2013 OEC RefresherStation 2 – Self Guided Review

Two Part Review

Section One: START Triage SystemSection One: START Triage System

Section Two: Triage Tag CompletionSection Two: Triage Tag Completion

START Triage System

SSimpleimple

TTriageriage

AAndnd

RRapidapid

TTreatmentreatment

Prepared By Ken Young ; Office of Education and Certification - MIEMSS - 1999

START Rapid approach to triaging large numbers of Rapid approach to triaging large numbers of

causalitiescausalities Initial patient assessment and treatment should Initial patient assessment and treatment should

take less than 30 seconds for each patienttake less than 30 seconds for each patient Easy to rememberEasy to remember START right where you are. At the first patient START right where you are. At the first patient

you come to, not the worst patient you may you come to, not the worst patient you may see.see.

START

First - clear the walking wounded using verbal instructions. First - clear the walking wounded using verbal instructions. – Direct them to the treatment areas for detailed assessment and Direct them to the treatment areas for detailed assessment and

treatment treatment – Tag These as Tag These as MINORMINOR

Now check your Now check your RPMRPMss

START RPM RRespiration'sespiration's

– None - Open the AirwayNone - Open the Airway Still None? - Still None? - DECEASEDDECEASED Restored?-Restored?- IMMEDIATEIMMEDIATE

– Present?Present? Above Above 3030 - - IMMEDIATEIMMEDIATE Below Below 3030 - - CHECK PERFUSIONCHECK PERFUSION

START RPM PPerfusionerfusion

– RadialRadial Pulse Absent Pulse Absent or or

Capillary Refill > Capillary Refill > 22 secs secs IMMEDIATEIMMEDIATE

– RadialRadial Pulse Present Pulse Present or or

Capillary Refill Capillary Refill << 22 secs secsCHECK CHECK MMENTAL STATUSENTAL STATUS

START RPM

MMental Statusental Status– Can NotCan Not Follow Simple Commands Follow Simple Commands

(Unconscious or Altered LOC)(Unconscious or Altered LOC)IMMEDIATEIMMEDIATE

– Can Can Follow Simple CommandsFollow Simple Commands DELAYEDDELAYED

START

Exceptions:Exceptions:

* Co- Workers* Co- Workers

* Emotional Disorder (uncontrollable)* Emotional Disorder (uncontrollable)

Both above get automatically labeled as Both above get automatically labeled as IMMEDIATEIMMEDIATE

START

If patient is If patient is immediateimmediate - priority 1 upon initial - priority 1 upon initial assessment, attempt to correct airway assessment, attempt to correct airway blockage or uncontrolled bleeding only before blockage or uncontrolled bleeding only before moving on to next patient.moving on to next patient.

STARTThe The STARTSTART process permits a very few rescuers process permits a very few rescuers

to rapidly triage a large number of patients to rapidly triage a large number of patients without specialized training.without specialized training.

ONLY After patients are moved to treatment ONLY After patients are moved to treatment areas where more detailed assessment and areas where more detailed assessment and treatment are conducted.treatment are conducted.

START When things get hectic with multiple patients When things get hectic with multiple patients

rev up your RPM’s.rev up your RPM’s.

–RR - Respiration - - Respiration - 3030

–PP - Perfusion - - Perfusion - 2 2

–MM - Mental status - - Mental status - CAN doCAN do

““30 – 2 – CAN do”30 – 2 – CAN do”

Section Two:Triage Tags Rip off numbered Rip off numbered

Triage StatusTriage Status Body DiagramBody Diagram Vitals / AVPUVitals / AVPU Patient NamePatient Name Notes/ TreatmentNotes/ Treatment Transport RecordTransport Record On back : Injury / On back : Injury /

Chief ComplaintChief Complaint

Triage Status Section– Perforated Tabs to rib off to correct Perforated Tabs to rib off to correct

Pt. status. Pt. status.

– Remove the upper tabs that are not Remove the upper tabs that are not appropriate for this Pt. Thus, the appropriate for this Pt. Thus, the top off the existing tag shows the top off the existing tag shows the color status for this Pt. condition.color status for this Pt. condition.

– If Pt. status deteriorates can rip off If Pt. status deteriorates can rip off to next status.to next status.

– Note: Each tag is sequentially Note: Each tag is sequentially number to track all Patientsnumber to track all Patients

Diagram - Chief Complaint Section Major obvious injuries or illness Major obvious injuries or illness

should be checked off on body should be checked off on body part of Human Figure for quick part of Human Figure for quick reference on front of Tag.reference on front of Tag.

More detail description to be More detail description to be written in on back of tag.written in on back of tag.

Multiple injuries - mark figure Multiple injuries - mark figure with “A” “B” and “C” to cross with “A” “B” and “C” to cross reference description details on reference description details on back.back.

Vitals - APVU

Initial Triage to include Initial Triage to include Time, Pulse, Resp. and Time, Pulse, Resp. and AVPU.AVPU.

Balance of items can be Balance of items can be filled at time of filled at time of treatment or second treatment or second triage.triage.

Patient Information Section Again, during MCIs this information is not always Again, during MCIs this information is not always

obtainable.obtainable. Some information is not a priority, can be added Some information is not a priority, can be added

throughout triage, treatment, transportation, and throughout triage, treatment, transportation, and hospital reception phases. hospital reception phases.

Jim-Bob Rumplestillskin

Notes / Treatment

Pertinent items such as SAMPLE and other history.Pertinent items such as SAMPLE and other history. Any treatment done on this patient with time. Any treatment done on this patient with time.

Please write legible and small as notes will Please write legible and small as notes will invariably added by others at a later date. invariably added by others at a later date.

Additional sets of vital can also be recorded here.Additional sets of vital can also be recorded here.

Transportation Record Section (front) Detachable by tear-off bottom of ticket Detachable by tear-off bottom of ticket Used to document patients removed from the scene Used to document patients removed from the scene

to a hospital or other facilityto a hospital or other facility Make certain unit, Injury, priority, depart time and Make certain unit, Injury, priority, depart time and

destination is marked. Use the column with the destination is marked. Use the column with the appropriate priority color to write in the appropriate priority color to write in the information.information.

HOSP NOTIFIED

Transportation Record Section (back) On the back of the tag that you detached has On the back of the tag that you detached has

additional comments section. Fill in pertinent additional comments section. Fill in pertinent information and treatment to date. information and treatment to date.

Transportation record to be given to Transportation Transportation record to be given to Transportation officer so he/she can track and log every tag number officer so he/she can track and log every tag number (Patient). (Patient).

HOSP NOTIFIED

Injuries – Chief Complaint Notes of injuries to Patient.Notes of injuries to Patient. Fill in the under the Fill in the under the

appropriate Triage (color) appropriate Triage (color) you have assigned.you have assigned.

Written notes here should Written notes here should match what you have match what you have checked of on the human checked of on the human diagram on the front.diagram on the front.

PROGRAM SUMMARY

Triage tag allows for continuous:Triage tag allows for continuous:– Triage assessments of patientTriage assessments of patient

– Patient information recordingPatient information recording

– Patient accountability & trackingPatient accountability & tracking

PROGRAM SUMMARY

One Tag = One PatientOne Tag = One Patient– Tags are not interchangeable, as each possesses a Tags are not interchangeable, as each possesses a

unique numberunique number– Tags cannot be ‘thrown away’ -- All tags need to Tags cannot be ‘thrown away’ -- All tags need to

be accounted for at end of the incident.be accounted for at end of the incident.– Do not altered previous notes on a tag; add to it as Do not altered previous notes on a tag; add to it as

necessary.necessary.– Pick-up Any Loose Tags and Report Them to Pick-up Any Loose Tags and Report Them to

Treatment Unit CoordinatorTreatment Unit Coordinator

PROGRAM SUMMARY

Establishing Establishing The System Of PatientThe System Of Patient

Triage, Treatment, and TrackingTriage, Treatment, and Tracking EarlyEarly in Any Multi Casualty Incident in Any Multi Casualty Incident Is the Key to Effectively Coordinating Is the Key to Effectively Coordinating

Patient FlowPatient Flow

Program Summary

Incident SiteTreatment Unit

Coordinator Morgue

Priority Red Patients Priority Yellow Patients Priority Green Patients

Transportation Group Supervisor

Transport Unit

StagingDisposition and

Medical Communications

North Hospital

South Hospital

East Hospital

West Hospital

Perfect Practice Makes Perfect

Practice the Use of These Procedures Practice the Use of These Procedures in Mock Situations, in Mock Situations, Before Before

You Really Need ItYou Really Need It