long quiz 1

• Scene size-up is a multifaceted process that occurs before and immediately upon arrival at the scene, prior to executing any other activities. The purpose is to expeditiously ensure that there is a safe scene on which to provide care, and that the proper resources are summoned to the scene according to the number of patients and their specific needs.
• Mass casualty incident (MCI) is defined as “an event that overwhelms the local healthcare system, where the number of casualties vastly exceeds the local resources and capabilities in a short period of time.”
• TRIAGE is a process which “places that right patient in the right place at the right time to receive the right level of care” (Rice & Abel. 1992)
• 3 TYPES OF TRIAGE

  1. PRIMARY
  2. SECONDARY
  3. TERTIARY
• Primary

  Performed at the first encounter with the patient

  May be done by EMS, first responders, or hospital staff
• Secondary

  Re-evaluation of primary triage after additional assessment and/or Intervention

  Often used at the hospital to prioritize patients for operative care or advances studies
• Tertiary

  Performed during ongoing definitive care

  Patients may arrive on foot or via non-EMS transport and require primary triage at the hospital
• Personal Abilities of an Effective Triage Officer

  1. Clinically experienced
  2. Good judgement and leadership
  3. Calm and cool under stress
  4. Decisive
  5. Knowledgeable of available resources
  6. Sense of humor
  7. Creative problem solver
  8. Available
  9. Experienced and knowledgeable regarding anticipated casualties
• DAILY TRIAGE

  It is performed by nurses on a routine basis in the ED, often utilizing a standardized approach, augmented by clinical judgment.
• INCIDENT TRIAGE

  It occurs when the ED is stressed by a large number of patients due to an acute incident or an ongoing medical crisis, but is still able to provide care to all patients utilizing existing agency resources
• DISASTER TRIAGE

  It is a general term employed when local EMS and hospital emergency services are overwhelmed to the point that immediate care cannot be provided to everyone who needs it because sufficient resources are not immediately available.
• SIMPLE TRIAGE AND RAPID TRIAGE (START)

  Is a triage method used by first respondents to quickly classify victims during a mass casualty incident (MCI) based on the severity of their injury. By using this, patients are sorted based on objective criteria on how they present. The severity of the injury and therefore treatment and/or transport priority is sorted by color code.
• The most basic way to use the START classification is to transport the victims in a fixed-priority manner:

  immediate victims

  delayed victims

  walking wounded.
• FOUR COLOR CODED TRIAGE SYSTEM

  Immediate/Emergent (Class I): Tagged as RED

  Delayed/Urgent (Class II): Tagged as YELLOW

  Minimal or minor/Non-Urgent (Class III): Tagged as GREEN

  Deceased/Expectant (Class IV): Tagged as BLACK
• Immediate/Emergent (Class I): Tagged as RED

  ● These are patients with uncompensated physiology and injuries that are life-threatening but probably amenable to rapid interventions

  ● These patients may die or sustain significant morbidity unless they receive rapid care in both the field and the hospital.
• Delayed/Urgent (Class II): Tagged as YELLOW

  ● These are patients with compensated physiology but significant potential for deterioration or morbidity if there are long delays before definitive care can be provided
• Minimal or minor/Non-Urgent (Class III): Tagged as GREEN

  ● These are patients who are physiologically well compensated and likely to remain so for an extended period of time.
• Deceased/Expectant (Class IV): Tagged as BLACK

  ● Those with no detectable vital signs, typically identified as victims not breathing
• JumpSTART TRIAGE

  pediatric version of START

  This triage tool is designed for children 1-8 years old

  Children should be reassessed frequently for changes in condition
• Considerations during Pediatric Triage

  1. Anatomic Differences: Size / Structure
  2. Physiologic Differences
  3. Immunologic Differences: Immature immune system
  4. Developmental Differences
• Modifications

  1. Rapid AVPU assessment for pediatric behavior instead of adult behavior
  2. Babies <12 months old are marked IMMEDIATE for highest priority of care
• SALT TRIAGE

  ● SORT based on whether victim can walk, wave or is still

  ● ASSESS complete an individual assessment to determine need for any life saving intervention

  ● LIFESAVING INTERVENTIONS such as control hemorrhage, open airway and follow algorithm

  ● TREATMENT and/or TRANSPORT
• JumpSTART TRIAGE Objectives

  • Optimize initial triage of children in the MCI setting
  • Enhance the effectiveness of resource allocation for all MCI victims
  • Reduce emotional burden on personnel assigned to initial the triage of children
• SYSTEMATIC ASSESSMENT

  The process use to identify life-threatening condition.

  Assessment concentrating on Level of Consciousness, Cervical Spinal Stabilization, Airway, Breathing, and Circulation. You will also be forming a General Impression of the patient to determine the priority of care based on your immediate assessment and determining if the patient is a medical or trauma patient.
• Patient identification is the process of "correctly matching a patient to appropriately intended interventions and communicating information about the patient's identity accurately and reliably throughout the continuum of care.
• PRIMARY SURVEY

  Focuses on airway, breathing, circulation and disability and serves to identify life- threatening condition so that appropriate interventions can be initiated
• Physical Assessment

  ● A structured physical examination allows the nurse to obtain a complete assessment of the patient.

  ● Observation/inspection, palpation, percussion and auscultation are techniques used to gather information