If tragedy strikes in a big way and you are overwhelmed by a medical emergency you may need to set up a Triage. Triage is the sorting of patients according to the urgency of their need for care. This system is used when it is not feasible to treat all patients at one time due to limitations. For instance a mass casualty situation, crowded emergency rooms or even battlefield scenarios. How effectively your triage works will depend on your organization and availability of resources. You should also remember that Triage is not treatment. You are sorting patients for those who will treat them and if you do not have those medical professionals available, it could be a very long wait.
If you have a group and it is your intention to be able to set up a Triage the first thing you will need to do is to establish a plan on how you will set up your triage. Make sure that you have a written plan and that it is actionable. It’s important to have a written plan so that things don’t get forgotten or slip through the cracks. Make sure that your plan is realistic and achievable based on your knowledge, capabilities and resources. Once you have your plan you should practice or at the bare minimum review that plan with all those that will be involved so that everyone is comfortable and familiar with their role. You will need to review your plan periodically because things or people may change and you will want to make sure that nothing has seeped out of that steel trap in everyone’s head. You will also want to keep that written plan nearby and accessible.
Of course the best case scenario is to have the availability of healthcare professionals such as doctors, nurses or EMT’s. If you don’t have this as an option, get training. There is a saying in the preparedness community, “two is one and one is none.” This holds true in this instance as well. If your one and only person with medical knowledge goes down, you have a problem. Everyone within you group should have at least a rudimentary understanding of first aid. There are many places to get that training from, the Red Cross, online courses, private courses or even community colleges that offer first responder or EMT courses.
When deciding on a location for your Triage area you need to keep your surroundings in mind. For instance, is the area safe? If there is a possibility of further injury or exposure to harsh elements such as snow, rain, or exposure to a lot of direct sunlight you will need to find a better location with some sort of protection. Is the area reasonably clean? You don’t want to setup in the city dump or up against the port-a-potty. The last thing your patient needs is a greater chance of infection.
In formal Triage settings, Triage tags are used to indicate a patients priority. This is to ensure that a patients priority is easily visible by those treating the patient and so that someone with life threatening injuries isn’t waiting for treatment because of someone with a cold. Triage tags use a color system to determine a patients priority, blue for deceased, black for expectant or deceased, red for immediate, yellow for delayed and green for minor. The person doing the initial start writes down the time and then initials it but does not fill out the tag. The tag is then torn to indicate the patients priority and attached to the patient. You should only spend about 30 or 40 seconds per patient and then move on to the next. When you Triage and tag your patient you will probably not be perfect, even the pros make mistakes, just do your best in that 30 – 40 seconds that you have. In the second stage of the process the tag would be filled out. This could be done by ambulance personnel, treatment personnel or those specifically assigned to the task.
When tagging patients the things to look out for are PM’s:
Respiratory Effort- Whenever approaching a patient in an emergency situation you need to check for responsiveness. Gently shake the patients shoulders and loudly ask if they are okay. Gasping or inadequate breathing should be considered unresponsiveness and requires immediate action. Normal respiration rate for adults at rest is between 12 – 16 breaths per minute anything over 30 likely means your patient is in shock and should be tagged red or Immediate. If the patient is vomiting roll them on to their side.
Pulses- Check the patients radial pulse by firmly placing two fingers on the arteries located at the wrist, the inside of the elbow or at the side of the neck. Count the number of beats per minute. If the patient has no pulse tag red or immediate. You can also do a blanch test by pressing on an area of the skin until the color is gone and then time how long it takes for the color to return once you have removed your fingers. If it takes longer than two seconds for the color to return, treat for shock by elevating the feet 12 inches and tag red or immediate. Do not elevate the feet if the patient is suffering from back, neck or head injury or possible broken hip or leg bones. If patient is suffering from severe bleeding take immediate steps to control bleeding.
Mental status- If the patient in conscious but unable to respond treat for shock and tag red or immediate.
Walking Wounded are generally tagged green and asked to move to a specified area. Someone should be with these patients to comfort them and keep them informed. If they are capable they can be utilized to help direct patients where they need to go. Those that may be deceased should be moved out of sight of the patients but kept nearby.
There are some important things to remember if you are in this situation. The first is to stay calm. You are going to be of little help if you are panicked. Second is no matter who you tagging do not get emotional even if you know them. Everyone deserves the same care and you must stay calm and focused. Third, remember that you are sorting patients not treating them and last, whatever your level of expertise, just do your best.
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Richard L Burkey