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
Casualties typically die within how long?
due to the inability to breathe, they bleed to death, or they have injuries which are so severe that the regulation by the brain of breathing and profusion is lost.
within the first hour
Wounded contaminated in a biological and/or chemical battlefield environment.
What must happen before entering treatment facility?
Decon
Considerations for pts with retained, unexploded ordinance
These patients should be segregated immediately and treated last
Enemy prisoners of war/internees/detainees
-Although treatment is based on medical necessity, the threat of ______________ must be prevented by careful screening and disarming all casualties prior to entering treatment or triage areas.
suicide bombers
Combat stress
a) _______: Immediate return to duty or return to unit or unit’s noncombat support element with duty limitations or rest.
b) _______: Send to combat stress control restoration center for up to 3 days reconstitution
a) Light Stress
b) Heavy Stress
BICEP mnemonic where resources and tactical situation allow.
a) ______: Keep interventions to 3 days or less of rest, food, and reconditioning.
b) _______: Treat as soon as symptoms are recognized. Do not delay!
c) _______: Keep in one area for mutual support and identity as service members.
d) _______: Reaffirm that we expect them to return to duty after brief rest; normalize the reaction and their duty to return to their unit.
e) _____: 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.
a) Brief
b) Immediate
c) Central
d) Expectant
e) Proximal
What are the phases of TCCC
(1) Care under fire
(2) Tactical field care
(3) Tactical evacuation
Quickly choose a casualty collection point based on:
(a)Proximity to patients
(b)Proximity to vehicular access.
(c)Proximity to HLZ
(d)Geography, safety “geographic triage.”
How many levels of care are there?
5
What role?
First medical care military personnel receive. Includes immediate life saving measures, disease and non-battle injury prevention and care, combat and operational stress control (COSC), patient location and acquisition.
Role 1
What does CRTS stand for?
Casualty receiving and treatment ships
What role?
Initial resuscitative care is the primary objective of care at this level. Saving life, limb, and when necessary stabilization for evacuation to level 3.
Role 2
What are the different types of CRTS
a) LHD
b) LHA
c) CVN
What CRTS has the largest medical capacity?
LHD
What are the role 2 platforms?
1) CRTS
2) MEDBN
3) Shock Trauma Platoon
4) Forward resuscitative surgical suite
5)Role 2 light maneuver (R2LM)
6)Role 2 enhanced (R2E)
Definition of what?
Forward deployed surgical suite developed due to the medical battalion being too large.
Forward resuscitative surgical suite (FRSS)
What Role 2 platform?
Provides basic secondary healthcare built around primary surgery, intensive care unit, and ward beds
Role 2 enhanced (R2E)
Light, highly mobile medical units designed to support lane maneuver formations. Conducts advanced resuscitation procedures up to damage control surgery
Role 2 light maneuver (R2LM)
What role?
The highest level of care available within a combat zone. Advanced resuscitative care is the primary objective of care.
Level (role/echelon) 3
What are the examples of Role 3
1) Fleet hospitals
2) Hospital ships (USNS Comfort/USNS Mercy)
What role?
Definitive medical care is the primary objective at this level.
-(a)OCONUS Hospital
Level (role/echelon) 4
What role?
Restorative and rehabilitative care is the primary objective of care at this level.
Level (role/echelon) 5
What type of EVAC?
The movement of casualties from the point of injury to medical treatment by non-medical personnel. Casualties transported under these circumstances may not receive en route medical care. Usually a lift of opportunity.
Casualty evacuation (CASEVAC)
What type of EVAC?
Timely, efficient movement and en route care provided by medical personnel to the wounded being evacuated from the battlefield to the military treatment facility (MTF) using medically equipped vehicles or aircraft. This includes transportation from one MTF to another by medical personnel, such as ship to shore.
Medical evacuation (MEDEVAC)
What type of EVAC?
Generally, utilizes USAF fixed-winged aircraft to move sick or injured personnel within the theater or operations (Intra-theater) or between two theaters(Inter-theater).
Aeromedical evacuation (AE)
What type of ground evac
HMMWV frame with armor protection for crew and patients
M997 Ambulance
What type of ground evac:
HMMWV frame with removable soft top.
M1035 Ambulance
What is an example of Non-medical vehicle that may be utilized for casualty transport when available
MK 23 & 7 ton
Methods of air evacuation
(1) UH 60 A Blackhawk
(2) SH-60B Seahawk
(3) CH-46 Sea Knight
(4) CH-53 D/E Sea Stallion
(5) CH-1 Huey
(6) MV-22 Osprey
(7) C-2 (COD) Greyhound
(8) P-3 Orion
(9)C-130 Hercules
What are the MEDEVAC/CASEVAC priorities?
(1) Urgent
(2) Priority
(3) Routine
What MEDEVAC/CASEVAC priority?
Casualty must be evacuated within 24 hours for further care.
(a)Examples include:
-1)Minor to moderate burns
-2)Simple, closed fractures
-3)Minor open wounds
-4)Terminal Casualties
Routine
What MEDEVAC/CASEVAC priority?
Casualty must be evacuated within 4 hours or condition could worsen.
(a)Examples include:
-1)Flail chest segments without respiratory compromise
-2)Open fractures
-3)Spinal injuries
-4)Major burns
Priority
What MEDEVAC/CASEVAC priority?
Casualty must be evacuated within 2 hours in order to save life, limb or eyesight.
(a)Examples include:
-1)Cardiorespiratory distress
-2)Uncontrolled hemorrhage
-3)Shock not responding to IV therapy
-4)Head injuries with signs of increased ICP
-5)Extremities with neurovascular compromise
Urgent
9 Line
What is line 1
(1) Location of pick up site (Grid coordinates).
9 Line
What is line 2
(2) Frequency/Call sign of pick up site.
9 Line
What is line 3
(3) Number of patients by precedence:
A- Urgent
C- Priority
D- Routine
9 line
Line 3 letters
A= _____
B= _____
C= _____
A- Urgent
B- Priority
C- Routine
9 Line
Line 4
what are its letters?
(4) Special equipment needed:
A- None
B- Hoist
C- Extraction equipment
D- Ventilator
9 Line
Line 5
What are its letters?
Number of patients by type
L - # of litter
A- # of ambulatory
9 Line
Line 6
What are its letters?
Security of pickup site:
N - No enemy
P - Possible enemy
E - Enemy in area
X - Armed escort required
9 Line
Line 7
What are its letters?
Method of marking pickup site:
A - Panels
B - Pyrotechnics
C - Smoke
D - None
E – Other
9 Line
Line 8
What are its letters?
Patient nationality and status:
A - US Military
B - US Civilian
C - Non US Military
D - Non US Civilian
E – EPW
9 Line
Line 9
What are its letters?
Contamination:
N- Nuclear
B- Biological
C- Chemical
What report is supplemental to a MEDEVAC request and should be sent as soon as possible provides vital information that helps the receiving MTF better prepare for the specific casualties inbound.
MIST report
True/False
MEDEVAC mission should be delayed while waiting for MIST information.
FALSE
Should not be delayed
Mist Report consists of what four things
(a) Mechanism of Injury
(b) Injuries Sustained
(c) Signs/Symptoms
(d)Treatment rendered
