2. OFF TO A GOOD S.T.A.R.T.
Trauma Triage and Mass Casualty
Incidents
Veronica Bonales, M.D.
RMH PreHospital Care Medical Director
HCEMCC Paramedic Coordinator
3.
4.
5. Mass Casualty Incident
Any incident that overwhelms the available resources
9/11
Two person EMS crew arriving at scene with three victims
6. Mass Casualty Incident
First unit on scene declares MCI
When additional units start en route, first unit starts triage
Usually involves setting up an Incident Command System
Triage, Treatment, Transport
7. Mass Casualty Incident
Triage everyone according to
START
Treatment of manageable
injuries
Transport in order of priority
and for definitive care
8.
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11.
12. - Assess and control the accident scene
- Tamponade external hemorrhage with direct pressure
- Protect the spine after blunt trauma
- Extricate the patient
- Supplement inspired O2
- Stabilize long bone fractures
17. Triage Principles
Triage – Fr. trier = to sort
Napoleon’s surgeon Larrey established the ambulance corps
and a method of setting priorities for the evacuation of war
casualties
18. Triage Principles
Triage – Fr. trier = to sort
Napoleon’s surgeon Larrey established the ambulance corps
and a method of setting priorities for the evacuation of war
casualties
- he picked up the war wounded that could be saved by quick
intervention (ie. amputation)
19. Triage Principles
Triage – Fr. trier = to sort
Napoleon’s surgeon Larrey established the ambulance corps
and a method of setting priorities for the evacuation of war
casualties
- he picked up the war wounded that could be saved by quick
intervention (ie. amputation)
- other surgeons quickly bandaged those that could go back
and fight
22. Triage Principles
Civil War:
Formal establishment of military field ambulance service
23. Triage Principles
Civil War:
Formal establishment of military field ambulance service
Surgeons continued the practice of collecting those who could
benefit from immediate medical intervention
25. Triage Principles
WWI and WWII
Increased use of field medics and the “buddy system”
Increased use of antibiotics
Aid stations and surgical hospitals moved closer to the front
27. Triage Principles
Korean War
MASH units and helicopters helped to further decrease the
number of battlefield casualties
This was further improved upon in the Vietnam conflict
where death rates decreased from 30% to 24%
Afghan and Iraq war casualty rates now 10%
33. Triage Principles
START Triage
Team of two can assess an average of one patient every 30
seconds.
40 casualties, two triage teams will take approximately 10
minutes to accurately assess
Only treatment rendered by the triage team
open a patient’s airway
by head tilt /neck lift
by insertion of an OPA
apply direct pressure to stop an obvious bleed or by
elevating the extremities.
40. Assess, Treat, (use bystanders)
When you have a color
STOP - TAG - MOVE ON
Move Walking Wounded
NO RESPIRATIONS after head tilt*
Breathing but UNCONSCIOUS
Perfusion Capillary refill > 2
or NO RADIAL PULSE
Control bleeding
minor decease Mental Status Unable to follow simple commands
d immedi
ate
Otherwise
delaye
d
REMEMBER:
Respirations < 30
Perfusion < 2
Mental Status - Can Do
41.
42. Triage Principles
· Evaluate patient using START
· Tear off the bottom of the tag
· Tear off a tracking slip and place it in the kit
· Attach tag to the patient with a tie
· Give tracking slips to the Triage Officer
47. Triage Principles
16 year old with 17 year old with 35 year old with 47 year old with
bleeding scalp lac. no spontaneous foreign body open tib-fib
respirations or fracture
pulse
48. Triage Principles
16 year old with 17 year old with 35 year old with 47 year old with
bleeding scalp lac. no spontaneous foreign body open tib-fib
respirations or fracture
pulse
49. Triage Principles
16 year old with 17 year old with 35 year old with 47 year old with
bleeding scalp lac. no spontaneous foreign body open tib-fib
respirations or fracture
pulse
50. Triage Principles
16 year old with 17 year old with 35 year old with 47 year old with
bleeding scalp lac. no spontaneous foreign body open tib-fib
respirations or fracture
pulse
51. Triage Principles
16 year old with 17 year old with 35 year old with 47 year old with
bleeding scalp lac. no spontaneous foreign body open tib-fib
respirations or fracture
pulse
52. Triage Principles
30 year old with 5 year old who 24 year old with 38 year old with
dislocated ankle seems confused broken finger no heartbeat and
and won’t talk no spontaneous
respirations
53. Triage Principles
30 year old with 5 year old who 24 year old with 38 year old with
dislocated ankle seems confused broken finger no heartbeat and
and won’t talk no spontaneous
respirations
54. Triage Principles
30 year old with 5 year old who 24 year old with 38 year old with
dislocated ankle seems confused broken finger no heartbeat and
and won’t talk no spontaneous
respirations
55. Triage Principles
30 year old with 5 year old who 24 year old with 38 year old with
dislocated ankle seems confused broken finger no heartbeat and
and won’t talk no spontaneous
respirations
56. Triage Principles
30 year old with 5 year old who 24 year old with 38 year old with
dislocated ankle seems confused broken finger no heartbeat and
and won’t talk no spontaneous
respirations
57. Triage Principles
19 year old with 29 year old with 7 year old with no 36 year old with
burns to soles of no visibile injuries pulses and no penetrating
feet spontaneous trauma and a
breaths after 2 swelling belly
rescue breaths
58. Triage Principles
19 year old with 29 year old with 7 year old with no 36 year old with
burns to soles of no visibile injuries pulses and no penetrating
feet spontaneous trauma and a
breaths after 2 swelling belly
rescue breaths
59. Triage Principles
19 year old with 29 year old with 7 year old with no 36 year old with
burns to soles of no visibile injuries pulses and no penetrating
feet spontaneous trauma and a
breaths after 2 swelling belly
rescue breaths
60. Triage Principles
19 year old with 29 year old with 7 year old with no 36 year old with
burns to soles of no visibile injuries pulses and no penetrating
feet spontaneous trauma and a
breaths after 2 swelling belly
rescue breaths
61. Triage Principles
19 year old with 29 year old with 7 year old with no 36 year old with
burns to soles of no visibile injuries pulses and no penetrating
feet spontaneous trauma and a
breaths after 2 swelling belly
rescue breaths
62. Assess, Treat, (use bystanders)
When you have a color
STOP - TAG - MOVE ON
Move Walking Wounded
NO RESPIRATIONS after head tilt*
Breathing but UNCONSCIOUS
Perfusion Capillary refill > 2
or NO RADIAL PULSE
Control bleeding
minor decease Mental Status Unable to follow simple commands
d immedi
ate
Otherwise
delaye
d
REMEMBER:
Respirations < 30
Perfusion < 2
Mental Status - Can Do
The concepts of dedicated ambulances and standardized medical equipment spread rapidly after the publication of the groundbreaking 1966 National Research Council report Accidental Death and Disability: The Neglected Disease of Modern Society.14 Victims of illness and injury in nonurban areas of the United States began to be triaged by trained, skilled medics, rather than the local hearse drivers who had provided civilian medical transportation services.\n
The concepts of dedicated ambulances and standardized medical equipment spread rapidly after the publication of the groundbreaking 1966 National Research Council report Accidental Death and Disability: The Neglected Disease of Modern Society.14 Victims of illness and injury in nonurban areas of the United States began to be triaged by trained, skilled medics, rather than the local hearse drivers who had provided civilian medical transportation services.\n
The concepts of dedicated ambulances and standardized medical equipment spread rapidly after the publication of the groundbreaking 1966 National Research Council report Accidental Death and Disability: The Neglected Disease of Modern Society.14 Victims of illness and injury in nonurban areas of the United States began to be triaged by trained, skilled medics, rather than the local hearse drivers who had provided civilian medical transportation services.\n
The concepts of dedicated ambulances and standardized medical equipment spread rapidly after the publication of the groundbreaking 1966 National Research Council report Accidental Death and Disability: The Neglected Disease of Modern Society.14 Victims of illness and injury in nonurban areas of the United States began to be triaged by trained, skilled medics, rather than the local hearse drivers who had provided civilian medical transportation services.\n
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Respirations, perfusion, mental status\n
Respirations, perfusion, mental status\n
Respirations, perfusion, mental status\n
Respirations, perfusion, mental status\n
Respirations, perfusion, mental status\n
Respirations, perfusion, mental status\n
Respirations, perfusion, mental status\n
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The wreckage of a Cessna 177 in which trainee pilot&#xA0; Jessica Dubroff, her father and her instructor were killed while engaging in a trans-continental record attempt. The accident was caused by the instructor pilot's improper decision to take off into deteriorating weather conditions which resulted in stall. 4/96\n
The wreckage of a Cessna 177 in which trainee pilot&#xA0; Jessica Dubroff, her father and her instructor were killed while engaging in a trans-continental record attempt. The accident was caused by the instructor pilot's improper decision to take off into deteriorating weather conditions which resulted in stall. 4/96\n
The wreckage of a Cessna 177 in which trainee pilot&#xA0; Jessica Dubroff, her father and her instructor were killed while engaging in a trans-continental record attempt. The accident was caused by the instructor pilot's improper decision to take off into deteriorating weather conditions which resulted in stall. 4/96\n
The wreckage of a Cessna 177 in which trainee pilot&#xA0; Jessica Dubroff, her father and her instructor were killed while engaging in a trans-continental record attempt. The accident was caused by the instructor pilot's improper decision to take off into deteriorating weather conditions which resulted in stall. 4/96\n