Triage and nursing Introduction s "Triage" is a French word meaning selection, classification.

In the health field triage means to classify the function of patients before they receive the provi sion of care they need. This function is set to classify where a significant num ber of patients. That's why the military health was the first institution to int roduce a triage system in the battlefields of the great war. The Civil Health, t riage is performed in Disasters and accidents with multiple victims. Preliminary considerations DISASTER disaster can be defined as an occurrence that causes severe abnormaliti es in people, goods, services and environment, exceeding the response capacity o f the affected community. EMERGENCY situation that appears when the combination of known factors, there arises a phenomenon or any unexpected event that causes damage or alterations to the people, goods, services or the environment, not to exceed the response capacity of the affected community . MULTIPLE ACCIDENT VICTIMS Situation in which they are involved more than one victim, and the resources ava ilable at that place and time are limited. Triage This method introduces a new system of classification of patients according to t heir severity from the clinical point of view so that two patients with differen t diagnoses may be included in the same group after triage system applied to the m. And the opposite may occur, ie that two patients with the same pathology belo ng to different triage groups as they prioritize the condition but not for the s eriousness of this. It also applies to the evacuation operations priority injure d by the disaster scene to different hospitals to avoid saturation of services. s Lets know each time what proportion of all existing disaster can expect and what not, so that guides the direction in which the department must focus its resour ces rationally, giving peace to the staff working. Allows the attention of the w ounded in an organized manner. This avoids the saturation of the emergency servi ces. This reduces waiting times and to remain at the scene of disaster, resultin g in improved care and a general increase in the odds of survival. Triage Properties s s s Types of triage s Within the triage can distinguish between two types: s First triage s

classification based on the need for immediate medical treatment s Second Triage s 2 The concept of triage that has different meanings according to different autho rs, schools or countries. The two meanings that occur most frequently are the Se cond Triage: s Types of triage s 1) relatively distant location of the accident, which injured should be moved to dispense some form of medical care. Usually it is a place protected from weathe r and provided with artificial light, heating and water supply. 2 This concept o f triage has an interest in disaster with a large number of injured or in circum stances where weather and other environmental factors impede the delivery of ass istance in the first place. 2) The other meaning of 2nd triage that is used with a certain regularity, is the valuation that is performed each wounded once stab ilized and ready for shipment, and that will help to establish the evacuation or der and the destination of each wounded. s Types of triage Triage 2 Triage Nursing 1st Triage Red Evacuation Wheel Yellow Green Black Disaster area 1st triage classification The rankings for the first triage must be swift and effective for this selection criteria have to be easy and effective in its implementation. We must bear in m ind that a disaster is to save the greatest number of injuries. For this we appl y the criterion known as "Language speaks, go no go" 1st Classification triage tool. performed by technicians trained for such action. The injured are on their own f eet. ANDA ANDA NO, NO TALK TALK Not Yes "No Habla" Unconscious "Speak" Conscious

Directing Green Zone Treatment Directing Red Zone 2nd lead triage 2 Rating Triage is the classification applicable to Triage In the second is wher e the evacuation of the injured to different centers. To make this classification must be taken into account: Regarding the wounded: • The severity of injuries 1 Red, 2 Yellow, Green 3rd, 4th Black • Possibility of su rvival of the wounded.€• Resources available. (Level of expertise available vehicles UCI Helicopters, etc ....) Hospitals. • Availability of specialized centers. • Distance to schools. • Other resources. Triage Classification 2. s For rapid classification for the subsequent evacuation of color codes are used u niversally accepted, and usually are assigned to those injured by a system of co ded cards, s Each card should contain as much as possible the following information: • Name and address of the patient. • Age and sex. • Identify on a diagram the injured areas. • R ecord the administration of medications, routes and time. • Place the name of the person doing the triage. Triage Classification 2. s Green Color NOT EVACUATE until they have completed the evacuation operations and EVACUATION REGULAR PRIMARY, using for this operation not vital transportation resources (bu ses, civilian transport, etc ...). They do not require immediate transfer to hospital because their injuries can be treated at the scene s s Triage Classification 2. 3 Minor injuries: No risk to your life • • Abrasions minor fractures, contusions • Minor burns. AB • Burns less than 15% of his. body. • Burns B less than 2% of sup. body. • Burns type less than 20% of sup. body. Triage Classification 2. s s Yellow Color

Patients whose injuries require hospital care, but its seriousness can be transf erred in a second round of evacuation (EVACUATION REGULAR) once they have been t reated cases PRIORITY EVACUATION Triage Classification 2. s AB burns over 30% of body surface involved. Type B burns over 10% of body surfac e involved. Burns complicated by major injuries or fractures or soft tissue lowe r. B Burns involving critical areas as hands, feet, face, no airway problem. Mod erate blood loss (500 cc). Back injuries with or without spinal cord damage. Con scious patients with brain damage-cameo s s s s s s important (mental confusion, subdural hematoma). Triage Classification 2. s Red Color Patients with serious injuries, and have a good chance of survival if they are t reated in hospital immediately. Require PRIORITY EVACUATION s Triage Classification 2. • Respiratory problems not correctable in the same place. • Cardiac arrest (which is seen at the time). • significant loss of blood (1 liter). • Loss of consciousness. • Drilling thoracic or abdominal puncture wounds. • Some severe fractures (pelvis, c hest, vertebrae). • Burns complicated by commitment at the airway. 2nd Classification Triage. s s s s s s CSF output by ear or nose. Rapid rise in systolic pressure. Bilious vomiting. Ch ange in respiratory rate. Pulse less than 60 minutes. Swelling or bruising under the eyes (raccoon fascia). Anisocoria. Weak motor reaction to sensory stimulati on. s s Triage Classification 2. s s Color Black. People who have died in the place (NOT EVACUATE)

Nursing Role s Withina a disaster nursing should have a leading role in two main ways: s Triage Nursing. s Due to their expertise in collecting and constant voloración figure is correct for classifying injuries according to severity to lead to different modules (red, y ellow, verde.negro). s Trauma care in the different modules. s Thanks to its capacity both in technique and patient care is the appropriate dis cipline to treat the injured classified at different levels (Red, Yellow, Green and black). Nursing Classification Tool. Ventilation. Not Opening and maintenance of airway with difficulty Yes Without difficulty > 30/min ... Yes Immediate Attention <30/min ... Check Infusion Not Exitus Immediate Attention Reds Black Reds Nursing Classification Tool Radial pulse alteration or filling capillary Yes Bleeding Control Immediate Attention Not Neurological status review Obey does not obey simple commands simple commands Red

At no immediate Immediate Attention Red Yellow