Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
DISASTER TRIAGE: S.T.A.R.T. & S.A.V.E. Carl H. Schultz, MD Professor of Emergency Medicine UC Irvine School of Medicine
Carl Spengler, MD 3 rd  Year EM Resident Oklahoma City Bombing <ul><li>“… We never saw a child come out of the federal bui...
Nature of Triage… <ul><li>I finally yelled for everybody to be quiet and calm down.  As I assessed the little girl, it was...
Goal of Disaster Triage <ul><li>Do the greatest good  for the greatest number of casualties </li></ul>
Triage Origin <ul><li>From the French verb,  t r i e r  , “to sort” </li></ul><ul><li>Napoleon’s time, to assign treatment...
Does Triage Work? <ul><li>Lessons from history </li></ul><ul><li>Scene control </li></ul><ul><ul><li>Convergence behavior ...
Key Concepts <ul><li>Resources are limited </li></ul><ul><ul><li>Supplies </li></ul></ul><ul><ul><li>Personnel </li></ul><...
Triage Practices <ul><li>Traditional </li></ul><ul><ul><li>Static, single point in time </li></ul></ul><ul><ul><li>Triage ...
Triage Practices <ul><li>Traditional </li></ul><ul><ul><li>Scoop and run </li></ul></ul><ul><ul><li>Designed to work withi...
Triage Practices <ul><li>Traditional </li></ul><ul><ul><li>Used for localized disaster scenes </li></ul></ul><ul><ul><li>D...
Patient Categories <ul><li>1.  Those who will die no matter what </li></ul><ul><li>2. Those who will do well no matter wha...
START Triage <ul><li>Simple Triage and Rapid Treatment </li></ul><ul><li>Designed to be performed by first responders (par...
START Triage <ul><li>Rapid method to perform INITIAL triage </li></ul><ul><li>Utilizes respiratory rate, palpable pulse, a...
START Triage <ul><li>GREEN:  those who are able to get up and walk away </li></ul><ul><li>RED:  those with respiratory com...
Modified  START
SAVE Triage <ul><li>Secondary Assessment of Victim Endpoint </li></ul><ul><li>All patients with at least a 50% chance of s...
SAVE Triage <ul><li>Benefit Value =  ————   X  Probability of survival   Resources required </li></ul>
 
SAVE Triage Areas of Assessment <ul><li>Vital Signs </li></ul><ul><li>Airway </li></ul><ul><li>Chest </li></ul><ul><li>Abd...
SAVE Triage Categories <ul><li>RED:  require immediate intervention </li></ul><ul><li>YELLOW:  require intervention but ca...
SAVE Triage Categories <ul><li>Periodic assessment of all categories is important </li></ul><ul><li>Patients may move from...
SAVE Triage Guidelines <ul><li>Crush Injury to Lower Extremity </li></ul><ul><ul><li>Patients are assessed using the MESS ...
SAVE Triage Guidelines <ul><li>Head Injury (adults) </li></ul><ul><ul><li>Use the Glascow Coma Score (GCS) </li></ul></ul>...
SAVE Triage Guidelines <ul><li>Burn Injury:  less than 50% chance of survival </li></ul><ul><ul><li>70% TBSA burn </li></u...
SAVE Triage Guidelines <ul><li>Abdominal Injury </li></ul><ul><ul><li>No data to guide evaluation </li></ul></ul><ul><ul><...
Initial Assessment: START Case #1 <ul><li>61 year old male pulled from smoking building.  Complaining of shortness of brea...
Initial Assessment: START Case #2 <ul><li>30 year old male found with bleeding head wound </li></ul><ul><li>RR =22 </li></...
Initial Assessment: START Case #3 <ul><li>20 year old female complaining of crushed lower extremity </li></ul><ul><li>RR =...
Initial Assessment: START Case #4 <ul><li>3 year old female found not breathing </li></ul><ul><li>RR =agonal </li></ul><ul...
Secondary Assessment: SAVE Case #2 <ul><li>30 year old male found with bleeding head wound </li></ul><ul><li>START Categor...
Secondary Assessment: SAVE Case #1 <ul><li>61 year old male pulled from smoking building.  Complaining of shortness of bre...
Secondary Assessment: SAVE Case #3 <ul><li>20 year old female complaining of crushed lower extremity </li></ul><ul><li>STA...
Upcoming SlideShare
Loading in …5
×

59

Share

Download to read offline

Disaster Triage START and SAVE

Download to read offline

Review of START and SAVE triage

Related Books

Free with a 30 day trial from Scribd

See all

Disaster Triage START and SAVE

  1. 1. DISASTER TRIAGE: S.T.A.R.T. & S.A.V.E. Carl H. Schultz, MD Professor of Emergency Medicine UC Irvine School of Medicine
  2. 2. Carl Spengler, MD 3 rd Year EM Resident Oklahoma City Bombing <ul><li>“… We never saw a child come out of the federal building alive. At one point, a group of people began screaming for me. A firefighter had brought out a little girl who was still breathing. People were preparing intravenous fluids, and a paramedic was getting the intubation equipment together. The crowd was screaming for the doctors to work on the child. </li></ul>
  3. 3. Nature of Triage… <ul><li>I finally yelled for everybody to be quiet and calm down. As I assessed the little girl, it was obvious that she had catastrophic head and chest injuries and that there was nothing left to save. I told a paramedic to wrap up the child in a blanket and do nothing. Several bystanders became emotionally decompensated and screamed, ‘You bastard!’ As I walked off, several people continued to curse me in the worst possible fashion. Unfortunately, that is the nature of triage”. </li></ul>
  4. 4. Goal of Disaster Triage <ul><li>Do the greatest good for the greatest number of casualties </li></ul>
  5. 5. Triage Origin <ul><li>From the French verb, t r i e r , “to sort” </li></ul><ul><li>Napoleon’s time, to assign treatment priorities with limited resources </li></ul><ul><li>Attention given first to most salvageable with most urgent conditions – get them back into battle </li></ul>
  6. 6. Does Triage Work? <ul><li>Lessons from history </li></ul><ul><li>Scene control </li></ul><ul><ul><li>Convergence behavior </li></ul></ul>
  7. 7. Key Concepts <ul><li>Resources are limited </li></ul><ul><ul><li>Supplies </li></ul></ul><ul><ul><li>Personnel </li></ul></ul><ul><li>Time for evacuation unknown or prolonged (the cavalry isn’t coming any time soon) </li></ul><ul><ul><li>Only austere field interventions are available </li></ul></ul>
  8. 8. Triage Practices <ul><li>Traditional </li></ul><ul><ul><li>Static, single point in time </li></ul></ul><ul><ul><li>Triage tags frequently used </li></ul></ul><ul><ul><li>Few patients </li></ul></ul><ul><li>Disaster </li></ul><ul><ul><li>Dynamic, multiple points in time </li></ul></ul><ul><ul><li>Documentation needs may exceed triage tag capacity </li></ul></ul><ul><ul><li>Large patient numbers </li></ul></ul>
  9. 9. Triage Practices <ul><li>Traditional </li></ul><ul><ul><li>Scoop and run </li></ul></ul><ul><ul><li>Designed to work within existing EMS </li></ul></ul><ul><li>Disaster </li></ul><ul><ul><li>Secondary exam and treatment performed </li></ul></ul><ul><ul><li>Assumes nonfunctional EMS system </li></ul></ul>
  10. 10. Triage Practices <ul><li>Traditional </li></ul><ul><ul><li>Used for localized disaster scenes </li></ul></ul><ul><ul><li>Dependent on communications and transportation </li></ul></ul><ul><li>Disaster </li></ul><ul><ul><li>Used for wide-spread disaster scenes </li></ul></ul><ul><ul><li>Does not depend on communication and less on transportation </li></ul></ul>
  11. 11. Patient Categories <ul><li>1. Those who will die no matter what </li></ul><ul><li>2. Those who will do well no matter what we do </li></ul><ul><li>Those who will derive long-term benefit from acute intervention </li></ul><ul><li>Early identification of #3 important </li></ul><ul><ul><li>Others benefit from comfort care </li></ul></ul>
  12. 12. START Triage <ul><li>Simple Triage and Rapid Treatment </li></ul><ul><li>Designed to be performed by first responders (paramedics) </li></ul><ul><li>Assumes personnel under a great deal of stress </li></ul>
  13. 13. START Triage <ul><li>Rapid method to perform INITIAL triage </li></ul><ul><li>Utilizes respiratory rate, palpable pulse, and mental status (ability to follow commands) </li></ul><ul><li>Begins by asking all that can walk to move away from triage officer </li></ul><ul><li>Assess using START those that remain </li></ul>
  14. 14. START Triage <ul><li>GREEN: those who are able to get up and walk away </li></ul><ul><li>RED: those with respiratory compromise (require airway assistance or have a respiratory rate  30), no palpable pulse at the wrist (but are breathing), or unable to follow commands </li></ul><ul><li>YELLOW: those who are not red but can’t walk </li></ul><ul><li>BLACK: dead </li></ul>
  15. 15. Modified START
  16. 16. SAVE Triage <ul><li>Secondary Assessment of Victim Endpoint </li></ul><ul><li>All patients with at least a 50% chance of survival using available resources get care </li></ul><ul><ul><li>Patient assessed by SAVE methodology in order of priority determined by START </li></ul></ul>
  17. 17. SAVE Triage <ul><li>Benefit Value = ———— X Probability of survival Resources required </li></ul>
  18. 19. SAVE Triage Areas of Assessment <ul><li>Vital Signs </li></ul><ul><li>Airway </li></ul><ul><li>Chest </li></ul><ul><li>Abdomen </li></ul><ul><li>Pelvis </li></ul><ul><li>Spine </li></ul><ul><li>Extremities </li></ul><ul><li>Skin </li></ul><ul><li>Neurologic Status </li></ul><ul><li>Mental Status </li></ul>
  19. 20. SAVE Triage Categories <ul><li>RED: require immediate intervention </li></ul><ul><li>YELLOW: require intervention but can tolerate a brief delay </li></ul><ul><li>GREEN: do not require intervention to prevent loss of life or limb </li></ul><ul><li>BLACK: dead or unsalvageable </li></ul>
  20. 21. SAVE Triage Categories <ul><li>Periodic assessment of all categories is important </li></ul><ul><li>Patients may move from one area to another </li></ul>
  21. 22. SAVE Triage Guidelines <ul><li>Crush Injury to Lower Extremity </li></ul><ul><ul><li>Patients are assessed using the MESS score </li></ul></ul><ul><ul><li>Score of 7 or more: amputate </li></ul></ul><ul><ul><li>Score less than 7: attempt limb salvage </li></ul></ul>
  22. 23. SAVE Triage Guidelines <ul><li>Head Injury (adults) </li></ul><ul><ul><li>Use the Glascow Coma Score (GCS) </li></ul></ul><ul><ul><li>Score 8 or above: treat </li></ul></ul><ul><ul><ul><li>Better than 50% chance of a normal or good neurologic recovery </li></ul></ul></ul><ul><ul><li>Score 7 or less: comfort care only </li></ul></ul>
  23. 24. SAVE Triage Guidelines <ul><li>Burn Injury: less than 50% chance of survival </li></ul><ul><ul><li>70% TBSA burn </li></ul></ul><ul><ul><li>Age > 60 with inhalational injury </li></ul></ul><ul><ul><li>Age < 2 with 50% TBSA burn </li></ul></ul><ul><ul><li>Age > 60 with 35% TBSA burn </li></ul></ul><ul><li>Comfort care only </li></ul>
  24. 25. SAVE Triage Guidelines <ul><li>Abdominal Injury </li></ul><ul><ul><li>No data to guide evaluation </li></ul></ul><ul><ul><li>4 ml/kg hypertonic saline X 2 </li></ul></ul><ul><ul><li>If no response, comfort care only </li></ul></ul><ul><ul><li>Role of handheld ultrasound? </li></ul></ul>
  25. 26. Initial Assessment: START Case #1 <ul><li>61 year old male pulled from smoking building. Complaining of shortness of breath. </li></ul><ul><li>RR =28 </li></ul><ul><li>Wrist Pulse: palpable </li></ul><ul><li>Mental Status: follows commands </li></ul><ul><li>START Category: yellow (delayed) </li></ul><ul><li>Treatment: nothing </li></ul>
  26. 27. Initial Assessment: START Case #2 <ul><li>30 year old male found with bleeding head wound </li></ul><ul><li>RR =22 </li></ul><ul><li>Wrist Pulse: palpable </li></ul><ul><li>Mental Status: unresponsive </li></ul><ul><li>START Category: red (immediate) </li></ul><ul><li>Treatment: apply pressure to stop bleeding </li></ul>
  27. 28. Initial Assessment: START Case #3 <ul><li>20 year old female complaining of crushed lower extremity </li></ul><ul><li>RR =20 </li></ul><ul><li>Wrist Pulse: palpable </li></ul><ul><li>Mental Status: follows commands </li></ul><ul><li>START Category: yellow (delayed) </li></ul><ul><li>Treatment: nothing </li></ul>
  28. 29. Initial Assessment: START Case #4 <ul><li>3 year old female found not breathing </li></ul><ul><li>RR =agonal </li></ul><ul><li>Wrist Pulse: palpable </li></ul><ul><li>Mental Status: unresponsive </li></ul><ul><ul><li>Open airway and give 15 seconds of ventilation. No change in respirations. </li></ul></ul><ul><li>START Category: black (dead) </li></ul>
  29. 30. Secondary Assessment: SAVE Case #2 <ul><li>30 year old male found with bleeding head wound </li></ul><ul><li>START Category: red (immediate) </li></ul><ul><li>EXAM: neurologic status </li></ul><ul><ul><li>Does not open eyes, does not speak, and withdraws to pain </li></ul></ul><ul><ul><li>GCS = 6 </li></ul></ul><ul><li>SAVE Category: black (unsalvageable) </li></ul>
  30. 31. Secondary Assessment: SAVE Case #1 <ul><li>61 year old male pulled from smoking building. Complaining of shortness of breath. </li></ul><ul><li>START Category: yellow (delayed) </li></ul><ul><li>EXAM: airway </li></ul><ul><ul><li>Singed nasal hairs and eyebrows. Coughing up carbonaceous material. Wheezing. No skin burns </li></ul></ul><ul><li>SAVE Category: black (unsalvageable) </li></ul>
  31. 32. Secondary Assessment: SAVE Case #3 <ul><li>20 year old female complaining of crushed lower extremity </li></ul><ul><li>START Category: yellow (delayed) </li></ul><ul><li>EXAM: extremities </li></ul><ul><ul><li>Crushed left leg. Massive tissue avulsion and hemorrhage. Limb numb. Patient is pale. </li></ul></ul><ul><ul><li>MESS = 8 or 9 </li></ul></ul><ul><li>SAVE Category: red (immediate) </li></ul>
  • SriLankaTours1

    Apr. 3, 2021
  • nurulkhaliesahishak

    Dec. 9, 2020
  • SusanAhas

    Sep. 15, 2020
  • JitrchanapatRaveevutthichoak

    Jul. 26, 2020
  • AhmedFarhan28

    Jul. 9, 2020
  • CircuitDixit

    Jul. 3, 2020
  • komolicasolanki

    Jun. 30, 2020
  • HemaChandru2

    Jun. 8, 2020
  • PremP8

    Apr. 3, 2020
  • RickyDemonChen

    Dec. 1, 2019
  • ShenseeTorres

    Oct. 17, 2019
  • ManaviDeshani

    Aug. 12, 2019
  • ZawHeinHtet1

    Aug. 5, 2019
  • PavankumarCampli

    Jul. 30, 2019
  • TawseefHameed

    Jun. 25, 2019
  • RahulBaravkar

    May. 19, 2019
  • cocodrilo1127

    Apr. 12, 2019
  • sarathong96

    Mar. 10, 2019
  • FaresAlharbi6

    Mar. 8, 2019
  • JavedIqbal138

    Feb. 16, 2019

Review of START and SAVE triage

Views

Total views

37,823

On Slideshare

0

From embeds

0

Number of embeds

143

Actions

Downloads

2,080

Shares

0

Comments

0

Likes

59

×