Triase dan Pananganan Gawat

Darurat
Hendro Wartatmo
PMPK FKUGM
 Triase (Triage)tosort
Doingthegreatestgoodforthegreatestnumberofpeople
using the available resources
usingtheavailableresources
Chaoticsituation asystemthatissimpleandclearis
mostlikelytosucceed
Triageshouldbeatoolbywhichaseeminglyunmanageable,
overwhelmingsituationcanbeorganized.
Triageshouldbeadynamicprocesscarriedoutatseveral
h ld b d d l
levelsthroughoutthesystem.
Oneofthegoalsoftriageshouldbetodiagnosecritical
One of the goals of triage should be to diagnose critical
injuriesrequiringlifesavingtreatmentintheshortestpossible
time.
 To
Tothisendpatientsarecategorizedintogroupstodetermine
this end patients are categorized into groups to determine
theirpriorityfortreatmentandtransporttodefinitivecare
facilities.
"priorityone,""emergency,"orthecolorredindicatesthe
needforimmediatecare;
"prioritytwo,""urgent,"orthecoloryellowindicatesthatcare
"priority two " "urgent " or the color yellow indicates that care
maybedelayedforalimitedperiodoftimewithoutsignificant
mortality;
"prioritythree,""nonurgent,"orthecolorgreenindicatesthat
caremaybedelayeduntilthepatientsintheothercategories
have been dealt with
havebeendealtwith.
Afourthgroup,describedwiththeterm"expectant"orthe
colorblack,hasbeenadvocatedbysometodenotepatients
whoaredeadorexpectedtodie.
 Trunkeysscurve
Trunkey curve

Trauma deaths

IImmediate
di t Early deaths Late deaths
deaths

0 1 2 3 4 5 6 1 2 3 4

hours weeks
Single Triage ( SIT )
SingleTriage(SIT)

Untuk pasien yangdatang

yang datang satu persatu
Sesuai situasi diUGDseharihari

*Triage:TechniquesandApplicationsinDecisionMaking.
Katharyn Kennedy,MDRichardVAghababian,MDLucilleGans,MDCPhuli
Lewis,MD
AnnalsofEmergencyMedicine.August1996Volume28Number2
 20 Luka Tdk ada
Lecet Tindakan
segera
50
15 CKR Paliatif
KORBAN
Triage
Officer
-# femur Tindakan
tertutup
- # terbuka
Life saving
-Ruptur
hepar
5 -Tension
Pnthorax
-Multiple
trauma dg
syok

Mening Km
10
-gal Mayat
 Tdk ada
20 Luka
Tindakan
Lecet
segera

50 Paliatif
15 CKR
KORBAN
Triage
-Multiple Tindakan
Officer 1 t
trauma dg
d Intensif
syok

-# femur Tindakan
4 tertutup
- # terbuka Life saving
-Ruptur
hepar
-Tension
Pnthorax

Mening Km
10
-gal Mayat
 Luka Rawat
Lecet Jalan

KORBAN CKR Obser

Ob
vasi
Triage
Officer
-# femur Ti d k
Tindakan
tertutup
- # terbuka Operasi
-Ruptur
1000 0rang !! hepar Operasi
-Tension
Pnthorax Operasi

- CKB
GCS = 3 R.Khusus

Mening Km
-gal Mayat
 Luka
Tertunda
Lecet

KORBAN CKR Penampungan

P
seadanya
Triage
Officer
-# femur A ti
Antri
tertutup
1000 0rang - # terbuka Antri
-Ruptur
hepar Antri
-Tension
Pnthorax Antri

CHAOS !!
- Multiple
M lti l
trauma dg Terlantar
syok

Mening Penuh,Iden
-gal tifikasi ?
 Luka Dipulangkan
Lecet / Pindahkan

KORBAN CKR Ruang rwtt

R
Yang layak
Triage
Officer
-# femur Ti d k
Tindakan
tertutup
- # terbuka Operasi-2
-Ruptur
1000 0rang hepar Operasi-3
-Tension
Pnthorax Operasi-1

- CKB Ruang
GCS = 3 khusus

Mening Km
-gal Mayat
 SingleTriage:

Untukpasientunggal
Kategoripasien
Immediate
(AMI,Perdarahandalam)
Urgent
U t
(Stroke,Apendisitis)
NonUrgent
(Luka,Dislokasi,Fraktur)
( , , )
SimpleTriase AndRapidTransport
( START )
(START)

Proposesfivecategories.
Usingacolorcodedsystem,itincludesabluecategoryfor
patients who are unlikely to survive or whose survival would
patientswhoareunlikelytosurviveorwhosesurvivalwould
dependonreceivingextensiveorcomplicatedtreatment
rapidly.Patientsinthiscategorywouldreceivetreatmentafter
priorityonebutbeforeprioritytwocases,providedtheir
numberswerenotsolargeastodetractfromthetreatment
oftheurgentpatients.
g p
Re Triage !!
ReTriage!!
SecondaryAssessement
Secondary Assessement forVictimsEndpoint
for Victims Endpoint
(SAVE)

Dilakukan bila jumlah korban luar biasa dan jauh melampaui

kapasitas penolong.
Kategori korban :
Yangakan selamat apapun tindakan yangdilakukan
Yangakan tidak selamat apapun tindakan yangdilakukan
Yangtidak
Yang tidak termasuk kedua golongan diatas ,keselamatannya
keselamatannya sangat
tergantung intervensi yg dilakukan tim penolong
 Medical Emergency Response
MedicalEmergencyResponse

Hospitalisation Transportation Damage

area Transfer area
 RedCross

Public
HealthPost
Hospital

Damaged
Area
Puskesmas

FieldHospital

RegionalResponse
Regional Response
ofHealthSector
Terima Kasih