Trauma Triage

Definition :
- Trauma triage is the use of trauma assessment for prioritizing of patients for treatment or transport according to their severity of injury.
injury
- It's the process by which patients are classified according to type & urgency of their condition to get the right patient to the right place
at the right time with the right care provider.
Aim :
- Rapid identification of patients that need immediate attention. Priority is then given to patients most likely to deteriorate
clinically.
Priniciple :
- Triage take account for vital signs , prehospital clinical course , mechanism of injury and other medical conditions.
Timing :
- Triage must reflect the changing state of the causality and is therefore a dynamic rather than static process.

Triage Priorities :
Color T priority Desicription
Red 1 Immediate - Those who can't survive without immediate treatment but who have the chance of survival
- Require significant interven%on within 1-2 1 hours.
triage ).
- For those who require observation and ( possible later re-triage )
Yellow 2 Urgent - Their condition is stable for the moment , and they are not in immediate danger of death.
- These victims will still need hospital care and would be treated immediately under normal
circumstances.
3 - Require interven%on within 2-4 2 hours.
Green Delayed - It's reserved for the "walking wounded" who will need medical are at some point, after more
critical injuries have been treated.
4 - Treatment at an early stage would divert resources from potentially beneficial casualities , with
Blue Expectant no significant change of a successful outcome.
who need extensive care within minutes.
- i.e. : Patients are unlikely to survive or those who
5 Expectant - Dead persons or are used for the decreases and for those whose injuries are so extensive that
Black
(Dead) they will not be able to survive given the care that is available.

Triage methods :
1- Triage sieve:
- The triage sieve can be used at the scene of major trauma and involves a rapid assessment.
vert the chaos of a large number of injured causalities into some sort of medical order using : Immobility & ABC
- The aim: to convert
It operates as follows:
1) Those who can mobilise independently are delayed [P3] (lowest priority).
Once other casualties have been assessed, the P3 casual%es should be reassessed as condi%ons
do change.
Watch for ambulant casualties carrying other casualties (especially adults carrying their
children); every casualty must be triaged.

2) In those who cannot walk determine if the casualty is breathing :

If there is no breathing ensure the airway is open (basic manoeuvres + adjuncts only).
- if breathing is absent still the casualty is treated as dead and no further resuscitation
undertaken.
- if breathing does return after airway opening the casualty is immediate [P1](top priority); efforts
should be made to ensure the airway remains patient: this must not delay the triage - get
someone else to maintain airway position.
No further assessment is needed for triage in P1 pa%ents .

3) In those who are breathing without the need for airway opening assess
the respiratory rate.
If high ( more than 29) or low (less than 10) the casualty is immediate [P1].
No further assessment is needed for triage in P1 pa%ents .

4) In those who are uncategorised so far assess the circulation :

either by capillary refill (be aware this may be delayed by cold rather than by shock) or by the
pulse rate.
If these are abnormal (more than 2 seconds, or HR more than 120/minute) the casualty is P1, if
normal they are urgent [P2].

5) As soon as the casualty has been assigned a triage category further assessment stops,
stops
and personnel carrying out triage move to the next casualty to triage them.
Treatment does not start until casualties have been triaged.

6) Casualties' triage category should be indicated on them,

them
so P1 casual%es can be iden%fied and treated first.

7) Personnel carrying out triage should maintain a record of the total number of casualties they
triage and the numbers within each category.
2- Triage sort :
- This is a slightly longer assessment using : Revised Trauma Score
- It generates a numerical value; the lower this is the more urgent the patient's management.

Revised Trauma Score (RTS)

• Used as a triage tool in a prehospital setting.
setting
• It is a common physiological scoring system based on the first data sets of 3 specific physiological parameters obtained from the patient.
• The three parameters are: the GCS, systemic blood pressure (SBP), and the respiratory rate (RR).
(RR)

Glasgow Coma Scale Systolic blood pressure Respiratory rate Value

13-15 >89 10-29 4

9-12 76-89 >29 3

6-8 50-75 6-9 2

4-5 1-49 1-5 1

3 0 0 0

12 = green (T3)
11 = yellow (T2)
< 10 = Red (T1)

Triage Labeling :
- Indicates the triage has been done.
- Indicates the current triage priority

- Features :
1- High visible.
2- Standard categories
3- Standard color.
4- Easy attachment.
5- Treatment record.
6- Easy changes.