Triage and Management of patients in a Mass CasualtySetting Flashcards
Define:
The process of prioritizing patient treatment during mass casualty events based on their need for or likely benefit from immediate medical attention.
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
What is the difference between multiple and mass casualties?
Multiple casualties DONO T exceed the resources and capabilities.
Mass Casualties: DO exceed the resources and capabilities.
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.
True/False
Massive hemorrhage takes priority over an airway problem.
True
Five Principles of Triage:
(1) Degree of life threat posed by the injuries sustained
(2) Injury severity
(3) Salvageability
(4) Resources
(5) Time, distance, and environment
What principle of triage?
Entails looking at each patient in a total global fashion and assessing the patient as a whole and not focusing on one severe injury.
Injury severity
What principle of triage?
The patient with the most severe injury may not be the patient who will be the first to receive care.
Salvageability
What principle of triage?
Determined by considering the order of priorities identified during the primary survey of an individual patient and applying these same principles to a group of patients.
Degree of life threat posed by the injuries sustained
What principle of triage?
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 care or evacuation.
Time, distance, and environment
True/False
If the patients’ needs exceed the resources capabilities, they should receive a higher priority.
FALSE
They receive a lower priority
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 _________ groups.
(3) Mode of _____ and ______ patients.
2) small manageable
3) evacuating and transporting
Categories of military triage:
“IDME for DIME”
(1) Immediate
(2) Delayed
(3) Minimal
(4) Expectant
What triage cat?
Needs lifesaving interventions within minutes up to 2 hours on arrival to avoid death or major disability.
Immediate
True/False
After all life-threatening conditions are successfully stabilized no further treatment is given to the casualty until all other “immediate” casualties are stabilized.
True
Examples of injuries in what triage Cat:
1) Massive Hemorrhage
2) Airway obstructions or potential compromise, including potential complicationsfrom 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
What Triage cat?
Requires medical attention but CAN wait.
-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
Delayed
Injuries of what triage Cat?
-include those who show NO signs of shock with the following injuries
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
8) Globe injuries
Delayed
What triage cat?
Can be treated with self aid, buddy air, and corpsman aid.
-Often referred to as “walking wounded.”
Minimal
Examples of what triage cat?
1) Minor burns, lacerations, contusions, sprains and strains.
2) Simple, closed fractures without neurovascular compromise.
3) Combat stress reaction.
Minimal
What triage Cat?
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.
Expectant
True/False
Expectant patients can be neglected do to requiring recourses above organic medical capability
FALSE
Shall not be neglected. They should be continued to be reassessed and if resources allow, comfort measures and pain medication should be provided.
What triage category should only be used when resources are limited. The goal is to not use limited resources with little chance of survival
Expectant
Examples of what triage cat:
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 colors on the civilian/NATO triage tag
a)______ (Deceased/Expectant): Fourth stripe on the tag, casualties are dead or non- salvageable and entails no care is needed.
(b) _______ (Minimal): Third stripe on the tag, casualties have minor injuries and will need minimal care. They should be transported after the immediate and delayed have been evacuated.
(c)______ (Immediate): Second stripe on the tag, casualties are in the most need of care andor transport to a higher echelon of care. They should receive care before all othercasualties.
(d) _______ (Delayed): First stripe on the tag, casualties will need care, but in no hurry.They will be transported only after the more critically injured have been stabilized andtransported.
(a)Black (Deceased/Expectant)
(b)Green (Minimal)
(c)Red (Immediate)
(d)Yellow (Delayed)
What phase of field triage
-Simply and quickly categorizing patients; identifying and stop life threats. Breaks patients down into more manageable groups.
Immediate life sustaining care
1) Speed is essential because any process that consumes time also may cost lives.
2) Accuracy is essential because misjudgments cost time and as a result life.
3) Care is limited to simple/quick interventions. Casualties are assessed and move to appropriate locations and assigned appropriate triage tags.
Primary Triage
What phase of field triage
Allows for adjustment on patient response, to direct more in-depth treatment and prepare for a nine-line medical evacuation request.
(a) Document, reassess, and sort patients by their treatment needs.
(b) Provide medical treatment as appropriate and available.
Secondary Triage
Continued management of patients where more complicated procedures should be weighed against the situation.
Tertiary Triage:
CPR should only be considered for non-traumatic disorders such as ….
hypothermia, near drowning, or electrocution
________ are due to disruptions in one, or all, of three bodily systems: the respiratory system, the vascular system, or the central nervous system.
Early trauma deaths
