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Triage in Mass casualty
นพ. พ�รชั�ย ดวงสอาด งานอ�บั�ติ�เหติ�และฉุ�กเฉุ�น โรงพยาบัาลนครพ�งค�
MCI : Mass casualty incident• An MCI is an event that exceeds the health care
capabilities of the response
MCI = Healthcare Needs > Resourse
Disaster–A disaster is an event that exceeds the
capabilities of response–A disaster is present when need exceeds
resources
Disaster = Need > Resource
Triage
• มาจากคำ�าว่�า v. “trier” – to separate , sort , sift ,select
• Severity and Priority– ดูคำว่ามต้�องการทางการแพทย์�สำ�าหร�บผู้�ป่�ว่ย์แต้�ละคำน
– ซึ่ !งต้�องคำ�าน งถึ งทร�พย์าการต้�างๆ ท$!ม$อย์�แล�ว่ดู�ว่ย์
ประว�ติ� History
ประว�ติ� History
• Baron Dominique Jean Larrey– Napoleon’s Surgeon Marshal• Military • 1st priority for minor injury
• Military : WW I
• Emergency Department
เป�าหมาย Aim
• “ Do the greatest good for the greatest number”
• “ ใช้�ทร�พย์ากรท$!ม$อย์�จ�าก�ดูน�'นเก)ดู ป่ระโย์ช้น�สำงสำ+ดู ก�บคำนหม�มาก ”ท$!สำ+ดู
ทำ าเม!"อไหร$ Timing
• Dynamic > Static
ทำ าเม!"อไหร$ Timing
• Retriage repeatedly– Site of incident– Treatment station– Prior to transport– Front door ER– During care
ล าด�บัความส าค�ญ PrioritiesCategory Description Color Priority
systemImmediate Casualties who require immediate life saving
treatmentRed P 1
Urgent Casualties who require treatment within 6 hours
Yellow P 2
Delay Less serious cases who require treatment butnot within a set time
Green P 3
Expectant Casualties: Blue1. who cannot survive treatment2. for whom the degree of intervention requiredis such that in the circumstances theirtreatment would seriously compromise theprovision of treatment for others
Blue
Dead Dead White/Black
Dead
ว�ธี�การ Triage
• เร'ว Quick• ง$าย Easy• ส าเนาได( Reproducible• ได(ประเด'น Describe major outcome• เป)นขั้�+นติอน Dynamic
MIMMS
• MAJOR INCIDENT MEDICAL MANAGEMENT AND SUPPORT–Triage Sieve–Triage Sort
MIMMS :Triage sieve
MIMMS :Triage sieve
MIMMS :Triage sieve
• Aim : จั�ดเร�ยงคนไขั้(ทำ�"ม�มากมาย ให(เป)นหมวดหม.$
• ใชั(เวลาน(อยกว$า 20 ว�นาทำ�ในคนไขั้(แติ$ละคนในคนทำ�"เคล!"อนไหวไม$ได(
• ABC
MIMMS :Triage sort
• More Complex• Measured value• Within 1min• Triage Tool and Monitor tool– Speed important less than Accuracy
MIMMS :Triage sort
MIMMS :Triage sort
ประเม�นเบั!+องติ(น Preliminary survey
• Specific exam and history
• Board categorization– อาการรวมๆ
สร�ป SummaryLocation Treatment Grade
performing triage
Triage method
Site Life saving Paramedic SieveCasualty clearing station
Life support Paramedic/doctor Sieve/sort
Casualty cleaning station
Advance LS Doctor Sort and preliminary survey
Hospital reception Advance LS Senior ER doctor/nurse
Sieve and sort
Hospital Life saving surgery Senior surgeon 1 and 2 survey
START triage
• Simple Triage and Rapid Treatment– Developed at Hoag Hospital in Orange County,
California• แบ�งเป่,น 4 triage categories• www.start-triage.com
START
• Ask all who can walk to move– Green
• Begin assessment based on RPM– Respiration– Pulse*– Mental Status
* Modified from capillary refill
START Triage
START Triage
RESPIRATIONS
NO
YES
Dead orExpectant
Immediate
Position Airway
NO YES
Over 30/min
Immediate
Under 30/min
PERFUSION
Cap refill> 2 sec
ControlBleeding
Immediate
Cap refill< 2 sec.
Failure to followsimple commands
Can followsimple commands
Immediate Delayed
MENTALSTATUS
No body Perfect
• PRACTISE , PRACTISE and PRACTISE !!!!!