Mass casualty Flashcards
Categories of triage?
(a) Number of injured
(b) Available resources
(c) Nature and extent of injurie(s)
(d) Change in patient’s condition
(e) Hostile threat in the area
Multiple casualty definition/
The number of patients and the severities of their injuries DO NOT exceed the resources and capabilities.
Mass casualty definition?
The number of patients and the severities of their injuries DO exceed the resources and capabilities.
Are there adequate resources in multiple casualties?
Yes
Adequate resources?
Resources include time, equipment, personnel and tactical situation as it relates to the number of patients. In the event of a multi-casualty incident where there are adequate resources, rapidly identify patient needs and match the correct resources.
Limited resources?
During a mass casualty situation where resources are limited, the goal is to identify patient needs and then to distribute the resources in a manner that provides the best care for the most possible patients.
5 principles to triage?
(1) Degree of life threat posed by the injuries sustained
(2) . Injury severity
(3) Salvageability
(4) Resources
(5) Time, distance, and environment
What does DIME stand for with regards to triage categories?
- Delayed
- Immediate
- Minimal
- Expectant
What is immediate?
Needs lifesaving interventions within minutes up to 2 hours on arrival to avoid death or major disability.
What is Delayed:
Requires medical attention but CAN wait.
(a) Includes those who may require a surgical procedure, but whose delay in surgical treatment will not endanger the life, limb, or eyesight of a patient.
(b) Sustaining treatment will be required such as IV fluids, splinting, administration of antibiotics, pain relief.
What is minimal?
Can be treated with selfaid, buddy air, and corpsman aid.
(a) Often referred to as “walking wounded.”
What is expectant?
Require complicated treatments that may not improve life expectancy.
(a) Even if they are the sole casualty with the optimal resources their survival would still be unlikely.
1) Massive Hemorrhage
2) Airway obstructions or potential compromise, including potential complications from facial burns or anaphylaxis
3) Tension pneumothorax
4) Penetrating chest wound WITH respiratory distress
5) Torso, neck, or pelvis injuries WITH shock
6) Head injuries requiring emergent decompression
7) Threatened loss of limb
8) Retrobulbar hematoma (threat to loss of sight)
9) Multiple extremity amputations
Immediate
1) Soft tissue injuries without significant bleeding.
2) Fractures
3) Compartment syndrome
4) Intra-abdominal and/or thoracic wounds
5) Moderate to severe burns with less than 20% of total body surface area
6) Blunt or penetrating torso injuries without the signs of shock
7) Facial fractures without airway compromise
Delayed
1) Minor burns, lacerations, contusions, sprains and strains.
2) Simple, closed fractures without neurovascular compromise.
3) Combat stress reaction.
Minimal
1) Massive head injuries with signs of impending death or in coma.
2) Cardiopulmonary failure.
3) Clearly dead casualty with no signs of life or vital signs regardless of mechanism of injury.
4) Second and third degree burns in excess of 85% total body surface area.
5) Open pelvic injuries with uncontrolled bleeding and class IV shock.
6) High spinal cord injuries.
Expectant
What are the colors of the triage tag?
- Black (Deceased/Expectant)
- Green (Minimal)
- Yellow (Delayed)
- Red (Immediate)
Green?
Minimal
Yellow?
Delayed
Red?
Immediate
Black?
Deceased/Expectant
Who MEDEVACs first?
Red (immediate)
Who MEDEVACs second?
Yellow (Delayed)
What is primary triage?
Simply and quickly categorizing patients; identifying and stop life threats. Breaks patients down into more manageable groups
What is secondary triage?
- Allows for adjustment on patient response, to direct more in-depth treatment and prepare for a nine-line medical evacuation request.
- Begin tx
- Begin MEDEVAC
What is tertiary triage?
Continued management of patients where more complicated procedures should be weighed against the situation.
CPR
When should CPR only be considered?
non-traumatic disorders such as hypothermia, near drowning, or electrocution.
What percent of the body burned is considered expectant?
85%
Order of perforated strips on NATO triage tags
Yellow
Red
Green
Black
What must be done for patients that are retained, unexploded ordinance?
segregated immediately and treated last
What is light and heavy stress category?
Light - Immediate return to duty or return to unit or unit’s noncombat support element with duty limitations or rest.
Heavy - Send to combat stress control restoration center for up to 3 days reconstitution.
What is the pneumonic for combat stress patients?
BICEPS
What does BICPE mean?
a) Brief: Keep interventions to 3 days or less of rest, food, and reconditioning.
b) Immediate: Treat as soon as symptoms are recognized. Do not delay!
c) Central: Keep in one area for mutual support and identity as service members.
d) Expectant: Reaffirm that we expect them to return to duty after brief rest; normalize the reaction and their duty to return to their unit.
e) Proximal: Keep them as close as possible to the unit. This includes physical proximity and using the ties of loyalty to fellow unit members. Do this through any available means. Do not evacuate away from the area of operation or the unit, when possible.
f) Simple: Do not engage in psychotherapy. Address the present stress response and situation only, using rest, limited catharsis and brief support.
What is care under fire?
(a) Get the patients who are not clearly dead to cover (not concealment) if possible.
(b) Continue with the mission/fight. Gain fire superiority!
If patient obeys commands, but has weak or absent pulse, what category would you triage them as?
Immediate, increased risk of dying
If patient obeys commands and has strong radial pulse, what triage category?
Minimal or delayed
What is tactical field care?
Immediate life saving measures, stop the bleed
Tactical evacuation?
Triage again, make any needed interventions, evac
