Disaster and Multi Casualty Traige System in Nursing Practice

 

S. Tamil Selvi

Principal, Dr. M. B. Sharma Nursing College,Ayush Parisar, Sailana Road, Ratlam (M.P) pin- 457001

 

 

ABSTRACT:

Triage is the process of quickly examining sick or injured people, the sorting of patients in emergency room according to the urgency of their need for care. Three categories of victim classified Red / Immediate means a patient whose life is in immediate danger and requires immediate treatment. Yellow / delayed means a patient whose life is not in immediate danger, Surgical or medical intervention is required within 2 - 4 hours. Green / Minimal Means a patient with minor injuries who will eventually require treatment, Minor fractures or lacerations are commonly seen in this group. Black/Expectant Means a patient who is either dead or has extensive injury and cannot be saved with the limited resources available.

 

 

 

INTRODUCTION:

The word triage comes from the French word Trier meaning to sort, Grouping patients based on the severity of their injuries and the likelihood of their survival is called triage.It is the process by which patients classified according to the type and urgency of their conditions to get the right patient to the right place at the right time with the right care provider. In a triage situation, urgent cases are seen by doctors first and non-life-threatening cases go last.

 

DEFINITION OF TRIAGE:²

The sorting of and allocation of treatment to patients and especially battle and disaster victims according to a system of priorities Designed to maximize the number of survivors. The sorting of patients as in an emergency room according to the urgency of their need for care

 

TYPES OF TRIAGE ³

SIMPLE TRIAGE

Simple triage is usually used in a scene of an accident or "mass-casualty incident" (MCI), in order to sort patients into those who need critical attention and immediate transport to the hospital and those with less serious injuries. This step can be started before transportation becomes available.

 

The completion of Initial assessment by physicians, nurses or paramedical personnel each patient may be Labeled which may identify the patient, display assessment findings, and identify the priority of the patient's need for medical treatment and transport from the emergency scene. The patients may be simply marked with coloured, flagging tape or with marker pens. Pre-printed cards also used for this purpose are known as a triage tags.

 

ADVANCED TRIAGE:

This advanced triage system involves a color-coding scheme using red, yellow, green, white, and black tags:

·        Red tags - (Immediate) are used to label those who cannot survive without immediate treatment but who have a chance of survival.

·        Yellow tags - (observation) for those who require observation. Their condition is stable for the moment and, they are not in immediate danger of death. These victims will still need hospital care and would be treated immediately under normal circumstances.

·        Green tags - (Wait) are reserved for the "walking wounded" who will need medical care at some point, after more critical injuries have been treated. They will require a doctor's care in several hours or days but not immediately, may wait for a number of hours or be told to go home and come back the next day ( minor fractures and soft tissue injuries).

·        White tags - (Dismiss) are given to those with minor injuries for whom a doctor's care is not required. First aid and home care are sufficient; Injuries are along the lines of cuts and scrapes, or minor burns.

·        Black tags - (Expectant) are used for the deceased and for those whose injuries are so extensive that they will not be able to survive given the care that is available.

 

CONTINUOUS INTEGRATED TRIAGE

Continuous integrated triage combines three forms of triage with progressive specificity to most rapidly identify those patients in greatest need of care while balancing the needs of the individual patients against the available resources and the needs of other patients. Continuous integrated triage employs:

·        Group (Global) Triage (i.e., M.A.S.S. triage)

·        Physiologic (Individual) Triage (i.e., S.T.A.R.T.)

·        Hospital Triage (i.e. E.S.I. or Emergency Severity Index) however any Group, Individual and/or Hospital Triage system can be used at the appropriate level of evaluation.

 

REVERSE TRIAGE:

Usually, Triage refers to Prioritizing admission. A similar process can be applied to discharging patients early when the medical system is stressed. This process has been called "reverse triage". During a "surge" in demand, such as immediately after a natural disaster, many hospital beds will be occupied by regular non-critical patients. In order to accommodate a greater number of the new critical patients, the existing patients may be triaged, and those who will not need immediate care can be discharged until the surge has dissipated, for example through the establishment of temporary medical facilities in the region.

 

UNDER TRIAGE AND OVER TRIAGE

UNDERTRIAGE:

 Under triage is the under estimating the severity of an illness or injury. An example of this would be categorizing a Priority 1 (Immediate) patient as a Priority 2 (Delayed) or Priority 3 (Minimal). Historically, acceptable under triage rates have been deemed 5% or less.

 

OVER TRIAGE:

Over Triage is the overestimating of the severity of an illness or injury. An example of this would be categorizing a Priority 3 (Minimal) patient as a Priority 2 (Delayed) or Priority 1 (Immediate). Acceptable over triage rates have been typically up to 50% in an effort to avoid under triage. Some studies suggest that over triage is less likely to occur when triaging is performed by hospital medical teams, rather than paramedics or EMTs.

 

TRIAGE COLOUR CODING LEVEL:⁵

 

FIGURE: 1

 

·        Red / Immediate – A patient whose life is in immediate danger and requires immediate treatment. This may include patients with airway obstruction or severe breathing problems.

·        Yellow / Delayed ‒ A patient whose life is not in immediate danger. Surgical or medical intervention is required within 2 - 4 hours. This may include patients with intra-abdominal bleeding or complicated fractures.

·        Green / Minimal – A patient with minor injuries who will eventually require treatment. Minor fractures or lacerations are commonly seen in this group.

·        Black / Expectant – A patient who is either dead or has extensive injuries and cannot be saved with the limited resources available.

START SYSTEM (SIMPLE TRAIGE AND RAPID TREATMENT^{) 1}

 

FIGURE: 2

 

START SYSTEM helps to assess the

·        Ventilation > 30/min

·        Perfusion <>

·        Mental status: unable to follow simple directions

 

START FIRST STEP -1

 

Green (Minor) Evaluate Ventilation (Step-2)

 

START SECOND STEP-2

 

START FIRST STEP -3

 

 

START FIRST STEP -4

 

 

Triage Category Guidelines ⁴

Red / Immediate (Priority i)

·        Asphyxia

·        Respiratory obstruction from mechanical causes

·        Tension pneumothorax

·        Maxillofacial wounds in which asphyxia exists or is likely to develop

·        Shock caused by major external hemorrhage

·        Major internal hemorrhage

·        Visceral injuries or evisceration

·        Cardio/pericardial injuries

·        Massive muscle damage

·        Severe burns over 25%

·        Dislocations

·        Major fracture

·        Major medical problems readily correctable

·        Closed cerebral injuries with increasing loss of consciousness

 

YELLOW / DELAYED (Priority II)

·        Major fractures (if able to stabilize)

·        Visceral injuries or evisceration

·        Cardio/pericardial injuries

·        Massive muscle damage

·        Severe burns over 25%

·        Vascular injuries requiring repair

·        Wounds of genitourinary tract

·        Thoracic wounds without asphyxia

·        Closed cerebral injuries with increasing loss of consciousness

·        Spinal cord injuries requiring decompression

·        Suspected spinal cord injuries without neurological signs

·        Injuries of the eye

·        Maxillofacial injuries without asphyxia

·        Complicated major medical problems

·        Minor medical problems

·        Victims with little hope of survival under the best of circumstances of medical care

 

Green / Minimal (Priority III)

·        patient with minor injuries

·        Minor fractures or lacerations

 

Black / Expectant (Priority IV)

·        Patient who is either dead or has extensive injuries and cannot be saved with the limited resources available.

 

CONCLUSION:

Triage remains the most important tool at our disposal when dealing with a major incident and/or disaster. It will ensure that limited medical resources are correctly directed towards those casualties who have the most life-threatening injuries..The triage tool is important that health professionals are aware of these systems and become proficient in their use.

 

 

 

ACKNOWLEDGEMENT:

The Authors Are Grateful to the authorities of Dr . M.B.Sharma Nursing College, Ratlam, M.P.

 

CONFLICT OF INTEREST:

The Author Declare No Conflict Of Interest

 

REFERENCE:

1.     Amado Alejandro Báez MD MSc and Matthew Sztajnkrycer MD PhD. START SYSTEM (Internet) Available From http://www.pitt.edu/~super7/17011-18001/17941.ppt

2.     Define Triage (Internet) Available From https://www.merriam-webster.com/dictionary/triage

3.     Wikipedia, Types Of Triage (Internet) Available From The free encyclopedia https://en.wikipedia.org/wiki/Triage

4.     RNPEDIA, Triage Guidelines (Internet) Available From -https://www.rnpedia.com/nursing-notes/fundamentals-in-nursing-notes/triage-principles/

5.     Smith (2012) Triage level of colour coding (Internet) Available From http://www.cmej.org.za/index.php/cmej/article/view/2585/2645Home, Vol. 30, No.11

 

 

 

 

 

 

 

 

 

 

 

Received on 23.09.2017       Modified on 29.10.2017

Accepted on 29.11.2017       ©A&V Publications All right reserved