PRE-HOSPITAL EMERGENCY CARE COURSE
www.basics.org.uk
Triage
Picture space
central
© BASICS Education March 2016
Objectives
•
Understand the nature of triage
•
Describe where triage is carried out
Triage
•
Why
•
Where
•
When
•
Who
C.S.C.A.T.T.T.
•
Command
•
Safety
•
Communication
•
Assessment
C.S.C.A.T.T.T.
•
Triage
•
Treatment
•
Transport
Triage, from the French “trier” - to separate, sift or select
Triage - aims
•
Right treatment
•
Right patient
•
Right place
•
Right time
•
Right transport
Triage - dynamic system
•
First look
•
Casualty Clearing Station
•
Evacuation
•
Hospital
•
Surgery
Triage - priorities
P
T
Description
Colour
1
1
Immediate
Red
2
2
Urgent
Yellow
3
3
Delayed
Green
1 hold
4
Expectant
Blue
Dead
Dead
Dead
White/Black
Triage - Priority 1
(Immediate)
•
Casualties who require immediate lifesaving interventions
T1
Triage - Priority 2
(Urgent)
•
Casualties who require surgical or other
interventions within 2 - 4 hours
T2
Triage - Priority 3
(Delayed)
•
Casualties whose treatment may be safely
delayed
for >4 hours
T3
Triage - Priority 4
(Expectant)
•
Casualties whose injuries are either so severe
that they are unlikely to survive, or whose
treatment would compromise the care of
others
•
Gold level decision
T4
Triage
Decisions need to be made
•
quickly
•
safely
•
reproducibly
Triage Sieve
•
Ideally a 2 person role
•
On-scene first look
Minimal Intervention to save
life
•
Can they walk ?
“If you can walk go over
there”
Triage Sieve
Triage Sieve
First treat or exclude catastrophic haemorrhage
Triage Sieve
Then separate out minor injuries and uninjured
survivors
Triage Sieve
At a Mass Casualty Incident if you are not
breathing, you are dead
Triage Sieve
Then level of consciousness, respiratory rate
and pulse (capillary refill) identify priority
Paediatric Triage Tape
© TJN Jun ‘06
Triage Sort
Follows Triage Sieve
•
Reassesses clinical priorities
•
Allows a senior clinician to input as well
Triage Revised Trauma Score (TRTS)
•
GCS
•
Systolic BP
•
Respiratory rate
Triage labelling
•
Indicates that triage has been done
•
Indicates the current triage priority
•
Forms part of the patient records
Triage Labelling
Alternatives?
•
•
Simple alternatives
•
coloured pegs
•
big pen
The only absolute requirement is that
everyone must understand the system
Identifying the T4 category
EXPECTANT
expectant
T3
T1
TRIAGE SIEVE
1 - Immediate
2 - Urgent
TRIAGE SORT
Casualty
Clearing
Station
2 - Urgent
Ambulance
Loading
Point
3 - Delayed
4 - Expectant
RECEIVING
HOSPITAL
1 - Immediate
4 - Expectant
RECEIVING
HOSPITAL
Incident
Site
Dead
Body
Holding Area
TEMPORARY
MORTUARY
RECEIVING
HOSPITAL
Triage
Questions ?
Summary
•
Triage is the first step in medical support
•
Triage is dynamic
•
Triage sieve quickly assigns priorities
•
Triage sort refines the priorities
•
Triage labels indicate current priority