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Triage Principles and Pressures in Conflict & Catastrophe Situations

Explore the concept of triage, its application in trauma care, different triage systems, and the dangers of under and over triage. Learn how to prioritize patients for treatment and transport efficiently in conflict and catastrophe situations. Discover the principles of care and shared approaches in managing triage. Associated reading materials available for further insight.

judithhollingsworth
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Triage Principles and Pressures in Conflict & Catastrophe Situations

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  1. Centre for Trauma, Conflict & CatastropheJim Ryan

  2. Conflict & Catastrophe Course Society of Apothecaries 6 October 2018 Triage – Principles & Pressures

  3. Learning Objectives • To define triage • To see where triage fits into the care pathway of the trauma victim • To differentiate between the 3 triage systems in use • To understand triage in action • To recognise the danger of under and over triage

  4. Associated Reading • Chapter 29 – Course Handbook, Part B Trauma & Triage 418-420 • Triage – Principles & Pressures – JM Ryan Eur J Trauma & Dis Med, 2008;34:427-432

  5. Triage, derived from the French verb trier, and is the process by which treatment and transport priorities are allocated to patients

  6. Jean DominiqueLarrey Surgeon to Napolean’s Imperial Guard

  7. The aim of triage is to get the right patients to the right care in the right way at the right time

  8. Principles of care – conflict & catastrophe Shared care – Time & place Triage – for resus, surgery & evac Forward surgery – cannot wait! The wound operation is staged First - wound excision – then DPS (C) Ist op at 2nd or 3rd Role

  9. Pressures Time factor Early access Minimalist approach at scene Accurate triage Rapid transport Stop the bleeding – changing role of IV fluids

  10. Triage Systems Physiological Anatomical Both

  11. Triage - Variants Resuscitation Triage Surgical Triage Transfer (Evacuation) Triage

  12. Triage Systems

  13. Multiple casualties Mass casualties

  14. P Table P1 Immediate priority P2 Second priority P3 Delayed treatment Cannot wait Urgent but can be stabilised for a time (30-60 mins) Can tolerate long delay

  15. T Table T1 Immediate T2 Urgent T3 Non urgent T4 Expectant Rapid treatment possible & good prognosis for survival Severe injuries but can wait (30/60 mins) Minor injury & can tolerate indefinite wait Severe multisystem injury, time consuming, prognosis?

  16. Triage – Time & PlaceDifferent Environments

  17. Majax - Environment Primary triage outside Circuits Avoid ‘contamination’ Flexibility

  18. Triage & Documentation

  19. Triage in UK – Method in Outline Sieve Sort Manage Move Hospital triage Management by priority Evacuation triage

  20. Triage Y PRIORITY 3(delayed) WALKING N N BREATHING DEAD After airway opening Y < 10 > 30 RESPIRATORYRATE PRIORITY 1(immediate) 10 to 29  2 sec < 2 sec CAPILLARYREFILL PRIORITY 2(urgent)

  21. Triage Undertriage Overtriage

  22. Training & Exercises

  23. Summary The most for the most Multi-system injury Combined injury Resuscitative surgery Didactic approach Shared care

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