TRIAGE
• mass- casualty or multi- casualty incident
• Involves >1 patient or situation that places great demand
on resources (stretched to limit)
• Triage is the sorting of two or more patients based on the
severity of their conditions to establish priorities for care
based on available resources
• Scene Safety
1. Size of hazard area
2. Safe and sheltered location to move patients
3. Self- protective measures
THE TRIAGE PROCESS
A. Sort patients to provide the best outcome for the
GREATEST number of patients
1. Rank in order of severity
2. Mark patients for visual identification
B. May need to modify triage process because of environment
1. Weather
2. Equipment
3. Manpower
4. Communication
5. Distance from definitive care
C. The 5 S’s
1. Safety Assessment
• Assess scene for safety
2. Simultaneous scene size up
• Size and severity
• Type of incident
• Approximate number of patients
• Severity of injuries
• Area involved, access
3. Send information
• Contact dispatch with your scene size-up
• Request assistance and additional resources
4. Setting up scene
• Obtain triage ribbon
• Identify triage areas
• Consider scene access and egress
5. START triage process
• Begin where you are
• Relocate green-tagged patients
• Move in an orderly pattern
• Maintain a patient count of casualties
• Provide minimal treatment
D. Triage Priorities
1. Red- highest priority patients
need immediate care (usually circulatory or respiratory)
2. Yellow- second highest priority
able to wait longer before transport (45 minutes)
3. Green- walking
able to wait several hours for transport
4. Black- dead
will die during emergency care (have lethal injuries)
*** mark triage priorities (tape, tag)
Triage Category: Red
• Red (Highest) Priority: • Airway and breathing
difficulties
Patients who need
• Uncontrolled or severe
immediate care and
bleeding
transport as soon as
• Decreased level of
possible
consciousness
• Severe medical problems
• Shock (hypoperfusion)
• Severe burns
Triage Category: Yellow
• Yellow (Second)
Priority: Patients
whose treatment and
transportation can be
temporarily delayed
• Burns without airway
problems
• Major or multiple
bone or joint injuries
• Back injuries with or
without spinal cord
damage
Triage Category: Green
• Green (Low) Priority:
Patients whose
treatment and
transportation can be
delayed until last
• Minor fractures
• Minor soft-tissue
injuries
Triage Category: Black
• Black (Lowest)
Priority: Patients who
are already dead or
have little chance for
survival. If resources
are limited, treat
salvageable patients
before these patients
• Obvious death
• Obviously
nonsurvivable injury,
such as major open
brain trauma
• Full cardiac arrest
TRIAGE TECHNIQUES
START
Simple
Triage
And
Rapid
Treatment
* In initial START Assessment mark with triage
ribbons, but only provide minimal treatment. Only
two interventions: (1) open the airway and (2) stop
excessive bleeding. START assessments should only
last 15-30 seconds per patient
1. Get up and walk
-Have patients move to safe location outside triage area that can
-Self defined green patients
2. Respiration: check for respiratory compromise
-not breathing after reposition airway = BLACK
< 30 breaths/minute = RED
> 30 breaths/minute = CONTINUE
3. Perfusion (pulse, circulation): radial pulse check
-weak, irregular or no radial pulse = RED
-strong radial pulse = CONTINUE
4. Mental Status
-fails to follow simple commands (mental status altered) = RED
- follows simple commands = YELLOW
Secondary Triage
1. Once resources are available and patients are transported to
treatment area, secondary triage begins.
2. In- depth reassessment
• Triage tags used. Called METTAGS. Used to indicate
triage category and specific injuries or vital signs.
3. Ongoing in treatment area
4. May change categories
Special Triage Situations
1. Injured rescuer
- Automatic Red
2. Hysterical patient or bystander
- Receives higher then usual priority
3. Child
- Receive higher category. If possible they should be transported
with parent. Check cap-refill in children.
4. Lowered body temp in outdoor environment (hypothermia)
- Hypothermic patients change to high priority
Triage of the Patient with multiple injuries
1. - Golden hour: average amount of time that elapses before a
patient with serious or multiple injuries starts to deteriorate rapidly.
For every 30 minute period after the Golden Hour, the patient’s
chances of survival are cut in half.
- be knowledgeable
- work quickly and efficiently
- establish priorities and improvise when necessary
2. Remember ABCs, then tackle blood loss
3. Long backboard to splint extremity fracture of speed transport
4. EXCEPTION Femur fracture: site should be treated seperately
with a traction splint.
Purpose: to control, coordinate and direct emergency
responders and resources
1. Call incident command system
2. Design to be used in daily operations
3. Effective at mass casualty incidents
4. Use with >1 patient and events that stretch resources and
equipment to limits
5. Types of out door incidents that might require it
- chair lifts, ice, rock, mountain climbing, river rafting
and avalanche
Emergency Operations Plan
1. Well designed
2. Well practices
3. Coordinated with local EMS and others
Typical Plan
 Command Center
 Treatment Area
 Run by area manager
 Supply Area
 Extrication
 Transportation Area
 Triage Area
 Rehabilitation Area