Field Triage

Field Triage in Trauma Dr KABERA Ren Family PhysicianBangui/CAR

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Introduction Trauma and injury play a significant role in the disease burden suffered by the population. In the U.S., unintentional injury is the leading cause of death for persons aged 144 years. In Rwanda and CAR, no publications. Emergency Medical personnel provide the entry point for which injured patients enter the health care system. They are responsible for the initial evaluation and management of injured patients in the field and play an integral role in the triage of the injured patient to the appropriate health care facility. The triage of injured patients to the appropriate health care facility plays a substantial role in patient outcome

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Introduction The nature of ED work means that some sorting system is required to ensure that patients with the most immediately life threatening conditions are seen first .A triage process aims to categorize patients based on their medical need and the available department resources. Triage is a dynamic process, placement in triage that not imply diagnosis or even lethality of a condition.

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Introduction The most common used process

Triage scale Color Time to be seen by a doctor Immediate RedImmediatelyVery urgent Orange Within 5-10 minutes Urgent YellowWithin 1hour Standard GreenWithin 2 hours Non urgent or desperate Blue Within 4 hours

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INTRODUCTUION There are four steps to the triage process: Step One: Physiologic Criteria, Step Two: Anatomic Criteria, Step Three: Mechanism-of-Injury CriteriaStep Four: Special Considerations.

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Step 1:Physiologic criteria Rapid identification of critically injured patients by assessing level of consciousness (GCS) and measuring vital signs. Vital sign criteria have been used since the 1987 version of the ACS Field Triage Decision Protocol It is recommended to transport to a facility that provides the highest level of care within the defined trauma system if any of the following are identified:Glasgow Coma Scale 13SBP of 20 mphIntrusion, including roof: >12 inches occupant site; >18 inches any siteEjection (partial or complete) from automobileDeath in the same passenger compartmentVehicle telemetry data consistent with a high risk for injuryAutomobile versus pedestrian/bicyclist thrown, run over, or with significant (>20 mph) impact.

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Step 4:Special considerations In Step Four, Emergency Medical personnel must determine whether persons who have not met physiologic, anatomic, or mechanism steps have underlying conditions or comorbid factors that place them at higher risk of injury or that aid in identifying the seriously injured patient.

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Special considerations It is recommended to transport to a trauma center or hospital capable of timely and thorough evaluation and initial management of potentially serious injuries for patients who meet the following criteria:Older adultsRisk for injury/death increases after age 55 yearsSBP 20 weeksEMS provider judgment

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ReferencesCenters for Disease Control and Prevention (CDC). Guidelines for Field Triage of Injured Patients.2012 Clinical Medicine 8th ED ,Emergency medicine 3rd ED .Oxford HandbooksBurt CW, McCaig LF. Staffing, capacity, and ambulance diversion in emergency departments: United States, 2006

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Singila mingiThank you

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