®
“Preparing Our Communities”
Welcome!
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® BDLS is a registered trademark of the American Medical Association
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Faculty Disclosure
• For Continuing Medical Education (CME) purposes as
required by the American Medical Association (AMA)
and other continuing education credit authorizing
organizations:
– In order to assure the highest quality of CME programming,
the AMA requires that faculty disclose any information relating
to a conflict of interest or potential conflict of interest prior to
the start of an educational activity.
– The teaching faculty for the BDLS course offered today have
no relationships / affiliations relating to a possible conflict of
interest to disclose. Nor will there be any discussion of off
label usage during this course.
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®
Chapter 1b
SALT Triage
(Sort, Assess, Life-Saving,
Treatment/Transport Triage)
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® BDLS is a registered trademark of the American Medical Association
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Objectives
• Describe the S.A.L.T. Triage method
• Describe the steps to perform S.A.L.T Triage
• Describe the Life Saving Interventions that are
performed in in S.A.L.T. Triage
• List the Triage Categories as defined in
S.A.L.T. Triage.
• Describe injuries that would place a patient in
each triage category
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What is Triage?
• French verb “trier” = to sort
• Assign priorities when resources
limited
• Do the greatest good for the greatest
number
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Source: DoD Photo Library, Public Domain
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What’s Unique About Disaster
Triage?
• Number of patients
• Infrastructure limitations
–
–
–
–
Limited providers
Limited equipment
Limited transport capabilities
Hospital resources overwhelmed
• Scene hazards
– Threats to providers
– Decontamination issues
• Multiple agencies responding
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SALT Triage
• Simple
• Easy to remember
• Groups large numbers of
patients together quickly
• Applies rapid life-saving
interventions early
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STEP 1: Global Sorting
• Priority 1: Still/Obvious life threat
• Priority 2: Wave/Purposeful
movement
• Priority 3: Walk
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Global Sorting: Action 1
• Action:
– “Everyone who can hear me and needs help,
move to [designated area]”
• Use loud speaker if available
• Goal:
– Group ambulatory patients using voice
commands
• Result:
– Those who follow this command - last
priority for individual assessment
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Global Sorting: Action 2
• Action:
– “If you need help, wave your arm or move your leg
and we will be there to help you in a few minutes”
• Goal:
– Identify non-ambulatory patients who can follow
commands or make purposeful movements
• Result:
– Those who follow this command - second priority
for individual assessment
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Global Sorting Result
• Casualties are now prioritized for
individual assessment
– Priority 1: Still, and those with obvious
hemorrhage
– Priority 2: Waving
– Priority 3: Walking
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Step 2: Individual Assessment
• Provide Life Saving Interventions
– Controlling major hemorrhage
– Opening airway if not breathing
• If child, consider giving 2 rescue breaths
– Chest needle decompression
– Auto injector antidotes
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S.A.L.T. Triage Categories
• Immediate
• Delayed
• Minimal
• Expectant
• Dead
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Immediate
• Serious injuries
• Immediately life
threatening problems
• High potential for
survival.
• Examples
Photo Source: www.swsahs.nsw.gov.au Public Domain
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– Tension pneumothorax
– Nerve agent exposed
patient
• severe shortness of
breath or seizures
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Delayed
• Serious injuries
– require care but
management can be
delayed without
increasing morbidity
or mortality.
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Photo Source: Phillip L. Coule, MD
• Examples
– Long bone
fractures
• neuro-vascular
intact
• 40% BSA
exposure to
Mustard
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Minimal
• Injuries- require
minor care or no care
without adverse
affect.
• Examples
– Abrasions
– Minor lacerations
– Nerve agent exposure
with mild rhinorrhea
Photo source: Phillip L. Coule, MD
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Expectant
• Important for preservation of resources
• DOES NOT MEAN DEAD!
• Should receive comfort care or resuscitation
when resources are available
• Serious injuries
– very poor survivability even with maximal care in
the hospital or pre-hospital setting.
• Examples
– 90% BSA burn
– Multiple trauma with exposed brain matter
– Severe traumatic brain injury with herniation
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Dead Patients
• Tag dead patients to prevent re-triage
• Do not move
– Except to obtain access to live patients
– Avoid destruction of evidence
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After Patients are Categorized
• Prioritization process is dynamic
– Changing patient conditions
– Changing resources
– Scene safety.
• After immediate patients have been cared for
– Expectant, delayed, or minimal patients should be
re-assessed
– Some patients will have improved and others will
have decompensated
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Treatment/Transport Priority
• Treatment and/or transport should be provided
for immediate patients first
– Then delayed
– Then minimal
• Expectant patients should be provided with
treatment and/or transport when resources
permit
• Efficient use of transport assets may include
mixing categories of patients and using
alternate forms of transport
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Patient #1
• 63 y/o male, prone, unresponsive
• Burns on extremities
• Did not move at “walk/wave” phase
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Patient #2
• 42 y/o female
• Walks to safety when instructed
• No bleeding, normal pulses, normal
breathing
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Patient #3
•
•
•
•
17 y/o male, lying supine, waving for help
Breathing well, follows commands
Normal vital signs
Can’t get up due to back pain and leg
weakness
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Patient #4
• 26 y/o male, unresponsive
• Contusions on head
• Good pulses, HR 104, RR 12
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Patient #5
• 52 y/o female, unresponsive
• Breathes when airway opened – needs to
have airway maintained manually
• Bleeding heavily from abdominal injury
• RR 8, HR 124
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Questions?
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