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QUESTION I
LIST EMERGENCIES, DISEASES AND INJURIES example,
HAEMORRHAGE, HEAD INJURY, FRACTURES, ETC

EMERGENCY
An emergency is a situation that poses an immediate risk to health, life, property,
or environment. Most emergencies require urgent intervention to prevent a
worsening of the situation, although in some situations, mitigation may not be
possible and agencies may only be able to offer palliative care for the aftermath.
While some emergencies are self-evident (such as a natural disaster that threatens
many lives), many smaller incidents require that an observer (or affected party)
decide whether it qualifies as an emergency. The precise definition of an
emergency, the agencies involved and the procedures used, vary by jurisdiction,
and this is usually set by the government, whose agencies (emergency services) are
responsible for emergency planning and management.
List of Health Emergencies
Europe’s 21st century emergencies are complex and demanding due to growing
global trends. They hit the region with a wide range of hazards, like measles
epidemics; outbreaks of vector-borne diseases; outbreaks of food-borne diseases
and growing antimicrobial resistance; floods, heat-waves, forest fires and other
extreme events due to climate change; earthquakes and other natural disasters–
possibly combined with chemical or nuclear contamination; conflicts and terrorist
attacks. The European Region is part of a highly interconnected world. An
emergency in one country often impacts many of its neighbours. Diseases can
spread at the speed of a regional airliner, and people fleeing emergencies often
cross international frontiers in search of help. Striking examples of emergencies in
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other parts of the world with repercussions in Europe and Africa are outbreaks of
Ebola, Coronavirus and the Syrian humanitarian crisis.
Below are some of the List Emergencies and How to Deal With Them
While our immediate response to an injury might be panic, keeping calm has never
been more helpful, whereby we can give first aid. The following is a list of aids in
common household injuries. If the situation is grave, do remember to call for
medical aid afterwards.
1. Burns and Scalds:-

Burns can be caused through dry heat such as fire or hot metal or contact with an
object charged with a high tension electric current, or friction with a revolving
wheel or fast-moving rope. Additionally, chemical burns occur with corrosive
chemicals like acids and alkalis. A scald is an injury caused by moist heat, like
boiling water, steam, hot oil or tar. The effects of a burn or a scald are the same.
There may be reddening of the skin or blister formation or destruction of the skin,
or of the deeper tissues. The areas of most burns and scalds, including the clothing
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are sterile for a short period, and efforts should be made to keep them so until
medical aid is possible.
General rules for treatment:-
1. Avoid handling the affected area more than necessary. See that your hands are
as clean as possible by washing them.
2. Do not apply lotions of any kind.
3. Do not remove burned clothing and do not break blisters.
4. Cover the area (including burned clothing), with a dry sterile dressing if
possible, or similar material such as clean lint, freshly-laundered linen.
5. Bandage firmly, except when blisters are present or suspected, in which case,
bandage lightly.
6. Immobilise the area by suitable means.
7. Treat for shock.
In case of a major burn, move the patient to the hospital as quickly as possible. The
patient will probably require an anaesthetic, so don’t give any oral medicines. If
the burns are caused by a corrosive chemical:-
For acids:-
1. Thoroughly flood the part with water.
2. Bathe the part freely with an alkaline solution made from two teaspoons of
baking soda or washing soda in one pint of warm water.
For alkalis:-
1. If the burn is caused by quicklime, brush off any remains.
2. Bathe the part freely with a weak acid solution, such as vinegar or lemon juice,
diluted with an equal quantity of warm water.
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2. Heart Attack/Chest Pain:-

A heart attack occurs when there is a loss of blood supply to the heart. This
happens when an artery supplying blood to the heart muscles is blocked by a blood
clot.
Symptoms:-
1. Pain and discomfort in the chest area.
2. Shortness of breath, stomach discomfort, fainting, sweating, pain in the neck,
jaws or shoulders.
Symptoms of heart attacks are different for men and women:-
Men have cold sweats, and pain may be felt descending through the left arm.
Women are more likely to have shortness of breath, stomach upset, dizziness and
tiredness. Treatment within the first 90 minutes of a heart attack dramatically
increases the chances of survival. Before the person reaches a hospital, an aspirin
tablet can lower the risk of clot formation. Seat the patient in a comfortable
position. If breathing isn’t normal or the patient is unresponsive, hands-on CPR
(Cardiopulmonary resuscitation) may be applied, to double the chances of survival.
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A heart attack generally causes chest pain for more than 15 minutes. Some people
have mild chest pain, while others have more-severe pain. The discomfort is
commonly described as a pressure or chest heaviness, although some people have
no chest pain or pressure at all. Women tend to have more-vague symptoms, such
as nausea or back or jaw pain. Some heart attacks strike suddenly, but many people
have warning signs hours or days in advance.
What to do if you or someone else may be having a heart attack
1. Call 911 or your local emergency number. Don't ignore the symptoms of a heart
attack. If you can't get an ambulance or emergency vehicle to come to you, have a
neighbor or a friend drive you to the nearest hospital. Drive yourself only if you
have no other option. Because your condition can worsen, driving yourself puts
you and others at risk.
2. Chew and swallow an aspirin while waiting for emergency help. Aspirin helps
keep your blood from clotting. When taken during a heart attack, it could reduce
heart damage. Don't take aspirin if you are allergic to it or have been told by your
doctor never to take aspirin.
3. Take nitroglycerin, if prescribed. If you think you're having a heart attack and
your doctor has previously prescribed nitroglycerin for you, take it as directed
while waiting for emergency medical help.
4. Begin CPR if the person is unconscious. If the person isn't breathing or you don't
find a pulse, begin CPR to keep blood flowing after you call for emergency
medical help.
Push hard and fast on the center of the person's chest in a fairly rapid rhythm —
about 100 to 120 compressions a minute.
5. If an automated external defibrillator (AED) is immediately available and the
person is unconscious, follow the device instructions for using it.
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3. Major Cuts:-

Major cuts or wounds can be classified as follows:-

 Incised wounds, caused by a sharp instrument like a razor.
 Lacerated wounds, which have torn and irregular edges, caused by
machinery, animal claws, etc.
 Contused wounds, accompanied by bruising of the tissues, caused by a
direct blow or by crushing.
 Puncture wounds, which have comparatively small openings, but may be
very deep, caused by a stab from any sharp-pointed instrument, like a
needle, knife or bayonet.
In case of wounds, follow the steps below:-
1. Place patient in a suitable position, elevating the bleeding part, unless it is a
fractured limb.
2. Do not disturb any blood clots formed.
3. Removing as little clothing as possible, expose the wound.
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4. Remove any foreign bodies which are visible, and can be easily picked out or
wiped off with a clean dressing.
6. Apply and maintain both direct and indirect pressure.
7. Apply a clean dressing and bandage.
8. Immobilise the injured part. When the wound is near a joint, immobilise it using
splints if needed.
Remember, that if there is a foreign body in the wound which cannot be removed
easily, cover it with a dressing, and build up sufficient pads around the wound
without applying pressure to the foreign body. If there is no foreign body in the
wound, but the cut is deep, ensure that you use enough padding into the wound’s
depths, and ensure pads project well above the level of the skin to ensure adequate
pressure on the torn ends of the blood vessels.
4. Heat Stroke:-

In case of heat stroke, immediately move the patient out of the heat, remove
excessive clothing, and cool them using whatever means possible, including;
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1. Placing the person in a tub of cool water or a cool shower

2. Spray with a garden hose
3. Sponge with cold water
4. Fan while misting with cool water
5. Place ice packs or cool, wet towels on the neck, armpits and groin
6. Cover with cool, damp sheets
7. Make the person drink cool water to rehydrate.
Heatstroke occurs when your body temperature rises rapidly and you're unable to
cool down. It can be life-threatening by causing damage to your brain and other
vital organs. It may be caused by strenuous activity in the heat or by being in a hot
place for too long. Heatstroke can occur without any previous heat-related
condition, such as heat exhaustion.
Heatstroke signs and symptoms include:
Changes in mental status or behavior, such as confusion, agitation, slurred speech
Hot, dry skin or heavy sweating, Nausea and vomiting, Flushed skin, Rapid pulse,
Rapid breathing, Headache, Fainting, which may be the first sign in older adults.
Seek emergency medical care if you suspect heatstroke, call 911 or your local
emergency number. Then immediately move the person out of the heat, remove
excess clothing, and cool him or her by whatever means available, for example:
Place in a tub of cool water or a cool shower, Spray with a garden hose, Sponge
with cool water, Fan while misting with cool water, Place ice packs or cool wet
towels on the neck, armpits and groin, Cover with cool damp sheets, Let the person
drink cool water to rehydrate, if he or she is able. Don't give sugary, caffeinated or
alcoholic beverages to a person with heatstroke. Also avoid very cold drinks, as
these can cause stomach cramps. Begin CPR if the person loses consciousness and
shows no signs of circulation, such as breathing, coughing or movement.
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5. Fractures:-

A simple fracture is when there is no wound leading down to the broken bone.
General symptoms and signs of a fracture:-
1. Pain at or near the seat of fracture
2. Tenderness or discomfort on general pressure over the fractured area
3. Swelling about the seat of fracture. This swelling frequently renders it difficult
to perceive other signs of fracture and care must be taken not to underestimate the
seriousness of the condition.
4. Deformity of the limb
5. The irregularity of the bone
General rules for treatment of fractures.
1. Treat the fracture on the spot: Don’t move the patient till the injured part has
been immobilised unless life is in immediate danger from some other cause. If,
however, circumstances are such that final immobilisation cannot be completed on
the spot, carry out a temporary fix to enable the patient to be moved for a short
distance to more suitable and safe surroundings. Haemorrhage and severe wounds
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must be dealt with before continuing with the treatment of fractures, with due
regard to requirements of both types of injuries.
2. Steady and support the injured parts at once, so that movement is impossible.
This prevents further injury and the increase in the bleeding which always takes
place at the site of the fracture. It also prevents broken bone ends from piercing or
damaging the skin, blood vessels, nerves or muscles.
3. Immobilise the fracture by the use of bandages or the use of splints.
Using the patient’s body as a means of support, application of bandages would be
adequate. Additional support of splints may be required when there is a possibility
of long or difficult transport before medical aid is possible. Splints are required
when both lower limbs are fractured.
The use of bandages:-
Never apply a bandage over the site of a fracture. They must be applied sufficiently
firmly to prevent harmful movements, but not so tightly as to prevent the
circulation of blood. In the case of a fractured limb, further swelling may occur,
causing the bandage to become too tight. Should this occur, loosen them at once to
allow normal circulation to return. Padding must always be placed between the
ankles and knees if these are tied together.
Fractures of the upper limbs:-
These may occur
1. Close to the shoulder
2. Near the middle of the shaft
3. Close to or involving the elbow joint.
Fracture of the forearm:-
Shortening is unlikely to be observed unless both bones are broken.
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Fracture of the lower end of the radius:-

This “Colles Fracture” is extremely common and frequently occurs due to a fall on
an outstretched hand. It may be mistaken for a sprain of the wrist, and on the other
hand, there may be a considerable deformity.
Fracture of the hands and fingers:-
Fracture of the bones of the hand may be accompanied by severe bleeding into the
palm.
Treatment of all fractures of the upper limb:-
 Do not remove the patient’s jacket, if any.
 Bend the elbow and lay the injured limb against their chest with the fingers
just touching the opposite shoulder.
 Apply adequate padding between the limb and the chest.
 Fix the hand in position with a collar and cuff sling, taking care that there is
no constriction at the wrist.
 Feel the pulse on the injured side to ensure there is no interference with the
circulation of the limb
 Secure the limb firmly to the chest by two broad bandages.
1. The first with its upper border level with the top of the shoulder.
2. The second with its lower border level with the tip of the elbow.
Tie off both bandages on the opposite side of the body, like in the picture.
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6. Electrocution:-

Caused by touching a live and naked wire, cable or rail, a shock may be relatively
mild, or extremely severe. Burning is a result, and the burns may be severe or deep,
especially with higher voltages. In case of a shock, prompt action can aid the
patient’s life. Perform the following steps.
1. Switch off the current, and if it cannot be put off, cut off supply by removing the
plug, breaking the cable or wrenching it free. Never attempt to cut a cable with a
knife or scissors.
2. Remove the patient from contact with the current with the greatest care, using
dry insulating materials. With domestic apparatus, gloves are good; a folded
garment or newspaper gives fair protection.
3. Reassure the patient.
4. Lay the patient down on their back, with the head low and turned to one side
unless there is an injury to the head, abdomen or chest when the head and
shoulders should be slightly raised and supported.
5. Loosen clothing around the neck, chest and waist.
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6. Wrap them in a blanket or rug.

7. Give sips of water, coffee or any liquid but never alcohol.
The danger from an electrical shock depends on the type of current, how high the
voltage is, how the current traveled through the body, the person's overall health
and how quickly the person is treated.
An electrical shock may cause burns, or it may leave no visible mark on the skin.
In either case, an electrical current passing through the body can cause internal
damage, cardiac arrest or other injury. Under certain circumstances, even a small
amount of electricity can be fatal.
When to contact your Doctor
A person who has been injured by contact with electricity should be seen by a
doctor.
Caution
 Don't touch the injured person if he or she is still in contact with the
electrical current.
 Call 911 or your local emergency number if the source of the burn is a high-
voltage wire or lightning. Don't get near high-voltage wires until the power
is turned off. Overhead power lines usually aren't insulated. Stay at least 20
feet (about 6 meters) away — farther if wires are jumping and sparking.
 Don't move a person with an electrical injury unless he or she is in
immediate danger.
When to seek Emergency Care
Call 911 or your local emergency number if the injured person experiences:
Severe burns, Confusion, Difficulty breathing, Heart rhythm problems
(arrhythmias), Cardiac arrest, Muscle pain and contractions, Seizures, Loss of
consciousness.
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Take these actions immediately while waiting for medical help:

 Turn off the source of electricity, if possible. If not, move the source away
from you and the person, using a dry, nonconducting object made of
cardboard, plastic or wood.
 Begin CPR if the person shows no signs of circulation, such as breathing,
coughing or movement.
 Try to prevent the injured person from becoming chilled.
 Apply a bandage. Cover any burned areas with a sterile gauze bandage, if
available, or a clean cloth. Don't use a blanket or towel, because loose fibers
can stick to the bh.
DISEASES AND INJURIES
What is an Occupational Injury/Disease?
An occupational injury is when a person is harmed as a result of a specific on-the-
job accident where the exact date and cause can be determined. An occupational
disease, on the other hand, is a type of work injury that occurs over time and
causes chronic ailment preventing you from performing your job duties or from
possibly ever working again. The main difference between an occupational injury
and disease is that occupational diseases do not derive from one particular incident,
but rather happen over a period of time or series of repetitive actions.
Brain damage, which is the destruction or degeneration of brain cells, is a common
occurrence in those who experience a head injury. Neurotoxicity is another cause
of brain damage that typically refers to selective, chemically induced neuron/brain
damage.
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A head injury is any injury that results in trauma to the skull or brain. The terms
traumatic brain injury and head injury are often used interchangeably in the
medical literature.[1] Because head injuries cover such a broad scope of injuries,
there are many causes—including accidents, falls, physical assault, or traffic
accidents—that can cause head injuries. Unlike a broken bone where trauma to the
body is obvious, head trauma can sometimes be conspicuous or inconspicuous. In
the case of an open head injury, the skull is cracked and broken by an object that
makes contact with the brain. This leads to bleeding. Other obvious symptoms can
be neurological in nature. The person may become sleepy, behave abnormally, lose
consciousness, vomit, develop a severe headache, have mismatched pupil sizes,
and/or be unable to move certain parts of the body. While these symptoms happen
immediately after a head injury occurs, many problems can develop later in life.
Alzheimer’s disease, for example, is much more likely to develop in a person who
has experienced a head injury.
Head injuries may be either closed or open. A closed head injury is any
injury that doesn’t break your skull. An open (penetrating) head injury is one in
which something breaks your scalp and skull and enters your brain. It can be hard
to assess how serious a head injury is just by looking. Some minor head injuries
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bleed a lot, while some major injuries don’t bleed at all. It’s important to treat all
head injuries seriously and get them assessed by a doctor.
What Causes a Head Injury?
In general, head injuries can be divided into two categories based on what causes
them. They can either be head injuries due to blows to the head or head injuries
due to shaking. Head injuries caused by shaking are most common in infants and
small children, but they can occur any time you experience violent shaking. Head
injuries caused by a blow to the head are usually associated with: motor vehicle
accidents falls, physical assaults, sports-related accidents etc. In most cases, your
skull will protect your brain from serious harm. However, injuries severe enough
to cause head injury can also be associated with injuries to the spine.
What are the Major Types of Head Injuries?
Hematoma: A hematoma is a collection, or clotting, of blood outside the blood
vessels. It can be very serious if a hematoma occurs in the brain. The clotting can
lead to pressure building up inside your skull. This can cause you to lose
consciousness or result in permanent brain damage.
Hemorrhage: A hemorrhage is uncontrolled bleeding. There can be bleeding in
the space around your brain, called subarachnoid hemorrhage, or bleeding within
your brain tissue, called intracerebral hemorrhage. Subarachnoid hemorrhages
often cause headaches and vomiting. The severity of intracerebral hemorrhages
depends on how much bleeding there is, but over time any amount of blood can
cause pressure buildup.
Concussion: A concussion occurs when the impact on the head is severe enough to
cause brain injury. It’s thought to be the result of the brain hitting against the hard
walls of your skull or the forces of sudden acceleration and deceleration. Generally
speaking, the loss of function associated with a concussion is temporary. However,
repeated concussions can eventually lead to permanent damage.
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Edema: Any brain injury can lead to edema, or swelling. Many injuries cause
swelling of the surrounding tissues, but it’s more serious when it occurs in your
brain. Your skull can’t stretch to accommodate the swelling. This leads to pressure
buildup in your brain, causing your brain to press against your skull.
Skull fracture: Unlike most bones in your body, your skull doesn’t have bone
marrow. This makes the skull very strong and difficult to break. A broken skull is
unable to absorb the impact of a blow, making it more likely that there’ll also be
damage to your brain. Learn more about skull fractures.
Diffuse axonal injury: A diffuse axonal injury (sheer injury) is an injury to the
brain that doesn’t cause bleeding but does damage the brain cells. The damage to
the brain cells results in them not being able to function. It can also result in
swelling, causing more damage. Though it isn’t as outwardly visible as other forms
of brain injury, a diffuse axonal injury is one of the most dangerous types of head
injuries. It can lead to permanent brain damage and even death.
What are the Symptoms of a head Injury/ Disease?
Your head has more blood vessels than any other part of your body, so bleeding on
the surface of your brain or within your brain is a serious concern in head injuries.
However, not all head injuries causes bleeding. It’s important to be aware of other
symptoms to watch out for. Many symptoms of serious brain injury won’t appear
right away. You should always continue to monitor your symptoms for several
days after you injure your head.
Common symptoms of a minor head injury include: a headache,
lightheadedness, a spinning sensation, mild confusion, nausea, temporary ringing
in the ears etc. The symptoms of a severe head injury include many of the
symptoms of minor head injuries. They can also include: a loss of consciousness,
seizures, vomiting, balance or coordination problems, serious disorientation, an
inability to focus the eyes, abnormal eye movements, a loss of muscle control, a
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persistent or worsening headache, memory loss, changes in mood, leaking of clear

fluid from the ear or the nose etc.
When does a head injury/Disease require medical attention?
Head injuries shouldn’t be taken lightly. See your doctor right away if you think
you have the symptoms of a serious head injury. In particular, you should always
seek immediate medical attention if you experience any of the following: loss of
consciousness, confusion, disorientation etc.
Either call 911 or your local emergency services or go to an emergency room.
Even if you don’t go to the ER immediately after the injury occurs, you should
seek help if you still have symptoms after a day or two.
How is a head Injury Treated?
The treatment for head injuries depends on both the type and the severity of the
injury. With minor head injuries, there are often no symptoms other than pain at
the site of the injury. In these cases, you may be told to take acetaminophen
(Tylenol) for the pain. You shouldn’t take nonsteroidal anti-inflammatory drugs
(NSAIDs), such as ibuprofen (Advil) or aspirin (Bayer). These can make any
bleeding worse. If you have an open cut, your doctor may use sutures or staples to
close it. They’ll then cover it with a bandage. Even if your injury seems minor, you
should still watch your condition to make sure it doesn’t get worse. It isn’t true that
you shouldn’t go to sleep after you have injured your head. But you should be
woken up every two hours or so to check for any new symptoms. You should go
back to the doctor if you develop any new or worsening symptoms. You may need
to be hospitalized if you have a serious head injury. The treatment you receive at
the hospital will depend on your diagnosis.
The treatment for severe head injuries/disease can include:
Medication: If you’ve had a severe brain injury, you may be given anti-seizure
medication. You’re at risk for seizures in the week following your injury. You may
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be given diuretics if your injury has caused pressure buildup in your brain.
Diuretics cause you to excrete more fluids. This can help relieve some of the
pressure. If your injury is very serious, you may be given medication to put you in
an induced coma. This may be an appropriate treatment if your blood vessels are
damaged. When you’re in a coma, your brain doesn’t need as much oxygen and
nutrients as it normally does.
Surgery: It may be necessary to do emergency surgery to prevent further damage
to your brain. For example, your doctor may need to operate to: remove a
hematoma, repair your skull, release some of the pressure in your skull etc.
Rehabilitation: If you’ve had a serious brain injury, you’ll most likely need
rehabilitation to regain full brain function. The type of rehabilitation you get will
depend on what functionality you’ve lost as a result of your injury. People who’ve
had a brain injury will often need help regaining mobility and speech.

QUESTION II
IT'S MANAGEMENT AND MASS CASUALTIES (TRIAGE) IN DETAILS.
Medical Emergencies & Managing Injuries
To help a person in need of medical attention, start with these steps:
 Check surrounding area for any dangers.
 Call the Department of Public Safety at 911 or activate a blue light phone.
Stay on the phone while the dispatchers assist you.
Victim with an Injury
 Do not move the injured person unless there is danger of further harm.
 If the injured person is bleeding, place a dry cloth on wound with gentle
pressure.
 Keep the injured person warm.
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Unconscious Victim:
 Check to see if person is responsive.
 Check to see if person is breathing, including signs of coughing and rising
chest.
 Do not exceed your training or knowledge when attempting to render first
aid.
Five Steps of Emergency Care, Injuries and Diseases
Sudden illness or injury can occur without warning, and while no one typically
plans a trip to the Emergency Department, everyone should know what to expect
after they arrive. The Emergency Department (ED) Medical Center provides urgent
care to patients who have traumatic injury, major illnesses or other issues that
require immediate treatment. The staff includes physicians, nurses and other
healthcare professionals who follow specific procedures so that you can get the
care you need as quickly as possible. Following are the five steps involved in
emergency, disease and injury management. The Steps of Care are; Triage,
Registration, Treatment, Reevaluation, and Discharge
Step 1 – Triage: Triage is the process of determining the severity of a patient’s
condition. Patients with the most severe emergencies receive immediate treatment.
That is why some patients may receive medical care before you, even if they
arrived at the ED after you. When you arrive at the ED, emergency technicians
determine the reason for your visit. A registered nurse will take your medical
history and perform a brief examination of your symptoms. The triage registered
nurse might assign you a priority level based on your medical history and current
condition according to the following scale: Level 1 – Resuscitation (immediate
life-saving intervention); Level 2 – Emergency; Level 3 – Urgent; Level 4 – Semi-
urgent; Level 5 – Non-urgent. In some cases, an emergency registered nurse may
start diagnostic testing to decrease the time spent waiting for medical treatment.
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Should your symptoms worsen as you wait, notify the emergency technician or
triage nurse immediately. Only one person may accompany the patient in the triage
area.
Step 2 – Registration: The registration process is important for two reasons: it lets
the ED staff gather information for your patient record and we obtain your consent
for treatment. Both are necessary to order diagnostic tests to enable the physician
determine the best treatment option for you. Patient Access Specialists can conduct
bedside registration for patients who have been taken directly to a treatment room.
Step 3 – Treatment: Every patient who comes to the Emergency Department
Regional receives treatment from an attending physician or mid-level practitioner.
Depending on your condition, a registered nurse may start an intravenous (IV) line.
The IV line will allow the nursing staff to quickly administer medications or fluids
that may be ordered by a physician. A nurse or technician may also take blood or
urine samples, or they may send you for an X-ray or other imaging test before a
physician sees you. Physicians may also order blood tests on an urgent basis. Test
results help emergency medicine physicians assess your condition. The results
could be available within one to two hours, while you are in the ED. However,
some test results may require a longer wait. During your treatment, the staff in the
ED will help make sure you are comfortable and informed. Only two visitors are
allowed at one time in the patient room.
Step 4 – Reevaluation: An ED physician or mid-level practitioner will reevaluate
your condition after they receive your test results because the results may give
them additional insight into the type of treatment you need. You know your body.
How you feel can be just as important as your test results, so be sure to let
physicians or nurses know about any pain or discomfort you may feel. The staff
may also contact your personal physician for additional information. If you do not
have a personal physician, we may refer you to an on-call physician. After your
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reevaluation, the attending physician determines whether you should be admitted

to the hospital or treated and sent home.
Step 5 – Discharge: Part of our job is to keep you healthy long after you’ve left
the ED. All patients receive written home-care instructions to follow when
discharged. The instructions describe how you can safely care for your wound or
illness, directions for your prescribed medications and recommendations for
follow-up medical care. It is important to fully understand all instructions. If you
have a question – let us know while you’re here. Or call 580-249-3001 once you
return home. Be sure to follow up with your personal or referred physician as well.
One to two weeks after your visit to the Emergency Department Regional Medical
Center, you may receive a phone call asking for your opinions about your stay.
Your comments allow us to continually provide outstanding emergency care to all
our patients.
MASS CASUALTIES (TRIAGE)
Triage refers to the evaluation and categorization of the sick or wounded when
there are insufficient resources for medical care of everyone at once. Historically,
triage is believed to have arisen from systems developed for categorization and
transport of wounded soldiers on the battlefield. In mass casualty situations, triage
is used to decide who is most urgently in need of transportation to a hospital for
care (generally, those who have a chance of survival but who would die without
immediate treatment) and whose injuries are less severe and must wait for medical
care. Triage is also commonly used in crowded emergency rooms and walk-in
clinics to determine which patients should be seen and treated immediately. Triage
may be used to prioritize the use of space or equipment, such as operating rooms,
in a crowded medical facility. In a walk-in clinic or emergency department, an
interview with a triage nurse is a common first step to receiving care. He or she
generally takes a brief medical history of the complaint and measures vital signs
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(heart rate, respiratory rate, temperature, and blood pressure) in order to identify
seriously ill persons who must receive immediate care. In a hospital, triage might
prevent an operation for an elective facelift from being performed if there are
numerous emergent cases requiring use of operating facilities and surgical nursing
staff.
In a disaster or mass casualty situation, different systems for triage have
been developed. One system is known as START (Simple Triage and Rapid
Treatment). In START, victims are grouped into four categories, depending on the
urgency of their need for evacuation. If necessary, START can be implemented by
persons without a high level of training. The categories in START are:
 the deceased, who are beyond help
 the injured who could be helped by immediate transportation
 the injured with less severe injuries whose transport can be delayed
 those with minor injuries not requiring urgent care.
Another system that has been used in mass casualty situations is an example of
advanced triage implemented by nurses or other skilled personnel. This advanced
triage system involves a color-coding scheme using red, yellow, green, white, and
black tags:
Red tags -(immediate) are used to label those who cannot survive without
immediate treatment but who have a chance of survival.
Yellow tags - (observation) for those who require observation (and possible later
re-triage). 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.
Green tags - (wait) are reserved for the "walking wounded" who will need medical
care at some point, after more critical injuries have been treated.
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White tags - (dismiss) are given to those with minor injuries for whom a doctor's
care is not required.
Black tags - (expectant) are used for the deceased and for those whose injuries are
so extensive that they will not be able to survive given the care that is available.
Issues of Concern
Mass casualty incidents triage systems are implemented to offer the greatest good
to the greatest amount of people as healthcare resources are limited or strained due
to the number of injured individuals. Treatment during triage is minimal, and this
is counterintuitive to normal pre-hospital protocols. The goal is to move patients
away from the incident and toward resources that offer more comprehensive care.
Most mass casualty incident triaging systems use tags or colored designations for
categorizing injured persons. It is important to designate areas where to tagged
and/or labeled individuals can relocate. These areas will dually serve as treatment
and loading zones for arriving ambulance crews. Triaging during a mass casualty
incident is a dynamic and fluid process which requires a certain degree of pre-
incident training. Patients may initially be triaged to one category but may be
switched to another due to changes in their clinical status. Many of the triage tags
have fold over tabs that are designed to switch patients between categories easily.
However, emphasis should be placed on rapid assessment and quick movement of
patients.
Primary triage systems are not built for determining resource allocation.
There may be various implementation strategies for treatment and evacuation once
patients have been triaged depending on the system or agency using the system.
They do not rely on the number of victims present or resources available, and some
have argued the need for a more sophisticated system allowing for consideration of
these factors. Triaging algorithms are simple, straightforward, and easy to use;
however, they can allow for over or under triaging depending on the situation.
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There are many available systems, and it is important to choose one and have it in
place as an important part of any disaster preparedness plan which can ultimately
help save lives.
Clinical Significance
Multiple triage systems are currently being implemented around the world. Some
of the more well-known algorithms include START (simple triage and rapid
treatment), SALT (sort, assess, lifesaving interventions, treatment/triage), STM
(Sacco triage method), Care Flight Triage, and SAVE (Secondary assessment of
victim endpoint). There is limited data available to support one system over
another. However, it is important to choose one and adhere to its algorithm to
maintain an ordered approach.