QUICK GUIDE:
Multi-Casualty Incident Triage
When the number of casualties exceeds our ability to provide Emergency Care as per our normal daily operations, the
focus for triaging shifts to the GREATEST GOOD FOR THE GREATEST NUMBER OF CASUALTIES. START Triage is a
process to rapidly identify patients and categorize them based on their ability to walk, their mental status, and the
presence or absence of ventilation or capillary perfusion.
KEY POINTS IN MCI RESPONSE:
1. REMAIN CALM.
2. KEEP AN EYE ON YOUR TEAMMATES!
3. STOP THE BLEEDING! USE DIRECT PRESSUE, WOULD PACKING (e.g. Hemostatic Gauze) OR TOURNIQUET.
4. BE MINDFUL OF THE FACT THAT PEOPLE MAY HAVE DIFFICULTY HEARING D/T TYMPANIC MEMBRANE RUPTURE IF
THERE WAS AN EXPLOSION.
5. IF CBRNE/TERRORIST INCIDENT, BE AWARE OF SECURITY RISK AND USE SITUATIONAL AWARENESS AT ALL TIMES.
6. IN INCIDENTS INVOLVING CHEMICALS, SIGNS OF SIGNIFICANT TOXIDROME (e.g. SLUDGEM) SHOULD BE TRIAGED
AS IMMEDIATE.
FIRST: Clear the Walking Wounded by verbal command. Tag these as MINOR and direct
them to the Minor Treatment Area. Remember, if they cannot ambulate they are in
DELAYED category.
SECOND: Now check your RPMs – Respirations, Perfusion, Mental Status
• Respirations: None? Open the Airway!
o Still None? – MORGUE/EXPECTANT in Adults
o Still None? – MORGUE/EXPECTANT in Pediatrics if after 5 rescue breaths given
and still no respirations. NOTE: Remember, DO NOT perform CPR in MCI Triage
unless the resources are available to do so! We will make EVERY EFFORT to salvage
the patient until the resources exhausted due to disaster and HCC/County Health
Officer initiates Austere Care Conditions.
o Breathing Restored? – IMMEDIATE
• Respirations Present?
o Above 30? – IMMEDIATE in Adults;; IMMEDIATE in Pediatrics if breathing Less
than 15 and Greater than 45
o Below 30 for Adults and normal for Pediatrics? – Continue on and Check Perfusion
• Perfusion?
o Radial pulse absent or cap refill > 2 sec OR tourniquet is in place to stop
uncontrolled hemorrhage – IMMEDIATE in Adults and Pediatrics
o Radial pulse present or cap refill ≤ 2 sec – Continue on and Check Mental Status
• Mental Status?
o Cannot follow simple commands (Unconscious or Altered LOC) – IMMEDIATE for Adults; IMMEDIATE for
Pediatrics if Posturing or Unresponsive
o Can follow simple commands or normal mentation - DELAYED
EXAMPLES OF MCI TRIAGE LEVELS [NOTE- ALWAYS FOLLOW LOCAL PROTOCOLS IN PLACE]
• IMMEDIATE Critical, life-threatening – compromised airway, shock, hemorrhage/tourniquet in place, radiation exposure > 600
•
•
•
rads but < 1,000 rads*.
DELAYED Potential for major illness or injury and cannot go to waiting area; requires treatment within 30 min to 2 hours,
radiation exposure > 200 rads but < 600 rads*.
MINOR Care may be delayed 2 hours or more; walking wounded/worried well, radiation exposure < 200 rads*.
MORGUE/EXPECTANT Dead or expected to die – massive head injury, extensive full thickness burns, radiation dose >1,000
rads (10 Gy) *. NOTE: Only utilize this level on secondary triage internally if no resources (staff/equipment) available, more
MCI Triage patients waiting evaluation and HCC/County Health Officer initiates Crisis Standard of Care Conditions.
*Source: Medical Planning and Response Manual for a Nuclear Detonation Incident: A Practical Guide from United States Department of Health and
Human Services (USDHHS)
QUICK GUIDE:
Multi-Casualty Incident Triage
*Source: Medical Planning and Response Manual for a Nuclear Detonation Incident: A Practical Guide from United States Department of Health and
Human Services (USDHHS)