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Overview :
Triage with
effective use of limited resources is important during a mass casualty incident
(MCI). Standardized terms and priority designation can improve communications
during the crisis. The authors are from Australia.
Considerations:
(1) Utilize medical resources on
critically ill patients with a reasonable probability of survival.
(2) Limit use of medical resources on
patients who will probably die or whose final outcome will not be affected by
immediate care.
(3) Repeated assessment is necessary
since an initial assessment may underestimate the severity of injury.
(4) The dead and any human body parts
should be clearly labeled and not transported to active treatment areas.
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Homebush
Triage Classification
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Priority
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Priority
Code
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Color
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dead
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not applicable
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E (echo)
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black
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dying
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terminal care only
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D (delta)
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white
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not urgent
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low
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C (Charlie)
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green
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urgent
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high
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B (bravo)
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yellow/gold
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immediate
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top
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A (alpha)
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red
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Simple Triage and Rapid Treatment
(modified START)
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Designation
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Anyone who
does not breath with simple airway maneuvers
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dead
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Anyone who can
walk
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not urgent
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Anyone who (a)
cannot walk (b) can obey commands (c) has a rapid radial pulse, AND (d) has a
respiratory rate < 30 breaths per minute
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urgent
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Anyone else
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immediate
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where:
• The original START used capillary
refill time (<= vs > 2 seconds) rather than a radial pulse.
Secondary
Assessment of Victim Endpoint (SAVE, Table 4, page 606)
(1) patients
with poor prognosis
(2) patients
with outcome unlikely to be altered by immediate care
(3) special
categories
Patients with
poor prognosis:
(1) Glasgow
coma score < 8 in an adult with significant head injury (text indicates a
pediatric patient with low GCS if hypoxia and hypotension present)
(2) chest trauma with abnormal vital
signs
(3) abdominal trauma with refractory
hypotension
(4) burns with < 50% probability of
survival
(5) adults > 60 years of age with burn
and significant inhalation injury
Patient with outcome unlikely to be
affected by immediate care:
(1) Mangled Extremity Severity Score
(MESS, described later in chapter): A score >= 7 indicates poor chance of
limb salvage and amputation is probable.
(2) spinal
trauma (requires care not usually accessible in an emergency situation)
(3) a pre-existing condition
Special categories
(1) health care workers with minor
injuries who would be able to assist in the medical response if simple
treatment is provided.
(2) non-traumatic emergencies
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