“Preparing Our Communities”

1. “Preparing Our Communities” Welcome!

2. Faculty Disclosure • For Continuing Medical Education (CME) purposes as required by the American Medical Association (AMA) and other continuing education credit authorizing organizations: • In order to assure the highest quality of CME programming, the AMA requires that faculty disclose any information relating to a conflict of interest or potential conflict of interest prior to the start of an educational activity. • The teaching faculty for the BDLS course offered today have no relationships / affiliations relating to a possible conflict of interest to disclose. Nor will there be any discussion of off label usage during this course.

3. Chapter 1bSALT Triage(Sort, Assess, Life-Saving, Treatment/Transport Triage)

4. Objectives • Describe the S.A.L.T. Triage method • Describe the steps to perform S.A.L.T Triage • Describe the Life Saving Interventions that are performed in in S.A.L.T. Triage • List the Triage Categories as defined in S.A.L.T. Triage. • Describe injuries that would place a patient in each triage category

5. What is Triage? • French verb “trier” = to sort • Assign priorities when resources limited • Do the greatest good for the greatest number Source: DoD Photo Library, Public Domain

6. What’s Unique About Disaster Triage? • Number of patients • Infrastructure limitations • Limited providers • Limited equipment • Limited transport capabilities • Hospital resources overwhelmed • Scene hazards • Threats to providers • Decontamination issues • Multiple agencies responding

7. SALT Triage • Simple • Easy to remember • Groups large numbers of patients together quickly • Applies rapid life-saving interventions early

9. STEP 1: Global Sorting • Priority 1: Still/Obvious life threat • Priority 2: Wave/Purposeful movement • Priority 3: Walk

10. Global Sorting: Action 1 • Action: • “Everyone who can hear me and needs help, move to [designated area]” • Use loud speaker if available • Goal: • Group ambulatory patients using voice commands • Result: • Those who follow this command - last priority for individual assessment

11. Global Sorting: Action 2 • Action: • “If you need help, wave your arm or move your leg and we will be there to help you in a few minutes” • Goal: • Identify non-ambulatory patients who can follow commands or make purposeful movements • Result: • Those who follow this command - second priority for individual assessment

12. Global Sorting Result • Casualties are now prioritized for individual assessment • Priority 1: Still, and those with obvious hemorrhage • Priority 2: Waving • Priority 3: Walking

13. Step 2: Individual Assessment • Provide Life Saving Interventions • Controlling major hemorrhage • Opening airway if not breathing • If child, consider giving 2 rescue breaths • Chest needle decompression • Auto injector antidotes

14. S.A.L.T. Triage Categories • Immediate • Delayed • Minimal • Expectant • Dead

15. Immediate • Serious injuries • Immediately life threatening problems • High potential for survival. • Examples • Tension pneumothorax • Nerve agent exposed patient • severe shortness of breath or seizures Photo Source: www.swsahs.nsw.gov.au Public Domain

16. Serious injuries require care but management can be delayed without increasing morbidity or mortality. Examples Long bone fractures neuro-vascular intact 40% BSA exposure to Mustard Delayed Photo Source: Phillip L. Coule, MD

17. Minimal • Injuries- require minor care or no care without adverse affect. • Examples • Abrasions • Minor lacerations • Nerve agent exposure with mild rhinorrhea Photo source: Phillip L. Coule, MD

18. Expectant • Important for preservation of resources • DOES NOT MEAN DEAD! • Should receive comfort care or resuscitation when resources are available • Serious injuries • very poor survivability even with maximal care in the hospital or pre-hospital setting. • Examples • 90% BSA burn • Multiple trauma with exposed brain matter • Severe traumatic brain injury with herniation

19. Dead Patients • Tag dead patients to prevent re-triage • Do not move • Except to obtain access to live patients • Avoid destruction of evidence

21. After Patients are Categorized • Prioritization process is dynamic • Changing patient conditions • Changing resources • Scene safety. • After immediate patients have been cared for • Expectant, delayed, or minimal patients should be re-assessed • Some patients will have improved and others will have decompensated

22. Treatment/Transport Priority • Treatment and/or transport should be provided for immediate patients first • Then delayed • Then minimal • Expectant patients should be provided with treatment and/or transport when resources permit • Efficient use of transport assets may include mixing categories of patients and using alternate forms of transport

23. Patient #1 • 63 y/o male, prone, unresponsive • Burns on extremities • Did not move at “walk/wave” phase

24. Patient #2 • 42 y/o female • Walks to safety when instructed • No bleeding, normal pulses, normal breathing

25. Patient #3 • 17 y/o male, lying supine, waving for help • Breathing well, follows commands • Normal vital signs • Can’t get up due to back pain and leg weakness

26. Patient #4 • 26 y/o male, unresponsive • Contusions on head • Good pulses, HR 104, RR 12

27. Patient #5 • 52 y/o female, unresponsive • Breathes when airway opened – needs to have airway maintained manually • Bleeding heavily from abdominal injury • RR 8, HR 124

28. Questions?