Triage

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Facilitator: Becca
Time: 15 mins; 0915-0930
Actual time:
Learning Objectives:
Materials: Readers.

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Intro to triage

Facilitator says

When there are more people in need than medic buddy pairs, we triage before engaging care.

Facilitator asks

Why might there be more people in need than medic buddy pairs? Good answers:

• Weather.

• Violence and panic.

• Big crowd.

• Misunderestimation: only one buddy pair decided to cover this march.

• Lots of people with special needs who didn't adequately prep (old people, people who don't often protest, people with chronic illness).

Facilitator says

More people needing aid than first-aiders is called a mass casualty incident. Casualties are not dead people, just people in need of aid.

Critical thinking story: Hurricane Sandy

Facilitator

¹ Hurricane Sandy's aftermath in Coney Island was a mass casualty incident -- tens of thousands of elderly people were without electricity in high-rise Housing Authority buildings and could not get downstairs because the elevators didn't work. They were unable to get their own food and medication, and were exposed to cold and carbon monoxide poisoning (from heating their apartments with their ovens). Only a few died, but at least thousands were "casualties" of the superstorm's aftermath. There were less than a dozen street medics. The small number of FEMA teams were restricted in which buildings they could search and what aid they could provide. So the medics developed a process for organizing and supervising non-streetmedic volunteers with biomedical or social work training to canvass the buildings, identify need, provide care, call for back-up from other organizations and 911, and refill prescriptions.

Triage assessment

Facilitator says

Once you engage care, you cannot abandon your patient if you spot someone should have been a higher priority for care. During scene assessment, you and your buddy pause to "sort things out" (Number four, are there any more?). Basic triage:

• How many people need aid?

• Who should get priority attention? Who can wait?

• What back-up is available, and how long will it take?

Who should get priority attention?

Facilitator says

Loudest person is not necessarily most seriously injured. Beware of the quiet person, or the person sitting or laying down. Someone who cannot get out of a bad situation on their own is a Disability-level emergency, and people with Airway or lowered level of responsiveness-level emergencies can't yell to get your attention.

What your buddy pair can do in a mass casualty incident

Facilitator says

The first buddy team on scene assesses the whole incident and decides who backup should prioritize when it arrives. If you're first on scene, stay in triage assessment role until relieved by a buddy pair competent to do the job (preferably the most highly-trained or most experienced medics on scene). Give a full report to replacement when you are relieved. If backup will be a long time coming, the first buddy pair also:

• Consolidates people needing aid in one place.

• Initiates lifesaving measures or evacuation of priority patients.

• May offer first aid.

If your buddy pair initiates care, transfer care only if:

• You are in immediate danger.

• Person refuses care (ethical issues here).

• Person of equal or greater training takes over.

• Care is completed.

Activate bystanders to:

• Use their specialized skills to help.

• Create privacy circle or pravacy blockade.

• Direct or guide "walking wounded" to action medical triage/care station you set up immediately outside danger zone.

• Sit with someone who was disabled by incident until back-up arrives.

Team roles

Triage assessment

Facilitator says

If you have a team structure of multiple buddy pairs who arrive at the incident together, the most experienced or most highly trained buddy pair continuously does only triage assessment and sends other buddy pairs to people most needing aid.

Scene assessment

Facilitator says

Buddy pair(s) dedicated to scene assessment do not need to be medically trained. They look for dangers and changes in the scene. If they see something, they say something to the triage assessment buddy pair.

Scene control, patient care, patient evacuation

Facilitator says

Check in with triage assessment buddy pair when you arrive on scene. They will direct you to the priority areas for scene control, casualty evacuation, or patient care.

Maintaining Patient Confidentiality when Activating Back-up

Do not transmit identifying information about patients over phones or radios, and certainly not by celly, twitter, facebook, or email. Don't ever transmit a patient's name, date of birth, ID #, or detailed description to anyone electronically. Don't share exact cross-streets or details of high-profile injury in more detail than necessary to dispatch appropriate back-up. This info could end up in court or otherwise be used against the patient later.

• Okay: "I'm at the southeast corner of Colfax and Broadway. Need back-up for an ankle injury. We might move."

• Bad: "I'm at the corner of Colfax and Broadway with Star, you know, the lady with the pink hair that was masked up in the bloc earlier? She tried to put up a tent, and the cops were arresting her, but then Alex pushed the one cop over and she got unarrested. Her ankle is sprained, so we're going to the bus shelter to treat her."