Instructor Guide. Triage Tags Aide Bags Blankets 5 patients cue cards for the patients attached in Appendix B

Transcription

1 Instructor Guide Title: START and JumpStart Time: 2 hours Materials: Triage Tags Aide Bags Blankets 5 patients cue cards for the patients attached in Appendix B Motivation: Familiarity with the START and JumpStart triage paradigms are essential to quick and efficient response to mass casualty incidents. Student Performance Objective: Given lecture, discussion and practical the students will be able to apply the concepts of START Triage. Enabling Objectives: Define triage Define START and JumpStart Determine when triage is necessary/what is an MCI Assess patients in a mock MCI I. Definitions a. Triage i. The assignment of urgency of medical needs or illnesses when there s a large number of patients ii. Assign degrees of urgency to the wounded or ill b. START i. Adults Only - Simple Treatment and Rapid Transport ii. Developed by Hoag Hospital and Newport Beach Fire Department in California in 1983 after several earthquakes iii. Four colors 1. Green walking wounded 2. Black - deceased 3. Red immediate treatment necessary 4. Yellow delayed treatment iv. RPM-30-2-Can Do 1. Patients that have RPM 30-2-Can Do will be considered immediate 2. Respiratory rate above Pulseless or Capillary refill over 2 seconds 4. Can follow simple commands or not c. JumpStart Pediatric Patients

2 II. i. Per MD Protocol pediatric patients are considered patients who have not reached their 15th Birthday ii. Developed by Dr. Lou Romig a disaster physician in Florida iii. Four Colors a. Green walking wounded b. Black deceases c. Red immediate treatment necessary d. Yellow delayed iv. <15 or >45 1. Patients that have less than 15 breaths or more than 45 breaths per minute are considered immediate 2. This only applies to pediatric patients When is triage necessary a. Per Maryland Medical Protocol b. When an MCI is declared by the local jurisdiction c. Mass Casualty/Multi-casualty incident occurs when the number of victims exceeds the number of medical personnel or resources immediately available and declared by the local jurisdiction d. Examples: i. More than 5 patients from one or related incidents ii. Multi-patient events that require specialized rescue iii. Three or more immediate Priority 1 patients iv. Multiple pediatric patients requiring specialized resources v. One or more burn patient meeting the burn center criteria vi. The use of two helicopters vii. The use of a Medical Ambulance Bus viii. Multiple patients with unusual signs and symptoms ix. Unresolved WMD incident x. Decontamination of more than 5 patients resulting in at least 1 transport xi. Unresolved hazardous materials incident that has the potential to affect multiple patients xii. Evacuation of licensed health care facility or housing complex for individuals requiring special assistance e. Procedures for after declaration of an MCI i. Initiate local SOPs/SOGs and local protocol ii. Notify EMRC as early in the incident as possible a. Use specific language b. Be very clear that the MCI protocol is being enacted iii. As soon as available the following should be communicated to EMRC 1. Type and general description of the incident 2. General location or address of the incident 3. Age range of patients 4. Estimated number of patients by priority 5. Approximate number of patients involved

3 III. IV. 6. Any hazardous agents involved Assessment a. Can you hear me? Can you walk? i. These patients are considered green ii. Move them to a secondary location for treatment by other providers b. Is the patient breathing i. No a. Reposition the airway 1 time b. Yes move to the next question what is the rate of breathing c. DO NOT ATTEMPT a second repositioning of the airway d. If the patient is still not breathing apply the BLACK triage tag ii. Yes 1. What is the rate a. Above 30 for adult patient RED TAG b. Less than 15 more than 45 for a pediatric patient RED TAG 2. If the patient s breathing is within guidelines move to the next question c. Assess perfusion i. Capillary Refill for adults greater than 2 seconds apply a RED TAG ii. If the pediatric patient has no palpable pulse apply a RED TAG iii. If perfusion is accurate move on to mental status d. Mental Status i. Adult patients that do not obey verbal commands and pediatric patients that have inappropriate actions for the A, V, and P on the AVPU chart RED TAG ii. Adult patients that obey verbal commands or Pediatric patients that have appropriate A,V, P on the AVPU chart can be a YELLOW TAG Patient Assessment Scenario/Mock MCI

4 Appendix A These scenarios are written to be used as your department deems necessary. If you have chief officers, have them assume the role of the incident commander. They should use the ICS structure to then set up the groups as necessary and involve multiple teams to assess the patients. Use these as a guideline to take these incidents as in depth as your department would like. Mock MCI Scenario 1 You are responding to a soccer game in September on an unusually hot day. There is a report of 20 patients who are experiencing signs and symptoms of heat exhaustion. You arrive on scene to find several patients laying in the grass behind the bleachers. Mock MCI Scenario 2 You are responding to a suspected hazardous materials incident at a high school with known illnesses near the Chemistry classes. The hazardous materials team is already in place at the school and decontaminating the students and teachers. You arrive on scene to find students rushing out of the school towards the decontamination area and some of them collapsing as they reach a cold zone area across the street.

5 Appendix B Patient Programming Notes These are to be given to the patients but not given to the EMS providers. Mock MCI Scenario 1 Patient 1 Laying on the ground, 25 year old male, diaphoretic, lethargic but responds to verbal commands, complains of nausea, rapid pulse, respirations of 24 Patient 2 Laying in the middle of the soccer field, 27 year old male, extremely warm skin, no sweat, unresponsive but breathing 32 times per minute, Patient 3 Sitting on the sideline, 13 year old female, complaining of cramps, sweating, skin is cool, breathing is 15 times a minute, patient is completely responsive and can move on her own Patient 4 Passed out by the tree next to the field, 40 year old female, unresponsive, not breathing, skin is hot. Patient 5 Sitting on the sideline, 10 year old male, diaphoretic, responds to verbal commands but cannot stand on his own, breathing 20 times per minute, Mock MCI Scenario 2 (the patients have left the decontamination area) Patient 1 16 year old male, breathing 12 times per minute, unresponsive, mucus coming from the nose Patient 2 14 year old female, breathing 14 times per minute, skin is flushed, mucus coming from the nose Patient 3 30 year old male, wheezing, responds to verbal commands, unknown respirations per minute due to wheezing, mucus coming from the nose and mouth Patient 4 15 year old female, unresponsive, not breathing, blood coming from the nose and mouth Patient 5 16 year old female, coughing profusely, cannot take a true respiration, cyanotic, thick green mucus coming from the nose and mouth