TRIAGE, STABILIZATION,

COMMUNICATION
&
TRANSPORTATION

TLS 2014
DEFINITION
- The sorting of patients according
to their need for emergency
treatment and evacuation.
- A French word meaning ‘to sort’.
TYPES OF TRIAGE
1. Hospital Triage
2. Field Triage
 Sorting out patients according to the severity of
injury and the priority of treatment.
- Performed according to the hospital’s
operation policy and depends upon these
factors :-
a) Manpower & staffing
b) Availability of facilities
c) Zoning of the area - critical,
semi-critical and non-critical
Triage Response Description of Category Clinical Descriptors (indicative only)
Category

Immediately Life-
Life-
Threatening
Cardiac arrest
Immediate
Conditions that are threats to Respiratory arrest
Category 1 simultaneous life (or imminent risk of
deterioration) and require Immediate risk to airway -
assessment and immediate aggressive impending arrest
treatment intervention.
Respiratory rate <10/min

Extreme respiratory distress

BP< 80 (adult) or severely

shocked child/infant

RED ZONE  Unresponsive or responds to

pain only (GCS < 9)

 Ongoing/prolonged seizure

 IV overdose and unresponsive

or hypoventilation
 Triage Response Description of Category Clinical Descriptors
Category (indicative only)

Imminently life-
life-threatening
The patient's condition is
serious enough or
deteriorating so rapidly
that there is the potential Airway risk - severe stridor or
of threat to life, or organ drooling with distress
system failure, if not
treated within ten Severe respiratory distress
minutes of arrival
Or Circulatory compromise
Category 2 Assessment Important time-
time-critical  Clammy or mottled skin, poor
and treatment perfusion
Treatment The potential for time-
time-critical  HR<50 or >150 (adult)
start within treatment (e.g.  Hypotension with haemodynamic
10 mins thrombolysis,
thrombolysis, antidote) to effects
make a significant effect
(assessment on clinical outcome Chest pain of likely cardiac nature
and depends on treatment
RED ZONE commencing within a few Very severe pain - any cause
treatment
Often minutes of the patient's
simultaneous arrival in the ED Blood sugar (eye tone) –
hypoglysemia
or

Very severe pain

Humane practice mandates Cont……
Cont……
the relief of very severe
pain or distress within 10
minutes
 CRITICAL SEMI-CRITICAL NON-CRITICAL
 All patients with life Hemodynamically  Closed # of upper limbs.
stable pts.
threatening injuries
e.g. airway obstruction  Minor injuries with no
 Closed # of lower vascular involvement.
 Thermodynamically
limbs.
unstable patients.
 Acute respiratory  Minor illnesses e.g
distress.  Open fractures. colds.
 Severe crush injury.
 Burns >20% BSA or  Medical conditions
involving face & chest. requiring intravenous
intervention.
 Comatose patients.
Performed outside the hospital usually at the
incident site.
- Two factors play an important role :-
a) The number of patients.
b) The severity of injuries to the patients.
- If (a) & (b) do not exceed the capability of the
facility & staff, patients with life threatening
problems are treated first.

- If (a) & (b) exceeds the capability of the facility &

staff, patients with the greater chance of survival
are managed first.
I. SCENE ASSESSMENT
- Check for hazards/potential
hazards.
- An idea of the ‘mechanism of
injury’.
II. TRIAGE
- In mass casualties - ask those who can

walk to a safe area

“START SYSTEM”
B) Triage Tag or Card
- Usually colour coded and large enough for
visualization.
- Colour codes are as follows:-
RED First Priority Victims.
YELLOW Second Priority Victims.
GREEN Third Priority Victims.
WHITE Dead Victims
FIRST UNIT ON SCENE START – Simple Triage And Rapid Treatment
What to do ?
How to begin ? 1 Call out

REMEMBER 5 S’s
Walking wounded Non Walking
&
1.SAFETY assessment Uninjured
2 RESPIRATIONS
2.SIZE UP the scene GREEN
Yes No
How big ?
How bad ? < 30/min > 30/min
3.SEND information: Position
3 PERFUSION RED Airway

4.SETUP the scene for Management

of the casualties. Capillary Refill
or Radial Pulse Yes No
5.START
Remember “RPM” Under 2 sec Over 2 sec
Or Pulse Present Or Pulse Absent RED WHITE
RESPIRATIONS
PERFUSION 4 MENTAL STATUS RED
MENTAL STATUS
Colour codes:
RED -IMMEDIATE Follows simple command Can’t follow simple command
YELLOW -DELAYED
GREEN -MINOR
YELLOW RED
WHITE -DEAD
Not walking on her own
◦ Breathing on her own at <
30 bpm
◦ + radial pulse
◦ Follows commands –
points to where it hurts…
YELLOW
 Not walking out on
own
 Initially not

breathing on own
 Breathing on own

once airway is
opened
RED
Not walking out on
own
• Breathing on own
and crying
• Breathing at 40 bpm
RED
• Carried to you by
bystanders
• Not breathing on own
• Not breathing after
airway is opened or re-
positioned
WHITE
 Not walking out on
own
• Breathing on own at
20 bpm
• + radial pulse
• Not following
commands
RED
Not walking out on
own
• Not breathing on
own
• Not breathing when
airway is opened
WHITE
III. EVACUATION DECISION &
CRITICAL INTERVENTIONS
- The principles of evacuation are based
upon:
‘Those who are stabilized first are
evacuated first’

- Priority of evacuation must be given to

those victims who are most critically injured.
- Based on two principles :-
1. Stabilization of the
Physiological Function.
2. Stabilization of the
Anatomical Function
1. Stabilization of the Physiological Function.
A) Respiratory
- Insert airway / E.T tube.
- Oxygen administration
- rate & methods.
- Suction.
- Mechanical ventilation if needed.
- Chest tube if necessary.
- N.G tube - to prevent aspiration.
B) Cardiovascular
- Control external bleeding.
- 2 large IV lines - start infusion.
- Restore blood volume losses.
- Indwelling urinary catheter - monitor output.
- Monitor BP / PR / RR
C) Central Nervous System
- Control hyperventilation (head injury
patients).
2. Stabilization of the Anatomical Function
- Wound dressing/care
- Cervical immobilization
– use of cervical collar
- Appropriate splint of fractures.

* Do not splint a deformed limb before

reduction.
Objectives of communication are:

1. To obtain help and assistance from a

resource centre.
2. To relay information for further
management and preparation for
receiving patients.
3. To facilitate transportation of the
patient in order to render treatment
as soon as possible.
4. To facilitate delegated medical acts.

1) Contact phase.
Confirms radio contact
between EMS unit and a
hospital or base station.
Step 1 - Identification
Paramedic identify himself
e.g. “Medic Base this is
Medic 1, M.A./S.N……
calling.
Step 2 - Facility response
e.g. “ This is M.A / S.N…..
at Medic Base go ahead
Medic 1”.
Communication Policy
2) Field Reports 3) Request for orders /
management plan
Most important phase of communication.
All important primary survey information and
request for appropriate orders transmitted during
this phase.
Step 1- Re identification
4) Sign Off
Step 2 – Chief Complaint / On Scene Report
- Pts. Data- age,sex, chief complaint. Step 1 – Base Station Closing
On scene report e.g.” Medic Base Clear”
-Time & level of injury,
-Mechanism of injury
-Physiological status Step 2 – EMS Unit Sign Off
-Anatomocal injuries e.g. “ Medic 1 over and out”
Step 3 – Life saving procedures / Resuscitation
e.g. intubation, cervical collar
applied,bleeding arrested.
Step 4 – Vital signs/Primary survey/
abnormalities.
Step 5 – Re evaluation of pts. Data, physiological
and anatomical status.
Step 6 – Estimated time of arrival (ETA)
 “The patient should be sent to
the closest appropriate hospital
depending on the patient’s
needs”
1. Responsibility for determining
transfer
a) Field to Hospital - Usually
the triage officer.

b) Hospital to Hospital - The

attending doctor is responsible
2. Transfer responsibilities
a) Referring Physician
- responsible for
- initiation of transport
- selection of an appropriate mode of transportation
- level of care required
- stabilizing the patient’s condition

b) Receiving Doctor
- must be consulted on the transfer of patient.
- determine whether the institution is able to
accept the patient.
3. Modes of Transportation
Choice of transport is based on the
availability of trained personnel and
proper equipment & which mode
provides the safest and most rapid
method of transportation.
4. Transfer Protocol (guidelines)
a) Referring Physician
- should speak directly to the receiving doctor
and provide the following information:-
i. Identification of patient.
ii. Brief Hx of incident, mechanism of
injury and any pertinent hospital data.
iii. Initial findings and patient’s
response to therapy administered
b) Information to transferring personnel.
Should be informed regarding the patient’s
condition includes:-
i. Airway maintenance/ventilation.
ii. Fluid therapy / volume replacement.
iii. Special procedures done.
iv. Resuscitation procedures & any changes that may
occur.
5. Management during transport
a. Continued support of cardio-respiratory system.
b. Continued blood volume replacement.
c. Monitoring of vital signs.
d. Use of appropriate medication as ordered by a
doctor.
e. Maintenance of communication with a doctor
during transfer.
f. Maintenance of accurate records during the
transport.
?
Thank you