Triage Guidelines
In the event of a massive disaster, the first emergency responders on the scene may have dozens or even hundreds of injured people to care for. In such a scenario, it is necessary to determine which victims who are in need of medical care are likely to respond most favorably. Proper triage procedures can result in a 40% increase in lives saved. Triagers should have basic first aid skills, although they do not necessarily need advanced medical training.
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All triage systems separate victims into three basic groups: Patients who will recover without care, patients who will die regardless of care, and patients who are likely to be saved by immediate medical attention. Some systems further distinguish patients who require less critical attention.
Time Frame
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When arriving at the scene of a disaster, first responders separate victims who are able to walk from those who cannot. Emergency workers are trained to then evaluate the needs of a patient within 60 seconds. Patients are given minimal lifesaving care immediately, and patients who responders have determined are in need of emergency surgery are shuttled to nearby hospitals, ideally within one hour of the initial accident.
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Respiration
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The first step to simple triage is to clear the victim's airway and determine if he is able to breathe. If the patient is unable to breathe on his own, make sure his airway is clear. If the victim is still not breathing, they are considered to be unlikely to survive and should be marked for pain relief or other palliative care. If the patient's respiratory rate is greater than 30 breaths per minute, they are likely in shock and must be marked for immediate attention.
Circulation
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If the patient is breathing but you cannot find a pulse, she is to be tagged for immediate care. Then perform a nail blanch test. This is done by pressing on a victim's fingernail until it turns white and releasing. If a patient is having circulation problems, it will take more than two seconds for color to return to the nail bed, and she is in need of immediate care. If a patient is bleeding, apply a simple pressure dressing.
Neurological Function
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To evaluate the nervous system of a disaster victim, ask the victim to perform simple commands such as squeezing your hand or stating the current year. If the patient is unable to do so, it indicates neurological damage, and he is in critical need of medical attention. If a patient is responding, he will still need medical care, though he is not in immediate danger and can be marked for delayed attention.
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References
- Photo Credit Mark D. Faram, USN/Dodmedia.osd.mil
