Triage

dr. Wirawan Anggorotomo, Sp.An.

SMF Anestesiologi dan Terapi Intensif

FK Univ.Malahayati/ RS Pertamina Bintang Amin
Bandar Lampung
Triage
The sorting of and allocation of treatment to patients and especially battle
and disaster victims according to a system of priorities designed to
maximize the number of survivors
(from the French trier, to sort)
(Merriam-Webster)
TRIAGE
Tindakan untuk mengelompokkan korban berdasarkan
beratnya cedera, kemungkinan untuk hidup, dan
keberhasilan tindakan berdasarkan sumber daya (SDM
atau peralatan) yang tersedia.
Triage:metode cepat untuk menentukan
prioritas penanganan pasien/korban
Casualty
Incident Site Collection Triage Unit Leader
Point

Simple Triage And Rapid Treatment

JumpSTART
Triage
• Triage harus dilakukan
SECEPATNYA

• Gunakan START/
JumpSTART untuk
menentukan prioritas

• 30–60 detik per pasien

• Pasang pita di bagian kiri

atas lengan atau kaki
 START – JumpSTART Triage
• Pisahkan pasien “walking wounded” dengan
perintah:
Jika anda dapat mendengar saya dan bisa bergerak,
pindah ke…..
• Arahkan korban ke titik kumpul atau area tindakan
untuk pemeriksaan dan penanganan lebih lanjut
• Tunjuk seseorang untuk mengawasi pasien dan
mengamankan area hijau
• Pita dipasang di titik kumpul
• Pasien/korban termasuk kategori MINOR
START/JumpSTART
Gunakan
START/JumpSTART untuk
menilai dan memilah pasien
yang tersisa

USE COLORED
RIBBONS ONLY
START/JumpSTART
Pengelompokan pasien dengan menilai RPM

Respirations

Pulse/perfusion

Mental Status
START First Step
Can the Patient Walk?

YES NO

Evaluate
Green Ventilation
(Minor) (Step-2)
START Step-2
Ventilation Present?
NO YES

Open Airway

Ventilation Present? > 30/Min < 30/min

NO YES Red/ Immediate

Black Red/ Immediate Evaluate Circulation

(Step-3)
 START Step-3
Circulation

Absent Radial Pulse Present Radial Pulse

Control Hemorrhage
Evaluate Level of
Consciousness
Red/ Immediate
START Step-4
Level of Consciousness

Can’t Follow Simple Can Follow Simple

Commands Commands

Red/ Immediate Yellow/ Delayed

 Combined START/JumpSTART Triage
CAN YOU YES ** Using the JS algorithm
MINOR SECONDARY TRIAGE ** evaluate all children first
WALK ? who did not walk under
their own power.
NO
Evaluate infants first in
BREATHING secondary triage using
NO Position Upper Airway IMMEDIATE
Breathing ? entire JS algorithm !

APNEIC
PEDIATRIC ADULT
HAS A NO PULSE
PULSE
APNEIC PEDI Neurological Assessment
YES 5 Rescue Breaths Expected /
Deceased A Alert
BREATHING
V Responds to
IMMEDIATE Verbal Stimuli
Responds to
Respiratory > 30 ADULT P
IMMEDIATE Painful Stimuli
Rate? PEDI Unresponsive
45 > OR < 15
< 30 ADULT U To Noxious
15 - 45 PEDI ADULT Stimuli
CR >2 Sec or NO PALPABLE PULSE
Perfusion ? IMMEDIATE
PEDI - NO PALPABLE PULSE
YES “P” INAPPROPRIATE POSTURING OR “U”
( PEDIATRIC )
Mental DOESN’T OBEY COMMANDS IMMEDIATE
Status ? ADULT
OBEY COMMANDS - ADULT
DELAYED
“A”, “V”, OR “P” ( APPROPRIATE) - PEDIATRIC

Http ://www . starttriage. com Http :// www . jumpstarttriage . com

 Adult Pediatric
Respirations > 30 BPM Respirations < 15 or > 45
CR > 2 seconds or CR > 2 seconds or no palpable
no palpable radial pulse radial or brachial pulse
Cannot follow simple Inappropriate “Pain”
commands (e.g., posturing) or
“Unresponsive”
Pneumothorax
Hemorrhagic Shock
Closed Head Injury
Adult: respirations, capillary refill, and mentation are normal
• Isolated burns

• Extremity fractures

• Stable other trauma

• Most patients with

medical complaints

Pediatric: “A,” “V,” or appropriate “P”

(e.g., withdrawal from pain stimulus)
• “Walking
wounded”
• Psychological
casualties
• Always look for
children being
carried and assess
them
• Obvious mortality or death
(pulseless and apneic)
• Decapitation
• Blunt trauma arrest
• Injuries incompatible with life
• Brain matter visible
Noji
Nojiet
etal,
al,NEJM
NEJM
Simpulan
• Triage memberikan penanganan yang efektif
dan efisien, membantu meningkatkan
kemampuan survival pasien sebanyak
mungkin
• Pengaturan sumber daya akan
meningkatkan efisiensi
• Pasien dengan cedera berat akan segera
ditangani dan ditransfer sesuai prosedur
• Menjamin akuntabilitas pasien
 START/JumpSTART—RPM
RESPIRATIONS
Is the patient breathing?
Yes
Adult – respirations > 30 = Red/Immediate
Pediatric – respirations < 15 or > 45 = Red/Immediate
Adult – respirations < 30 = check perfusion
Pediatric – respirations > 15 and < 45 = check perfusion
START/JumpSTART—RPM
RESPIRATIONS
Is the patient breathing?

No
Reposition the airway…
Respirations begin =
IMMEDIATE/RED
If patient is APNEIC
 Adult – deceased = BLACK
 Pediatric: Pulse Present – give
5 rescue breaths
 respirations begin =
IMMEDIATE/RED
 absent respirations –
deceased = BLACK
 START/JumpSTART—RPM
PULSE/PERFUSION
Is the RADIAL pulse present?

Is capillary refill (CR) LESS than < 2

seconds?
Yes
Check mental status

No
Adult: Pulse absent or
CR > 2 seconds patient
= IMMEDIATE/RED
Pediatric: No palpable
pulse patient =
IMMEDIATE/RED
 START/JumpSTART—RPM
MENTAL STATUS…
Can the patient follow simple commands?

No
Adult = IMMEDIATE / RED
Pediatric – “P” pain causes inappropriate
posturing or “U” unresponsive to noxious
stimuli = IMMEDIATE/ RED
 START/JumpSTART
If the patient is IMMEDIATE/RED upon initial
assessment…then, before moving the patient to the
treatment area, attempt only life-saving interventions:

Airway, Needle Decompression, Tourniquet,

Antidote

DO NOT ATTEMPT ANY OTHER

TREATMENT AT THIS TIME