Disaster Triage Nursing
WHEN WE SAY DISASTER, hindi lang ito nag fa fall
under the NATURAL CAUSE
Madaming klase ng disaster
✓ Manmade – Terrorism, economic sabotage,
pandemic
✓ In triaging, dito natin ma so sort out kung sino ang
nangangailangan ng treatment ASAP
TRIAGE – Triage means to group or rank (TO
PRIORITIZE). In the ER, patients are triaged based on
their presenting signs and symptoms. The patients
who have severe symptoms are seen immediately,
while patients who don’t will have to wait to be
seen.
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EX: Putol na bahagi ng katawan – severe bleeding
3. Major burns that affects a high percentage of the body:
Burns can affect the circulation and the respiratory
system (depending on the burn type and where its
located)
4. Respiratory trauma
EX: Pneumothorax (nag iinflate ang chest pero hirap
huminga ang pasyente = may internal bleeding
MORE EX: Severe pain, DOB, Levine’s sign
Yellow TAG:
delayed
-
Iba ang color ng emergency at disaster,
ganon din pag hospital or community
-
TRIAGE COLOR TAGS:
1. RED
3. BLACK
2. YELLOW
4. GREEN
Red TAG: Immediate
-
-
When a patient is tagged red, stop, and get them
treatment because they have first priority in
receiving care.
Seen 1st
Injuries are life threatening but can survive if
treated immediately
Severe alteration in breathing, circulation, and
neuro/mental status.
These are the following conditions that would cause a
wounded individual to be tagged Red:
1. Spinal cord injuries – Remember, various areas of the
spinal cord controls breathing, brain and heart function.
Shock can occur like neurogenic, cardiogenic etc.
May mga scenarios na nagkakaroon ng vehicular
accident, it is very important na HUWAG SILA
GAGALAWIN HANGGAT HINDI NAKAKA RATING ANG
AMBULANCE. Kasi we never know kung ano yung
apektado internally, and once DAMAGED ang SC and
ginalaw ito, magkakaroon ng mas malalang damage, and
ang damage sa SC is irreversible or wala na pag asa mag
regenerate.
2. Severe bleeding (internal or external): If the patient is
treated immediately so the bleeding could be stopped
and transfused with blood product they may live.
When a patient is tagged yellow, their
treatment is delayed but for only about an hour
or so because they could turn critical based on
their presenting injuries.
2nd priority
o Significant injuries but their breathing,
circulation and mental status are within
normal range, but this could change
EX:
✓ Bone fractures (Major fractures that requires medical
treatment)
✓ Integumentary damages (open wounds, deep
lacerations)
Green TAG: Minor
- Many times, these wounded individuals are termed
WALKING WOUNDED.
Therefore, these
patients can get up and move around.
- Their injuries are minimal
- Can be delayed for several hours or they can treat
themselves
Black TAG:
Expectant
-
Wounded is dying or expired
Injuries are deadly to the point the individual will
not survive.
Absence of breathing, circulation, and mental
status
START Method
(Simple Triage and
Rapid Treatment)
-
This method can help determine what tag
color a wounded victim is assigned.
This method is for ADULT
First you want to look at the wounded individual
and ask yourself “what is the wounded victim
doing? Are they able to walk around? OR are
they unable to walk or move?”
Green TAG
✓ Can walk around and move
✓ Breathing, circulation and mental status are within
normal range
Red TAG
✓ Unable to walk
BREATHING: GREATER THAN 30BPM
NOTE: IF THE PATIENT IS BREATHING BUT LESS THAN
30BPM, CHECK THE CIRCULATION!!
NOTE: Pag ni reposition yung airway and nagkaroon ng
breathing RED TAG ITO!
✓ Less than 2 seconds capillary refill
✓ NO MENTAL STATUS
✓ Unable to obey your commands
Yellow TAG
✓ Unable to walk
✓ ABLE to obey your commands
✓ Normal circulation
Black TAG
✓ Unable to walk
✓ After you RE-POSITION THE AIRWAY and STILL
NOT BREATHING