Triage in Mass Casualties

Triage Fundamentals - First Steps First

• Definition: From French "trier" (to sort); systematic process of prioritizing casualties in Mass Casualty Incidents (MCIs) based on injury severity, urgency, and survivability.
• Primary Goal: "Do the greatest good for the greatest number" by efficiently allocating limited resources.
• Key Principles:
  • Rapid assessment & categorization.
  • Treat salvageable, life-threatening injuries first.
  • Dynamic & continuous (re-triage).
  • Simple, reproducible, quick.

⭐ In Mass Casualty Incidents, the most experienced medical personnel should ideally perform triage to ensure optimal resource allocation and decision-making under pressure.

Triage Categories & START - Code Red, Action Go!

Triage sorts casualties by urgency of treatment. Goal: "Do the greatest good for the greatest number."

• Triage Categories (Color Codes):
  • 🔴 RED (Immediate/P1): Life-threatening, salvageable. E.g., Airway compromise, severe hemorrhage, shock.
  • 🟡 YELLOW (Delayed/P2): Serious injuries, can wait hours. E.g., Major fractures, moderate burns (without airway issues).
  • 🟢 GREEN (Minor/P3): "Walking wounded." E.g., Minor lacerations, abrasions.
  • ⚫ BLACK (Expectant/Deceased/P0): Dead or unsalvageable. E.g., Apnea after airway opening, massive brain injury.

START Algorithm (Simple Triage And Rapid Treatment): For adults. Assesses Respirations, Perfusion, Mental Status (📌 RPM).

• Step 1: Walking?
  • Yes → 🟢 GREEN.
  • No → Proceed to Step 2 (Assess RPM).
• Step 2: Respirations (R):
  • Absent? → Open airway.
    • Still absent? → ⚫ BLACK.
    • Spontaneous breathing resumes? → 🔴 RED.
  • Rate > 30/min or < 10/min? → 🔴 RED.
  • Rate 10-30/min? → Proceed to Step 3.
• Step 3: Perfusion (P):
  • Capillary Refill Time (CRT) > 2 sec OR absent radial pulse? → 🔴 RED (Control major bleeding!).
  • CRT ≤ 2 sec AND radial pulse present? → Proceed to Step 4.
• Step 4: Mental Status (M):
  • Cannot follow simple commands? → 🔴 RED.
  • Can follow simple commands? → 🟡 YELLOW.

⭐ In START triage, if an adult patient is apneic, opening the airway is the only initial treatment. If breathing does not resume spontaneously after this maneuver, they are tagged BLACK.

Triage in Action & Nuances - Tag, Track, Treat

• Tagging: Standardized color tags (Red, Yellow, Green, Black).
  • Securely attached, clearly visible.
  • Record: ID, vitals, injuries, initial treatment.
• Tracking: Maintain casualty log.
  • For accountability & communication.
  • Prevents loss to follow-up.
• Treat (Initial Stabilization):
  • Focus: Life-Saving Interventions (LSIs) - ABCs.
  • Control major hemorrhage.
  • Stabilize for transport; no on-site definitive care.
• Important Nuances:
  • Dynamic Process: Re-triage vital: conditions change.
  • Special Populations:
    • Children: JumpSTART (<8 yrs/<45kg) or Pediatric Triage Tape (PTT).
    • Pregnant: Prioritize mother for fetal survival.
  • Minimize over-triage (resource strain) & under-triage (↑ mortality).

⭐ In pediatric triage (e.g., JumpSTART), if a child is apneic with a pulse, 5 rescue breaths are given; if breathing starts, tag RED. If not, tag BLACK.

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High‑Yield Points - ⚡ Biggest Takeaways

• Triage goal: Maximum good for the maximum number in mass casualties.
• START Triage uses RPM: Respirations (>30/min), Perfusion (Cap Refill >2s), Mental Status (cannot obey commands).
• Red (Immediate): Life-threatening, high survival with prompt care (e.g., shock).
• Yellow (Delayed): Serious injuries, can wait hours (e.g., stable fractures).
• Green (Minor): "Walking wounded," minor injuries (e.g., minor cuts).
• Black (Expectant): Deceased or unsurvivable (e.g., apneic after airway opening).
• Re-triage is crucial as conditions change.