Professional Documents
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LT COL TA AKINBO
FSS BNSC(Hons) RN RM ICN
Ag Chief Matron
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COL SB ONIFADE FSS MSS MBBS MSc MBA ACIPM DIP(French) FMCOG
Ag CMD
MILITARY HOSPITAL LAGOS
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INTRODUCTION
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INTRODUCTION
Triage is derived from Old French word “trier” which
means “to sort”….(to separate, sift or select). It is a
process for sorting injured people into groups based
on their need for or likely benefit from immediate
medical treatment.
INTRODUCTION (CONT’D)
• It is a method of quickly identifying victims who
have immediate life-threatening injuries & who have
the best chance of surviving.
• A process by which priorities are set for the
management of mass casualties
• In a mass casualty situation, triage aims at doing the
best for the most and not everything for everyone
• Accomplish the greatest medical good for the
greatest number of people
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INTRODUCTION (CONT’D)
• Triage consists of rapidly classifying the injured
on the basis of severity of their injuries and their
survival with prompt medical intervention
• It is usually adapted to locally available skills
and resources
• It is the process of determining the priority of
patients’ treatments vis-à-vis the severity of their
conditions
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INTRODUCTION (CONT’D)
Primitive triage system classified patients based on:
a. Those who were likely to live, regardless of what
care they received.
b. Those who were likely to die, regardless of what
care they received.
c. Those for whom immediate care might make a
positive difference in outcome.
Modern approaches to triage are more scientific:
Outcome and grading of the victims is frequently
the result of clinical assessments
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INTRODUCTION (CONT’D)
Triage procedures are important in the
management of Mass Casualty.
A Mass Casualty incident is an event
which generates more patients at one
time than locally available resources can
manage using routine procedures.
Mass Casualty management requires
exceptional emergency arrangements
and additional or extraordinary
assistance.
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INTRODUCTION (CONT’D)
Adequate knowledge and good practice
of Triage, especially during Mass
Casualty management could enhance
efficient use of resources and
consequently safe lives.
It is therefore imperative that officers of
the NAMC have the basic and requisite
knowledge of Triage.
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AIM
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AIM
TO DISCUSS TRIAGE PROCEDURES DURING
MASS CASUALTY MANAGEMENT WITH
STUDENTS OF YOUNG OFFICERS COURSE
(MEDICAL) 35/2020.
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SCOPE
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SCOPE
1. PLANNING A TRIAGE
2. TRIAGE TEAM
3. TRIAGE DOCUMENTATION
4. TRIAGE PROCESS
5. TRIAGE CATEGORIES
6. TYPES OF TRIAGE
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PLANNING A TRIAGE
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PLANNING A TRIAGE
Preparation before an anticipated crisis
Organisation of the personnel
Organisation of the space
Organisation of the infrastructure
Organisation of the equipment
Organisation of supplies
Training
Communication
Security
Convergence reaction = relatives, friends &
the curious (especially the armed ones)
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• Nursing groups
TRIAGE DOCUMENTATION
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TRIAGE DOCUMENTATION
• Include basic information
• Short-form
• Clear
• Concise
• Complete
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TRIAGE PROCESS
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TRIAGE PROCESS
Triage is a dynamic process:
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TRIAGE CATEGORIES
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TRIAGE CATEGORIES
a. Serious wounds: Resuscitation and
immediate surgery.
b. Second priority: Need surgery but can
wait.
c. Superficial wounds: Ambulatory
management.
d. Severe wounds: Supportive treatment.
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WW in the field
(GSW, mine, blast)
100 wounded
30 - 40 % 60 - 70 %
No surgery Hospital care
EPIDEMIOLOGY OF TRIAGE:
SHORT EVACUATION TIME
• Category I 5 - 10%
• Category II 25 – 30%
• Category IV 5 - 7%
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Tagging
• Complements
Triage
• Rapid
Identification
of patient
• Color Coded /
Bar Coded
system
• Plastic
“bands” can
substitute tags
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Source:
Source:Google
GoogleImage
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TYPES OF TRIAGE
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TYPES OF TRIAGE
1. Simple triage
2. Advanced triage
In triage classification, different countries use different
triage systems. The most commonly used and
internationally accepted is the 4-color code system
viz:
a. RED: indicates high priority treatment or transfer
b. YELLOW: indicates medium priority
c. GREEN: indicates ambulatory patients
d. BLACK: indicates moribund or dead patients
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Simple Triage
Usually used in a scene of an accident of a
mass-casualty incident (MCI) in order to sort
patients into those who need critical attention
and immediate transportation to the hospital
and those with minor injuries
Can be started before transportation is
available
Patient categorization could be by printed
triage tags of color flagging
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START SYSTEM
START- Simple Triage And Rapid
Treatment
• Created in the 1980’s by Hoag Hospital
and the Newport Beach CA Fire Dept
• Allows rapid assessment of victims
• It should not take more than 15 sec/Pt
• Once victim is in treatment area more
detailed assessment should be made
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YES NO
Evaluate Ventilation
Green
(Step-2)
(Minor)
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START Step-2
Ventilation Present?
NO YES
Open Airway
NO YES
Red/ Immediate
Black
Red/ Immediate Evaluate Circulation
(Step-3)
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START Step-3
Circulation
Evaluate Level of
Control
Consciousness
Hemorrhage
Red/
Immediate
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START Step-4
Level of Consciousness
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Contaminated Patients
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START-Overview
Remember …..RPM
• R- Respirations- 30
• P- Perfusion- Radial Pulse
• M- Mental- Follows Commands
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ADVANCED TRIAGE
• In this form of triage, physicians may decide that
some seriously injured patients should not receive
advanced care as they are likely to die despite
treatment
• It is used on patients with less severe injury
• Also used to divert scarce resources away from
patients that have high probability of dying in order
to increase the chances of those more likely to
survive
• It has ethical implications
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REVERSE TRIAGE
• Here the less wounded are treated
preferentially to the more severely wounded
• It may be used in war situations where there
is the need for soldiers to return to combat
roles as possible
• It could also be employed in situations where
medical staffers are among the wounded
where it may be advantageous for them to
survive to continue providing care to others
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APPLIED TRIAGE
• This is used to quickly sort out cases in the
early stages of injury.
• First responders may be overwhelmed by
the scope of patients and injuries in the
early phases of a disaster.
• Patient Assist method [PAM] is used to
rapidly establish a Casualty Collecting
Point [CCP].
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Under-triage:
• This is the process of under-estimating the
severity of an illness or injury
• An example is the process of categorizing a
Priority 1[Immediate] patient as Priority
2[Delayed] or even Priority 3 [Minimal]
• Acceptable under-triage rate is 5%
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Over-triage:
Is the process of over-estimating the level to which
an individual has been wounded or ill
Example is categorizing Priority 3[Minimal] patient
as Priority 2 [Delayed] or Priority 1 [Immediate]
Acceptable over-triage rate is 50% in an effort to
avoid under-triage
Over-triaging may be minimized when triaging is
done by trained hospital medical teams instead of
paramedics or EMTs
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CONCLUSION
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CONCLUSION
• Triage is a method of quickly identifying victims
who have immediate life-threatening injuries and
who have the best chance of surviving.
• Disaster management poses challenges that are
distinct from normal medical practice
• There is paradigm shift in care and transport of
causalities when the number exceeds available
resources. Therefore, there are changes in response
plan and focus, thus mass causality management.
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REFERENCES
1. Triage and management of mass casualty. Précis for
young officers’ course medical. Nigerian Army School of
Medical Sciences
2. Trauma, triage and scoring. Available at
www.patient.info/doctor/trauma-triage-and-scoring.
Accessed on 14 August 2017
3. Kilner T; Triage decisions of prehospital emergency
health care providers, using a multiple casualty scenario
paper exercise. Emerg Med J. 2002 Jul;19(4):348-53.
4. Scoring Systems. Available at www.trauma.org. Accessed
on 14 August 2017
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REFERENCES (CONT’D)
5. Husum H, Strada G; Injury Severity Score versus New Injury Severity Score
for penetrating injuries. Prehosp Disaster Med. 2002 Jan-Mar;17(1):27-32.
6. Paffrath T, Lefering R, Flohe S; How to define severely injured patients?-An
Injury Severity Score (ISS) based approach alone is not sufficient. Injury.
2014 Oct;45 Suppl 3:S64-9. doi: 10.1016/j.injury.2014.08.020
7. Eid HO, Abu-Zidan FM; New Injury Severity Score Is a Better Predictor of
Mortality for Blunt Trauma Patients Than the Injury Severity Score. World J
Surg. 2014 Sep 5.
8. Jouni Pousi; 2014: Principles of TRIAGE - Medical point of view
9. World Health Organisation: 2001: Establishing a Mass Casualty
Management system.
10. CJC Igboanusi; 2017: Triage and Management of Mass Casualties. Lecture
delivered to Students of Senior Executive Management Course , Nigerian
Army School of Medical Sciences, Ojo-Lagos.
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