The Principles of Triage
Medical triage is when victims are evaluated, sorted by the urgency of the assessment and set up for immediate or delayed treatment. Triage is an effective strategy when:
- There are more victims than rescuers.
- There are limited resources.
- Time is critical.
Conduct a size up of the area prior to starting triage. Make sure the area is safe and free from hazards.
Personal Protective Equipment (PPE)
Safety always comes first and you should don your personal protective equipment (PPE)
- protect your eyes from victim’s body fluids
- N95 mask
- protect your eyes and mouth from victim’s body fluids
- Sturdy shoes or boots
- Non-latex exam gloves
- protect your hands from victim’s body fluids
Wearing your exam gloves under your work gloves will save you time when attending a victim. All you have to do is remove your work gloves and you are ready to assess or treat the victim. Remember to change or disinfect gloves between victims.
Approaching the Victim
When approaching a victim
- Approach the victim so he or she can see you.
- Identify yourself – name and organization you are affiliated with.
- ALWAYS request permission to treat the victim. The victim has the right to refuse treatment. Go on to the next victim. If the victim is unresponsive, consent is implied. If possible, ask a parent or guardian before treating a child.
- Respect cultural differences when possible.
- All medical patients are legally entitled to confidentiality. Always be mindful and respectful of the privacy of their medical condition.
Triage in a Disaster Environment
- Stop, Look, Listen and Think
- Before your team starts, stop and size up the situation by looking around and listening. Think about your safety, capability and limitations, and decide if you will approach the situation. If you decide to proceed, quickly make a plan about your approach that all members will understand.
- Conduct Voice Triage
- Begin by calling out “Community Emergency Response Team – if you can walk, come to the sound of my voice.” Speak loudly and firmly. Walnut Creek SAR teams may have bullhorns. If there are survivors who are ambulatory, tag them “M” (minor or green) and direct them to a designated location. If rescuers need assistance and there are ambulatory survivors, then these survivors should be asked to provide assistance. These survivors may also provide useful information about the location of victims.
- Start Where You Stand
- and follow a systematic route. Start with the closest victim and work outward in a systematic fashion.
- Evaluate Each Victim
- Treat “I” Victims Immediately
- Initiate airway management, bleeding control, and/or treatment for shock.
- Document Triage Results for
- Effective deployment of resources.
- Information on the victims’ locations.
- A quick record of the number of casualties by degree of severity.
Evaluating a Victim During Triage
- Start with the airway, At an arm’s distance, make contact with the victim and speak loudly. If the victim does not respond, then:
- Position the airway.
- Look, listen, feel.
- Check breathing rate. Abnormally rapid respiration (above 30 per second) may indicate shock. Maintain the airway and treat for shock and tag “I”.
- If the victim is not responsive after two attempts to open the airway, tag the victim “DEAD”.
- Second, check for bleeding.
- Stop uncontrolled bleeding.
- Perform blanch test for capillary refill (greater that two seconds tag “I”).
- Or perform a radial pulse test.
- If pulse is present, continue to assessment of mental status.
- If pulse is absent or abnormal, elevate status to “I” and treat for bleeding and shock.
- Third, check mental status. If no response, the victim’s status is “I”.
If the victim passes all the tests and is not “M”, his or her status is “D”. If the victim fails any test, the status is “I”. Everyone gets a tag.
Victims’ conditions are evaluated and the victims are prioritized into one of four categories:
- Immediate (I – red) The victim has life-threatening injuries (airway, bleeding or shock) that demand immediate attention to save his or her life. Rapid lifesaving treatment is urgent. These victims are marked with a red tag or labeled “I”.
- Delayed (D – yellow) Injuries do not jeopardized the victim’s life. The victim may require professional care, but treatment can be delayed. These victims are marked with a yellow tag or labeled”D”.
- Minor (M – green) Walking wounded and generally ambulatory. These victims are marked with a green tag or labeled “M”.
- Dead (DEAD – black) No respiration after two attempts to open the airway. These victims are marked with a black tag or labeled “DEAD”. Do not move DEAD victims. The area should be treated as a possible crime scene.
NEXT – The Three Killers