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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.
give 2 rescue breathes. Then scan for bleeding. the scene becomes unsafe. “look. breathing) sequence for infants and children who don’t respond and aren’t breathing normally. CPR always begins with chest compressions no matter who the victim is and whether you witnessed their collapse or not. 1) The AHA follows the CAB (compressions. The AHA has eliminated. listen and feel for breathing” from its guidelines. airway. START SYSTEM Simple triage and rapid treatment From Wikipedia. If the victim still isn’t breathing normally. and is currently widely used in the United States. listen. The ARC still instructs. I’m only going to discuss the differences in their guidelines. Differences: The primary difference is how breathing is assessed. The responder checks for breathing. 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. “look. Continue giving 30 compression and 2 breaths until you find an obvious sign of life. . you are too exhausted to continue. 7) 8) Open the airway with a head tilt-chin lift and give 2 breaths. 2013 Begin CPR with 30 chest compressions. Receno BSN IV-4 6) NCM 201 SKILLS JUNE 21. The ARC still uses this approach as part of their guidelines for infants and children. 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. an AED arrives or EMS (Emergency Medical Services) arrives.pdf 3. listen and feel” for breathing.org/idc/groups/heartpublic/@wcm/@ecc/documents/downloadable/ucm_317350. The method was developed in 1983 by the staff members of Hoag Hospital and Newport Beach Fire Department located in California. INFANT AND CHILD CPR Rather than include a list of both organizations’ sequences for infant and child CPR. and feel” for breathing in the assessment for infants and children. 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. The rate of compressions is at least 100 compressions a minute.heart. REFERENCES:http://inhomecpr.Marien H. Push down at least 2 inches for an adult. The ARC continues to include the step of quickly scanning for severe bleeding after checking for breathing. After each compression let the chest come back up to its normal position. However. 2) The AHA has also eliminated “look.com/in_home_cpr_news/cpr-guidelines-for-american-heart-associationand-american-red-cross/ http://www. but how this is done is not specifically stated. The AHA does not include this step.
the START classifications are used to determine the order in which victims should undergo secondary triage. The only medical intervention used prior to declaring a patient deceased is an attempt to open the airway. No further interventions or therapies are attempted on deceased patients until all other patients have been treated. 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. START is not a system for determining resource allocation. The classification algorithm used in START does not depend on the number of victims or on the number of resources available to treat them. 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. thereby identifying the ambulatory. unresponsive (unable to follow commands)  All other patients are classified as delayed. Modifications to START and Similar Triage Systems Numerous agencies have developed modifications to START or new triage systems similar to START. The most basic way to use the START classifications is to transport victims in a fixed priority manner: immediate victims. followed by the walking wounded. Treatment and Evacuation After all patients have been evaluated. Therefore.Marien H. or walking wounded. . Patients who are breathing and have any of the following conditions are classified as immediate: respiratory rate greater than 30 per minute. capillary refill greater than two seconds. patients. responders use the START classifications to determine priorities for treatment or evacuation to a hospital. although physical tags are not necessary if patients can be physically sorted into different areas. nor does using START alone provide any prioritization of patients within any of the four triage classes. One early proposed modification substituted the presence of a radial pulse for capillary refill in classifying patients as immediate. Non-ambulatory patients are then assessed.  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. followed by delayed victims. which are used by some agencies to indicate each victim's status.More detailed secondary triage systems such as SAVE may also be used: in this case. significant differences in implementation of treatment and evacuation may exist across different agencies using START. Receno BSN IV-4 Classification NCM 201 SKILLS JUNE 21. Any patient who is not breathing after this attempt is classified as deceased and given a black tag.
You must identify and separate patients rapidly. for 23 patients request five ambulances. according to the severity of their injuries and their need for treatment.org/wiki/Simple_triage_and_rapid_treatment Simple Triage and Rapid Treatment (START) By using a casualty sorting system. consensus has emerged that triage should be more sophisticated. and so forth. Like many other triage systems. even the severity of their injuries. These visual surveys give you an initial impression of the overall situation. its simplicity. colors. Your Initial Report . 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. The visual survey should enable you to estimate initially the amount and type of help needed to handle the situation. The primary modification for use with pediatric patients is to change the "normal" respiratory rate: since children breathe faster than adults. One such modification is known as JumpSTART. you are focusing your activities in the middle of a chaotic and confusing environment. Receno BSN IV-4 Modification for Pediatric Patients NCM 201 SKILLS JUNE 21.Marien H. and do not shout. and black :http://en. in multiple. Field experience has shown that a good rule of thumb initially. for 35 patients. REFERENCE  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.or mass-casualty situations. En route Even while you are responding to the scene of an incident. Limitations There is no accepted measure to judge the appropriateness of any given system in mass casualty triage. Pediatric Triage Tape. As you prepare to give the first vital report. is to request one ambulance for every five patients. be calm. and CareFlite Triage. 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. be concise. including the potential number of patients involved.wikipedia.Stay Calm The first thing you should do upon arriving at the scene of an incident is to try to stay calm. START suffers from implementation problems such as substantial amounts of overtriage One of the major strengths of START. and possibly. . use clear language (no signals or radio jargon). look around. yellow. by incorporating resource limitations and capacity in determining how to prioritize patients. You are trying to give the communications center a concise verbal picture of the scene. Where will help come from? How long will it take to arrive? Initial Assessment . you should be preparing yourself mentally for what you may find. Since START was developed.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. and get an overview of the scene. Perhaps you've been to the same location. is also a major limitation. green. request seven ambulances.
rescue squad. You might give the following report: "This is a major accident involving a truck and a commercial bus on Highway 305. and assign patients to broad categories based on their need for treatment. take several deep breaths to give your mind time to catch up with your eyes and to try to calm your voice. You cannot stop during this survey. except to correct airway and severe bleeding problems quickly." 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. Dispatch additional police units to assist. There are approximately 35 victims. Other rescuers will provide follow-up treatment. 2013 Before starting.Marien H. Your job is to sort (triage) the patients. I am requesting the fire department. There are people trapped. about 2 miles east of Route 610. Repeat: This is a major accident. conduct a rapid assessment. and seven ambulances at this time. Receno BSN IV-4 NCM 201 SKILLS JUNE 21. The START System: It really works! . Remember that your job is to get to each patient as quickly as possible.
If the patient is breathing and the breathing rate is less than 30 per minute. 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. REMEMBER: Your job is to find and tag the patients --those who require immediate attention. they are probably not at risk of immediate death. This is the only time in emergency care when there may not be time to properly stabilize every injured patient's spine. in a systematic manner. Colored surveyors' tape or colored paper tags may be used. move on to the circulation and mental status observations in order to complete your 30-second survey. Each patient must be evaluated quickly. and Mental Status (RPM). In this type of multiple. Move in an orderly and systematic manner through the remaining victims. This system allows first responders to open blocked airways and stop severe bleeding quickly. Triage Tagging: To Tell Others What You've Found Patients are tagged for easy recognition by other rescuers arriving on the scene. If patients can get up and walk. based on three primary observations: Respiration. Open the airway.or mass-casualty situation. SPECIAL NOTE: The treatment of cervical spine injuries in multiple or mass casualty situations is different from anything that you've been taught before. 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. position the patient to maintain the airway and -. . Tagging is done using a variety of methods determined by your local Emergency Services System. If the patient is breathing. you then need to determine the breathing rate. Perfusion.tag the patient . correct life-threatening airways and breathing problems. Examine each patient. quickly clear the mouth of foreign matter. If the patient is not breathing. Patients with breathing rates greater than 30 per minute are tagged . you may have to ignore the usual cervical spine guidelines when you are opening airways during the triage process. Patients who need help maintaining an open airway are . Use a head-tilt maneuver to open the airway. If a patient complains of pain on attempting to walk or move. 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. Receno BSN IV-4 NCM 201 SKILLS JUNE 21. Perfusion and Mental Status. and transportation. those victims who can walk are asked to move away from the immediate rescue scene to a specific designated safe area. starting with Respiration (breathing). In order to make the situation more manageable. The patients who are left in place are the ones on whom you must now concentrate.Marien H. stabilization. 2013 The Simple Triage And Rapid Treatment ( START) system was developed to allow first responders to triage multiple victims in 30 seconds or less. the patients will be re-triaged for further evaluation. These patients are now designated as . These patients are showing one of the primary signs of shock and need immediate care. The stop at each patient should never take more than one minute. Respiration or Breathing: It all STARTS Here. do not force him or her to move.if the patient breathes -. treatment. As more rescue personnel arrive on the scene. stopping at each person for a quick assessment and tagging.
the goal is to find. between the midline and the radius bone (forearm bone on the thumb side).or mass-casualty incident. Many events are happening at the same time and the incident commander will know where your help and skills can best be used. tag the patient as breathing and does not start to breathe with simple airway maneuvers. the patient should be NCM 201 SKILLS JUNE 21. (These patients are "unresponsive" to verbal stimuli. As more highly trained rescue and emergency personnel arrive on the scene. and conducting the initial START triage. traffic control. As time and resources permit. and transportation. . You must keep your fingers there for five to ten seconds." "Squeeze my hand. accurately report your findings to the person in charge by using a format similar to that used in the initial arrival report. After you have reported this information. The process of shock may continue and some conditions will become more serious as time goes by. This observation is done on patients who have adequate breathing and adequate circulation.Marien H.and mass-casualty incidents. Mental Status: Open Your Eyes The last part of the RPM series of triage tests is the mental status of the patient. If the radial pulse is present." "Close your eyes. It is not large and may not be easily felt in the wrist. Receno BSN IV-4 If you are in doubt as to the patient's ability to breathe. 2013 . The radial pulse is located on the palm side of the wrist. You may also be assigned to provide emergency care to patients. A patient who is unresponsive or cannot follow this type of simple command is . be sure to report to the incident commander before going to work. By virtue of training and local protocols. or to assist with ambulance or helicopter transportation. stabilization. Other important information. Remember that injured patients do not stay in the same condition. Additional assistance required. Working at a Multiple. To check the radial pulse." Patients who can follow these simple commands and have adequate breathing and adequate circulation are tagged tagged . As more rescue personnel arrive on the scene. to help move patients. The best field method for checking circulation (to see if the heart is able to circulate blood adequately) is to check the radial pulse. Then slide it into the notch on the palm side of the wrist. treatment. Perfusion or Circulation: Is Oxygen Getting Around? The second step of the RPM series of triage tests is circulation of the patient. go back and recheck the condition of all patients to catch changes in condition that may require upgrading to attention.) START is Used to Find Patients This system is designed to assist rescuers to find the most seriously injured patients. If the patient is not tagged . place your index and middle fingers on the bump in the wrist at the base of the thumb. to check for a pulse. Test the patient's mental status by having the patient follow a simple command: "Open your eyes. Note the following: Approximate number of patients. clearly and accurately reporting the situation. the first responder will probably also be called on to participate in many other ways during multiple. In addition to initially sizing up an incident. In every situation involving casualty sorting. the patients will be re-triaged for further evaluation. or patient movement.or Mass-Casualty Incident You may or may not be the first person to arrive on the scene of a multiple. move to the final observation of the RPMseries: Mental status. If the radial pulse is absent or irregular the patient is tagged . Numbers that you've triaged into the four levels. If other rescuers are already at the scene when you arrive. stabilize and move Priority One patients first. A patient may be re-triaged as many times and as often as time allows. the incident commander is that person who is in charge of the rescue operation. you may be assigned to use your skills and knowledge to provide patient care. fire protection.
Unless you have received training in handling hazardous materials and can take the necessary precautions to protect yourself. You Should Know: The responder's role at multiple. But not all hazardous materials problems will be placarded.or mass-casualty incident. Manufacturers and transporters should display the appropriate placard.S. since there are very few specific antidotes or treatments for most hazardous materials injuries. The START system is an excellent and easily understood triage or casualty sorting method. their four-digit identification numbers. How to use the START system. These patients should be removed from the contaminated area. and transported to a hospital.Marien H. given any necessary emergency care. Because most fatalities and serious injuries sustained in hazardous materials incidents result from breathing problems. for better identification of the hazardous substance.or mass-casualty incidents. You Should Practice: Using the START system during a simulated multiple. 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. REMEMBER: Contaminated patients will contaminate unprotected rescuers! Emergency treatment of patients who have been exposed to hazardous materials is usually aimed at supportive care. Be sure to find the proper response to the problem before beginning patient treatment. REMEMBER: A hazardous materials placard indicates a potential problem. It also describes the emergency care of ill or injured patients. responders must protect themselves from injury and contamination. Responders should be involved in periodic community disaster drills so that their skills and capabilities can be tested and improved. These numbers are used by professional agencies to identify the substance and to obtain emergency information. 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. exposing many people to injury or contamination. Federal law requires that hazardous materials placards be displayed on all vehicles that contain large quantities of hazardous materials. and proper emergency actions to control the scene. Department of Transportation published the Emergency Response Guidebook. ." Once the appropriate protection of the rescuers has been accomplished. The single most important step when handling any hazardous materials incident is to identify the substance(s) involved. you should keep far away from the contaminated area or "hot zone. which lists the most common hazardous materials. 2013 Triage in Hazardous Materials Incidents Hazardous materials (Hazmat) incidents involving chemicals occur every day. decontaminated by trained personnel. During a hazardous materials incident. IF THERE IS ANY SUSPICION OF A HAZARDOUS MATERIALS SPILL STAY AWAY! The U. Receno BSN IV-4 NCM 201 SKILLS JUNE 21. How to recognize a hazardous materials placard. Summary Every responder must understand the principles and operations behind your casualty sorting system. along with a four-digit identification number.
Marien H. 2013 . Receno BSN IV-4 NCM 201 SKILLS JUNE 21.
This action might not be possible to undo. Are you sure you want to continue?