Triage in Mass casualty

นพ. พ�รชั�ย ดวงสอาด งานอ�บั�ติ�เหติ�และฉุ�กเฉุ�น โรงพยาบัาลนครพ�งค�

MCI : Mass casualty incident• An MCI is an event that exceeds the health care

capabilities of the response

MCI = Healthcare Needs > Resourse

Disaster–A disaster is an event that exceeds the

capabilities of response–A disaster is present when need exceeds

resources

Disaster = Need > Resource

Triage

• มาจากคำ�าว่�า v. “trier” – to separate , sort , sift ,select

• Severity and Priority– ดูคำว่ามต้�องการทางการแพทย์�สำ�าหร�บผู้�ป่�ว่ย์แต้�ละคำน

– ซึ่ !งต้�องคำ�าน งถึ งทร�พย์าการต้�างๆ ท$!ม$อย์�แล�ว่ดู�ว่ย์

ประว�ติ� History

ประว�ติ� History

• Baron Dominique Jean Larrey– Napoleon’s Surgeon Marshal• Military • 1st priority for minor injury

• Military : WW I

• Emergency Department

เป�าหมาย Aim

• “ Do the greatest good for the greatest number”

• “ ใช้�ทร�พย์ากรท$!ม$อย์�จ�าก�ดูน�'นเก)ดู ป่ระโย์ช้น�สำงสำ+ดู ก�บคำนหม�มาก ”ท$!สำ+ดู    

ทำ าเม!"อไหร$ Timing

• Dynamic > Static

ทำ าเม!"อไหร$ Timing

• Retriage repeatedly– Site of incident– Treatment station– Prior to transport– Front door ER– During care

ล าด�บัความส าค�ญ PrioritiesCategory Description Color Priority

systemImmediate Casualties who require immediate life saving

treatmentRed P 1

Urgent Casualties who require treatment within 6 hours

Yellow P 2

Delay Less serious cases who require treatment butnot within a set time

Green P 3

Expectant Casualties: Blue1. who cannot survive treatment2. for whom the degree of intervention requiredis such that in the circumstances theirtreatment would seriously compromise theprovision of treatment for others

Blue

Dead Dead White/Black

Dead

ว�ธี�การ Triage

• เร'ว Quick• ง$าย Easy• ส าเนาได( Reproducible• ได(ประเด'น Describe major outcome• เป)นขั้�+นติอน Dynamic

MIMMS

• MAJOR INCIDENT MEDICAL MANAGEMENT AND SUPPORT–Triage Sieve–Triage Sort

MIMMS :Triage sieve

MIMMS :Triage sieve

MIMMS :Triage sieve

• Aim : จั�ดเร�ยงคนไขั้(ทำ�"ม�มากมาย ให(เป)นหมวดหม.$

• ใชั(เวลาน(อยกว$า 20 ว�นาทำ�ในคนไขั้(แติ$ละคนในคนทำ�"เคล!"อนไหวไม$ได(

• ABC

MIMMS :Triage sort

• More Complex• Measured value• Within 1min• Triage Tool and Monitor tool– Speed important less than Accuracy

MIMMS :Triage sort

MIMMS :Triage sort

ประเม�นเบั!+องติ(น Preliminary survey

• Specific exam and history

• Board categorization– อาการรวมๆ

สร�ป SummaryLocation Treatment Grade

performing triage

Triage method

Site Life saving Paramedic SieveCasualty clearing station

Life support Paramedic/doctor Sieve/sort

Casualty cleaning station

Advance LS Doctor Sort and preliminary survey

Hospital reception Advance LS Senior ER doctor/nurse

Sieve and sort

Hospital Life saving surgery Senior surgeon 1 and 2 survey

START triage

• Simple Triage and Rapid Treatment– Developed at Hoag Hospital in Orange County,

California• แบ�งเป่,น 4 triage categories• www.start-triage.com

START

• Ask all who can walk to move– Green

• Begin assessment based on RPM– Respiration– Pulse*– Mental Status

* Modified from capillary refill

START Triage

START Triage

RESPIRATIONS

NO

YES

Dead orExpectant

Immediate

Position Airway

NO YES

Over 30/min

Immediate

Under 30/min

PERFUSION

Cap refill> 2 sec

ControlBleeding

Immediate

Cap refill< 2 sec.

Failure to followsimple commands

Can followsimple commands

Immediate Delayed

MENTALSTATUS

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No body Perfect

• PRACTISE , PRACTISE and PRACTISE !!!!!