ORGANIZATION OF TRAUMA CARE Flashcards
The process of prioritizing patient treatment during mass casualty events based ontheir
need for or likely benefit from immediate medical attention
Triage
Sets the stage for the evaluation, treatment and transport of the injured
Should NOT be considered with finality
Triage
Triage Categories can change based upon
(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
The number of patients and the severities of their injuries DONOT
exceed the resources and capabilities
Multiple casualties***
Resources include time, equipment, personnel and tacticalsituation
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.
Adequate resources:
The number of patients and the severities of their injuries DO exceed the
resources and capabilities
Mass Casualties***
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.
Limited resources
Five Principles of Triage
(1) Degree of life threat posed by the injuriessustained
(2) Injury severity
(3) Salvageability
(4) Resources
(5) Time, distance, and environment
(a) Determined by considering the order of priorities identified during the primarysurvey
of an individual patient and applying these same principles to a group of patients.
(b) Massive hemorrhage takes priority over an airway problem.
Degree of life threat posed by the injuriessustained
(a) Entails looking at each patient in a total global fashion and assessing the patient as a
whole and not focusing on one severe injury.
(b) Regardless of the injuries sustained, do not become too focused on one patient.Attempt
to remain emotionally detached.
(c) Ideally patients should be triaged based solely on the severity of their injuries andnot
nationality
Injury severity
(a) The patient with the most severe injury may not be the patient who will be the first to
receive care.
(b) Consideration for survival of the patient, in a mass casualty situation CPR for victimsof
blast or penetrating traumas who have no pulse, respirations, or any other signs of life
often times will be unsuccessful and should not be conducted.
(c) Attempts to resuscitate trauma patients in arrest have been futile even in the urban
setting where the victim is in close proximity to a trauma center
Salvageability
(a) Often only consumables and equipment are considered, but all aspects ofthe
management, treatment, care and evacuation of casualties must be included.
(b) If the patients’ needs exceed the resources capabilities, they should receive a lower
priority.
(c) During mass casualties the determining factor is not the magnitude of the incident orthe
total number of casualties. The determining factor shall be whether or not you have
enough resources to efficiently and effectively manage the incident
Resources
(a) Quick management of a patient may result in their triage category being lowered. The
initial management of a massive hemorrhage which was appropriately transitioned to a
pressure bandage may lower their immediate need for careor evacuation.
(b) Mission planning, knowledge of treatment facilities and an overall understanding ofthe
capabilities of the unit in the given environment, and individual resources are required
in the decision-making process.
(a) Quick management of a patient may result in their triage category being lowered. The
initial management of a massive hemorrhage which was appropriately transitioned to a
pressure bandage may lower their immediate need for careor evacuation.
(b) Mission planning, knowledge of treatment facilities and an overall understanding ofthe
capabilities of the unit in the given environment, and individual resources are required
in the decision-making process.
Application of Triage Principles:
(1) Decisions made are based on the best information available at the time.
(2) It categorizes a large number of patients into small manageable groups.
(3) Mode of evacuating and transporting patients.
Military Triage
(1) Designed to maintain a fighting force.
(2) Limits the use of resources for that purpose.
(3) Priorities are based on returning the injured victim to a fightingcapacity.
(4) Abandonment of casualties is NEVER to be considered.
(5) Always performed by the most qualified person available.
(6) Determine the tactical environmental situation and determine the need tomove.
(7) Number and location of injured.
(8) Available assistance to the provider.
(9) Evacuation support in the area of operation.
IDME or DIME
(1) Immediate
(2) Delayed
(3) Minimal
(4) Expectant
Needs lifesaving interventions within minutes up to 2 hours on arrival toavoid
death or major disability.
Immediate
(a) After all life-threatening conditions are successfully stabilized no further treatmentis
given to the casualty until all other “immediate” casualties are stabilized.
(b) Salvage of life takes priority.
Requires medical attention but CAN wait.
Delayed
(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.
Can be treated with selfaid, buddy air, and corpsman aid.
Minimal
(a) Often referred to as “walking wounded.”
(b) These casualties should be continued to be used for scene security or help treat themore
seriously wounded.
Require complicated treatments that may not improve life expectancy
Expectant
(a) Even if they are the sole casualty with the optimal resources their survival would still be
unlikely.
(b) Shall not be neglected. They should be continued to be reassessed and ifresources
allow, comfort measures and pain medication should be provided.
(c) Category should only be used when resources are limited. The goal is to not use limited
resources with little chance ofsurvival.
Once the casualties triage status has been determined the _____ canbe
attached so that it remains visible to other rescue personnel.
Civilian/NATO triage tag
Triage tags consist of four colors
white body; a black perforated strip; a redperforated
strip; a green perforated strip; and a yellow perforated strip
Fourth stripe on the tag, casualties are dead ornonsalvageable and entails no care is needed.
Black (Deceased/Expectant):
hird stripe on the tag, casualties have minor injuries and willneed
minimal care. They should be transported after the immediate and delayed have been
evacuated
Green (Minimal)
