Disaster scene set up and field triaging

1. Disaster and Field Triaging
Dr Selvendra

2. Disaster
• Incident that occurs in a sudden manner,
complex in nature, resulting in the loss of
lives, damages to the property or the
environment as well as affecting the daily
activities of the community
• Requires the handling of resources,
equipment, and manpower from various
agencies as well as effective coordination.
• Involves complex action, long period of
duration

3. TYPES OF DISASTERS
• Natural disaster e.g. flood,landslide
• Industrial disaster e.g. fire
• Accidents of dangerous/hazardous material
• Collapse of high rise buildings
• Aviation accidents in public places
• Railway accidents
• Major fire incident
• Collapse of hydroelectric dam
• Nuclear and radiological accidents
• Release of toxic gas in public places
• Air and environmental disasters e.g. haze

4. Disaster management in Malaysia
• Majlis Keselamatan Negara Directive 20
• NSC formed Disaster Management and
Relief Council
• Its aim is to coordinate disaster
management at 3 levels – District,
State, and Federal

5. Agencies Involved in Disaster
• PDRM
• Tentera Diraja Malaysia
• Special Malaysia Disaster Assistance and Rescue
Team (SMART)
• Jabatan Kajicuaca
• Jabatan Pengairan dan Saliran
• Jabatan Kerja Raya
• Jabatan Kebajikan
• NGO e.g. PBSM, St. John Ambulance
• JPAM
• International cooperation

6. HIGHLAND TOWERS
TRAGEDY 1993

7. TRIPLE TEN BUS ACCIDENT MAYHEM..
ON THE 10TH.10.10.. AT SIMPANG AMPAT,
AYER KEROH,
NORTH SOUTH HIGHWAY

8. THE GENTING TOURIST BUS ACCIDENT ~ THE GROUND ZERO

9. Tsunami 2004

14. YET ANOTHER BUS ACCIDENT WITHIN ONE
MONTH FOR GENTING BOUND PASSENGERS ~
sept 2013

16. Field Triage

17. Definition of Triage
• the process of deciding which patients
should be treated first based on how sick
or seriously injured they are.

18. Goal of Multicasualty Triage
“To do the best for the most
with the least.”

19. START
(Simple Triage And Rapid Treatment)
Triaging < 15s

20. START
• Triage categories:
– Green (ambulatory)
– Red (immediate)
– Yellow (delayed)
– Black (dead or
nonsalvageable)
• Components of
Assessment
– Ambulation
– Respirations
– Perfusion
– Mental status

21. START Triage
RESPIRATIONS
NO
YES
Position Airway
NO YES
Non-salvageable
Immediate
Over 30/min
Immediate
Under 30/min
PERFUSION
Radial Pulse
Absent
Control
Bleeding
Immediate
Radial Pulse
Present
MENTAL
STATUS
Failure to follow
simple commands
Can follow
simple commands
Immediate Delayed

22. JumpSTART
• For pediatric age group
• Reduce over and under triaging
• Achievable in 15s

23. The JumpSTART Field Pediatric Multicasualty Triage System ©
(Patients aged 1- 8 years)
Black = Deceased/expectant
Red = Immediate
Yellow = Delayed
Green = Minor/Ambulatory
Identify and direct all ambulatory patients to designated
Green area for secondary triage and treatment. Begin
assessment of nonambulatory patients as you come to them.
Proceed as below:
Spontaneous respirations?
NO
Open airway
Spontaneous respirations?
YES
IMMEDIATE
NO
DECEASED
YES
NO
Peripheral pulse?
YES
Perform 15 sec.
Mouth to Mask
Ventilations
Spontaneous respirations?
YES
IMMEDIATE
NO
DECEASED
Check resp. rate
< 15/min
or
> 40/min
or irregular
IMMEDIATE
15 - 40/ min,
regular
Peripheral pulse?
NO
IMMEDIATE
YES
Check mental status
(AVPU)
AVP
(appropriate)
DELAYED
P (inappropriate)
U
IMMEDIATE
MINOR
© Lou Romig MD, FAAP, FACEP, 1995

24. JumpSTART: Breathing?
• If breathing spontaneously, go on to the
next step, assessing respiratory rate.
• If apneic or with very irregular breathing,
open the airway using standard positioning
techniques.
• If positioning results in resumption of
spontaneous respirations, tag the patient
immediate and move on.

25. JumpSTART: Respiratory Rate
• If respiratory rate is 15-40/min (roughly
one breath every 2-4 seconds),
proceed to assess perfusion.
• If respiratory rate is <15 or >40/min
(slower than one breath every four
seconds or faster than one breath
every 2 seconds) or irregular, tag
patient as immediate and move on.

26. JumpSTART:Perfusion
• If peripheral pulse is palpable, proceed
to assess mental status.
• If no peripheral pulse is present (in the
least injured limb), tag patient
immediate and move on.

27. JumpSTART: Mental Status
• Use AVPU scale to assess mental status.
• If Alert, responsive to Verbal, or
appropriately responsive to Pain, tag as
delayed and move on.
• If inappropriately responsive to Pain or
Unresponsive, tag as immediate and move
on.

28. ThIef n“oJ burmeapthsintag ratf”t ePr aairrtway opening, check
for peripheral pulse. If no pulse, tag patient
deceased/nonsalvageable and move on.
 If there is a peripheral pulse, give 15 sec of
Mouth to Mask ventilations (about 5 breaths).
If apnea persists, tag patient
deceased/nonsalvageable and move on.
• If breathing resumes after the “jumpstart”, tag
patient immediate and move on.

29. START/JumpSTART:
Differences
• Apneic children are rapidly assessed for
sustained circulation.
• Apneic children with circulation receive a
brief ventilatory trial as an additional airway
opening and stimulating maneuver.
• Respiratory rates are adjusted.
• Peripheral pulse is substituted for cap. refill.
This is now done in START too.
• AVPU is used to assess mental status.