting system. for 23 patients request five ambulances. in multiple. and CareFlite Triage. You must identify and separate patients rapidly. One such modification is known as JumpSTART. Limitations There is no accepted measure to judge the appropriateness of any given system in mass casualty triage. . be calm. Field experience has shown that a good rule of thumb initially. Perhaps you've been to the same location. for 35 patients. Where will help come from? How long will it take to arrive? Initial Assessment . Like many other triage systems. colors. even the severity of their injuries.Stay Calm The first thing you should do upon arriving at the scene of an incident is to try to stay calm. The visual survey should enable you to estimate initially the amount and type of help needed to handle the situation. and possibly. REFERENCE [2] Each of these systems uses four or five triage classes with the red. 2013 START has also been modified to provide better treatment for children. For example. The primary modification for use with pediatric patients is to change the "normal" respiratory rate: since children breathe faster than adults. You are trying to give the communications center a concise verbal picture of the scene. according to the severity of their injuries and their need for treatment. use clear language (no signals or radio jargon).Creating a Verbal Image The initial report is often the most important message of a disaster because it sets the emotional and operational stage for everything that follows.or mass-casualty situations. Pediatric Triage Tape. Since START was developed.wikipedia. yellow. green. and black :http://en. and get an overview of the scene. Your Initial Report .

You cannot stop during this survey. Repeat: This is a major accident. about 2 miles east of Route 610. Your job is to sort (triage) the patients. 2013 Before starting. Dispatch additional police units to assist. Receno BSN IV-4 NCM 201 SKILLS JUNE 21. Other rescuers will provide follow-up treatment. I am requesting the fire department. and seven ambulances at this time. The START System: It really works! . There are people trapped. conduct a rapid assessment." Sorting the Patients It is important not to become involved with the treatment of the first or second patient with whom you come in contact. rescue squad. and assign patients to broad categories based on their need for treatment. You might give the following report: "This is a major accident involving a truck and a commercial bus on Highway 305.Marien H. except to correct airway and severe bleeding problems quickly. take several deep breaths to give your mind time to catch up with your eyes and to try to calm your voice. There are approximately 35 victims. Remember that your job is to get to each patient as quickly as possible.

Perfusion and Mental Status. stopping at each person for a quick assessment and tagging. These patients are showing one of the primary signs of shock and need immediate care.tag the patient . Tagging is done using a variety of methods determined by your local Emergency Services System. position the patient to maintain the airway and -. Colored surveyors' tape or colored paper tags may be used. This is the only time in emergency care when there may not be time to properly stabilize every injured patient's spine. In this type of multiple. Perfusion. If the patient is breathing and the breathing rate is less than 30 per minute. As more rescue personnel arrive on the scene. Move in an orderly and systematic manner through the remaining victims. Patients with breathing rates greater than 30 per minute are tagged . Examine each patient. correct life-threatening airways and breathing problems.if the patient breathes -. These patients are now designated as . delayed care / can delay up to three hours urgent care / can delay up to one hour immediate care / lifethreatening victim is dead / no care required The First Step in START: Get up and Walk! The first step in START is to tell all the people who can get up and walk to move to a specific area. and Mental Status (RPM). in a systematic manner. quickly clear the mouth of foreign matter. Each patient must be evaluated quickly. tag the patient with a red tag and MOVE ON! How To Evaluate Patients Using RPM The START system is based on three observations: RPM--Respiration. If the patient is breathing. those victims who can walk are asked to move away from the immediate rescue scene to a specific designated safe area. The START system is designed to assist rescuers to find the most seriously injured patients. The Second Step in START: Begin Where You Stand Begin the second step of START by moving from where you stand.Marien H. Triage Tagging: To Tell Others What You've Found Patients are tagged for easy recognition by other rescuers arriving on the scene. based on three primary observations: Respiration. The stop at each patient should never take more than one minute. If the patient is not breathing. move on to the circulation and mental status observations in order to complete your 30-second survey. they are probably not at risk of immediate death. stabilization. Open the airway.or mass-casualty situation. In order to make the situation more manageable. treatment. Patients who need help maintaining an open airway are . do not force him or her to move. This system allows first responders to open blocked airways and stop severe bleeding quickly. Respiration or Breathing: It all STARTS Here. The patients who are left in place are the ones on whom you must now concentrate. Use a head-tilt maneuver to open the airway. you then need to determine the breathing rate. Receno BSN IV-4 NCM 201 SKILLS JUNE 21. starting with Respiration (breathing). 2013 The Simple Triage And Rapid Treatment ( START) system was developed to allow first responders to triage multiple victims in 30 seconds or less. you may have to ignore the usual cervical spine guidelines when you are opening airways during the triage process. SPECIAL NOTE: The treatment of cervical spine injuries in multiple or mass casualty situations is different from anything that you've been taught before. and transportation. If a patient complains of pain on attempting to walk or move. If patients can get up and walk. the patients will be re-triaged for further evaluation. REMEMBER: Your job is to find and tag the patients --those who require immediate attention. .

or to assist with ambulance or helicopter transportation.or mass-casualty incident. Additional assistance required. If the radial pulse is present.) START is Used to Find Patients This system is designed to assist rescuers to find the most seriously injured patients. tag the patient as breathing and does not start to breathe with simple airway maneuvers. If other rescuers are already at the scene when you arrive. the goal is to find. To check the radial pulse. Note the following: Approximate number of patients.or Mass-Casualty Incident You may or may not be the first person to arrive on the scene of a multiple. the patient should be NCM 201 SKILLS JUNE 21. fire protection. traffic control. If the radial pulse is absent or irregular the patient is tagged . Working at a Multiple. . (These patients are "unresponsive" to verbal stimuli." "Squeeze my hand. Mental Status: Open Your Eyes The last part of the RPM series of triage tests is the mental status of the patient. Receno BSN IV-4 If you are in doubt as to the patient's ability to breathe. the patients will be re-triaged for further evaluation.Marien H. 2013 . Test the patient's mental status by having the patient follow a simple command: "Open your eyes. to help move patients. Then slide it into the notch on the palm side of the wrist. A patient may be re-triaged as many times and as often as time allows. You must keep your fingers there for five to ten seconds. As time and resources permit. stabilize and move Priority One patients first.and mass-casualty incidents." "Close your eyes. treatment. This observation is done on patients who have adequate breathing and adequate circulation. As more highly trained rescue and emergency personnel arrive on the scene. Remember that injured patients do not stay in the same condition. If the patient is not tagged . The process of shock may continue and some conditions will become more serious as time goes by. Other important information. As more rescue personnel arrive on the scene. A patient who is unresponsive or cannot follow this type of simple command is . accurately report your findings to the person in charge by using a format similar to that used in the initial arrival report. between the midline and the radius bone (forearm bone on the thumb side). to check for a pulse. be sure to report to the incident commander before going to work. place your index and middle fingers on the bump in the wrist at the base of the thumb. In every situation involving casualty sorting. move to the final observation of the RPMseries: Mental status. you may be assigned to use your skills and knowledge to provide patient care. Many events are happening at the same time and the incident commander will know where your help and skills can best be used. Perfusion or Circulation: Is Oxygen Getting Around? The second step of the RPM series of triage tests is circulation of the patient. The radial pulse is located on the palm side of the wrist. the first responder will probably also be called on to participate in many other ways during multiple. After you have reported this information. You may also be assigned to provide emergency care to patients. and conducting the initial START triage. the incident commander is that person who is in charge of the rescue operation. It is not large and may not be easily felt in the wrist. or patient movement. stabilization. In addition to initially sizing up an incident. By virtue of training and local protocols. and transportation. The best field method for checking circulation (to see if the heart is able to circulate blood adequately) is to check the radial pulse. go back and recheck the condition of all patients to catch changes in condition that may require upgrading to attention. clearly and accurately reporting the situation." Patients who can follow these simple commands and have adequate breathing and adequate circulation are tagged tagged . Numbers that you've triaged into the four levels.

Department of Transportation published the Emergency Response Guidebook. These numbers are used by professional agencies to identify the substance and to obtain emergency information. given any necessary emergency care. constant reevaluation of the patients in Priorities Two and Three is necessary so that a patient whose condition worsens can be moved to a higher triage level. triage in hazardous materials incidents has one major function--to identify victims who have sustained an acute injury as a result of exposure to hazardous materials.or mass-casualty incident. Summary Every responder must understand the principles and operations behind your casualty sorting system. The single most important step when handling any hazardous materials incident is to identify the substance(s) involved. Receno BSN IV-4 NCM 201 SKILLS JUNE 21. But not all hazardous materials problems will be placarded. It also describes the emergency care of ill or injured patients. for better identification of the hazardous substance. REMEMBER: Contaminated patients will contaminate unprotected rescuers! Emergency treatment of patients who have been exposed to hazardous materials is usually aimed at supportive care.or mass-casualty incidents. and transported to a hospital. IF THERE IS ANY SUSPICION OF A HAZARDOUS MATERIALS SPILL STAY AWAY! The U. which lists the most common hazardous materials. Manufacturers and transporters should display the appropriate placard. REMEMBER: A hazardous materials placard indicates a potential problem. since there are very few specific antidotes or treatments for most hazardous materials injuries. How to recognize a hazardous materials placard. responders must protect themselves from injury and contamination. During a hazardous materials incident. Federal law requires that hazardous materials placards be displayed on all vehicles that contain large quantities of hazardous materials. their four-digit identification numbers. The START system is an excellent and easily understood triage or casualty sorting method. . you should keep far away from the contaminated area or "hot zone. You Should Practice: Using the START system during a simulated multiple.Marien H." Once the appropriate protection of the rescuers has been accomplished. These patients should be removed from the contaminated area. Be sure to find the proper response to the problem before beginning patient treatment. along with a four-digit identification number. Responders should be involved in periodic community disaster drills so that their skills and capabilities can be tested and improved. exposing many people to injury or contamination. decontaminated by trained personnel.S. 2013 Triage in Hazardous Materials Incidents Hazardous materials (Hazmat) incidents involving chemicals occur every day. and proper emergency actions to control the scene. Unless you have received training in handling hazardous materials and can take the necessary precautions to protect yourself. How to use the START system. You Should Know: The responder's role at multiple. Because most fatalities and serious injuries sustained in hazardous materials incidents result from breathing problems.

Receno BSN IV-4 NCM 201 SKILLS JUNE 21. 2013 .Marien H.

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