Visual 3.1

Unit #3-Triage Objectives

1. Identify the “killers.”

2. Apply techniques for opening airways, controlling bleeding, and treating for shock.

3. Conduct triage under simulated disaster conditions.

Visual 3.2

Safety / Health Considerations

1. Wash hands frequently using soap and water2. Wear medical gloves; change after each patient.3. Wear a mask and goggles.4. Keep bandages/dressings sterile.

Avoid contact with body fluids….

Discard infectious materials properly.

Remember Rule # 1!Assess the situation….

Visual 3.3

What is Triage?

Triage (n, v) from the French ~~~

means = to Sort (circa 1918)

CERT goal in a disaster situation – where victims overwhelm 1st responders – is to treat as many as possible; as efficiently as possible

THE GOOD OF THE MANY OUTWEIGHS ….

Visual 3.4

Treatment of Life-Threatening Conditions

The “Killers”: Airway obstruction- Lack of oxygen intake can

lead to brain damage or death in a very few minutes.

Bleeding, excessive- Life cannot continue without an adequate volume of blood to carry oxygen to body tissues.

Shock- Unless shock is prevented or treated, death may result even though the

injury would not otherwise be fatal.

Visual 3.5

Opening The Airway

• A patient with suspected air way obstruction must be treated immediately.

• Common obstruction is the tongue.

• Steps in Opening Airway:

(Spinal Damage ? - Head - Tilt/Chin Lift Method) 1. Shake the patient by touching the shoulder and shout “ Can you hear me”. 2. No response, place fingers on each side of jawbone and lift up.

3. Look for chest rising.

4. Listen for air exchange.

5. Feel for abdominal movement.

NO 2nd Response - MOVE ON

Visual 3.6

Controlling Bleeding - Types

Arterial Venous Capillary

• ARTERIAL bleeding is bright ,oxygen-rich red blood, under pressure, which spurts from the wound.

• VENOUS bleeding is dark, oxygen poor blood flows from a wound in a steady stream.

• CAPILLARY bleeding is dark red blood which tends to ooze from a wound.

Visual 3.7

Controlling External Bleeding

Direct pressure stops most bleeding.Place a sterile gauze pad or a clean cloth over the wound. If bleeding does not stop in 10 minutes, press harder over a larger area.

Wear disposable gloves to protect against disease

If bleeding persists, use elevationcombined with direct pressure over the wound.

Visual 3.8

Controlling With Bleeding Using Pressure Points

Form the arm, Compress the Brachial artery.

For the leg, compress the Femoral artery

Visual 3.9

Recognizing & Treating For Shock

Shock is the results of insufficient oxygenated blood being delivered to every part of the body.

This creates irreversible damage to the body.

• Systems of Shock: 1. Rapid, shallow breathing ( rate greater than 30 per minute).

2. Cold, pale skin ( capillary refill greater than 2 sec.

3. Extreme thirst

4. Anxiety 5. Failure to respond to simple commands, <===== such as “Squeeze my Hand.”

Cont. next slide

Visual 3.10

Recognizing & Treating For Shock

• Treatment for Shock:

1. Lay patient on his/her back.

2. Elevate the feet 6 - 12 inches. ( No signs of head or back injury). 3. Maintain body temperature ( e.g., cover the ground and patient with a blanket).

4. Maintain airway.

5. Control Bleeding.

• DO NOT give a patient anything to eat or drink. (Patient in shock often vomit)

Visual 3.11

S.T.A.R.T. System of Triage

START – Simple Triage and Rapid treatment Provides an rapid approach to triage a large number of patients. 60 Second assessment of patient based on:

1. Respiration “A”2. Circulation “B”3. Mental Status “S”

Uses plastic stripes or ribbons (placed on wrist).1. RedRed - Immediate Care2. Yellow Yellow -- Delayed Care3. GreenGreen - Ambulatory ( minor)4. Black – Dead

Video===PC

Visual 3.12

Professional Responders use Tags

Visual 3.13

START STEPS

1. Call out for ‘walking wounded’ [GREEN]

2. Triage the nearest victim [60 seconds]

3. Treat life-threatening situations [ABS]

4. Move on to next victim

5. Report findings to ICS

6. ICS – assign transport teams to Medical treatment area

Visual 3.14

S.T.A.R.T. - Simple Triage& Rapid Treatment

Call Out

START Where You Stand• Assess the Scene• Callout to patient for Assistance• Determine Safety

WalkingWounded & Uninjured

AMBULITORY( Green -Minor )

Hold in a Specific Location

Remember to Fully TRIAGE ASAP

YES

Over 30/Min. orUnder 10/Min.

Non - Walking

Under 30/Min. orOver 10/Min.

RESPIRATIONS

NO

Position AirwayLook, Listen & Feel

NO

Reposition Airway

NO

IMMEDIATE (Red) PERFUSION

Radial Pulse Capillary Refill

Absent Present

IMMEDIATE (Red)

Under 2/Sec. Over 2/Sec.

IMMEDIATE (Red)MENTAL STATUS

Can’t Follow Simple Commands

Follows Simple Commands

DELAYED (Yellow) IMMEDIATE (Red)

Adult Respiration's Rate (12 – 20 Breaths/Min.)

Blanch Test: Pinch nailBed; Color should returnIn less than 2 seconds

Adult Pulse60 – 100/ min.

Blood flow throughorgans and tissues of the body

DEAD ? IMMEDIATE (Red)

Visual 3.15

TRIAGE Simplified

Rule # 5: Thirty, two, How are you?

1. Walking wounded – GREEN

2. Respirations Greater 30 – RED

3. No Respirations? Airway reposition.

– Now Breathing? RED

– No result- BLACK

4. Capillary refill > 2 seconds; excessive bleeding? RED

5. No Simple commands (squeeze hand)? RED

If Respirations <30, Capillary refill <2, Alert = Yellow

Visual 3.16

Triage

Practice examples

Exercise

Questions

Visual 3.17

Triage Pitfalls

No team plan, organization, or goal Indecisive leadership Too much time/focus on one injury/victim Treatment (rather than triage) performed

Visual 3.18

Review: Triage

Three killers: A, B, S Use START technique – 30,2,How are you? Call out for “Walking wounded” A – Reposition airway B – Direct pressure C – Simple command Report to ICS for victim transport