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MASS Triage

MASS Triage. Chapter 1 Part B. Objectives. Define disaster triage List components of MASS triage Discuss importance and utilization of triage tags Identify victim triage categories for simulated triage scenario . Triage System Types.

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MASS Triage

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  1. MASS Triage Chapter 1 Part B

  2. Objectives • Define disaster triage • List components of MASS triage • Discuss importance and utilization of triage tags • Identify victim triage categories for simulated triage scenario

  3. Triage System Types Triage systems “sort” patients for a variety of purposes and situations: • Military Triage • Emergency Department Triage • Disaster Triage

  4. Disaster Triage • Sorting patients by the seriousness of their condition and the likelihood of their survival • To achieve the greatest good for the greatest number possible • Dependent on resourcesavailable

  5. Disaster Triage Factors impacting available resources: • Volume and severity of patients • Limited providers • Infrastructure limitations • Inadequate hazard preparation (HAZMAT, etc.) • Limited transport capabilities • Multiple agencies responding • Hospital Resources Overwhelmed

  6. Disaster Triage Methods used must be: • Simple • Effective • Easily remembered • Able to sort large numbers of patients quickly

  7. Disaster Triage Key Principles: • Life, Limb or Vision Threat • Medical Intervention Needed • Transportation Access

  8. Disaster Triage • How do I identify the most injured victims quickly? • How do I get ambulatory or least injured victims out of the dangerous scene quickly?

  9. D-I-S-A-S-T-E-R ParadigmTriage Triage Categories: • “ID-me”! “Identify Me” • A mnemonic for sorting patients during triage I – Immediate D – Delayed M – Minimal E – Expectant D -DEAD

  10. D-I-S-A-S-T-E-R ParadigmTriage M.A.S.S. Triage System M – Move A – Assess S – Sort S – Send

  11. MASS Flow Chart

  12. M.A.S.S Triage • Move • Anyone who can walk is told to MOVE to a collection area • Remaining victims are told to MOVE an arm or leg • Assess • Remaining patients who didn’t move (help these people first) • Sort • Categorize patients by “ID-me” • Immediate, Delayed, Minimal, Expectant, Dead • Send • Transport IMMEDIATE patients first • Send to Hospitals and Secondary Treatment Facilities

  13. M.A.S.S Triage Key Principle of MASS Triage: • Group, then Sort! …then Transport!

  14. D-I-S-A-S-T-E-R ParadigmMASS Triage Model “MOVE” Step 1: • Goal • Group - Ambulatory Patients • Action: • “Everyone who can hear me and needs medical attention, please move to the area with the green flag” • “ID-me” Category • Minimalinitial group

  15. D-I-S-A-S-T-E-R ParadigmMASS Triage Model “MOVE” • Minimal group, initial screening • Airway, breathing, and circulation intact • Mental status: able to follow commands • Not likely low blood pressure or breathing trouble • Some conditions worsen, more urgent triage category • Must be reassessed and monitored • Limitations: not based upon individual assessment yet • Actively managing this group will reduce self-transports and perhaps unnecessary overburdening of nearest hospital ER’s • Assess last, after Immediate and Delayed groups

  16. D-I-S-A-S-T-E-R ParadigmMASS Triage Model “MOVE” Step 2: • Goal • Group – can’t walk, but awake and able to follow commands to MOVE an arm or leg • Action: • Ask the remaining victims “everyone who can hear me please raise an arm or leg so we can come help you” • “ID-me” Category • Delayedinitial group

  17. D-I-S-A-S-T-E-R ParadigmMASS Triage Model “MOVE” • Delayed group • Airway, breathing, and circulation adequate to follow simple commands • Mental status: Conscious & able to follow simple commands • May have low blood pressure or low oxygen level • Likely significant injuries present • Limitations: not based upon individual assessment yet • Assess second, after Immediate group

  18. D-I-S-A-S-T-E-R ParadigmMASS Triage Model “ASSESS” • Goal • Group – Identify location of who is left, unable to ambulate and unable to follow simple commands • Action: • Proceed immediately to these patients and deliver immediate life-saving interventions • “ID-me” Category • Immediateinitial group

  19. D-I-S-A-S-T-E-R ParadigmMASS Triage Model “ASSESS” • Immediate group • ABC status unknown, immediate assessment • Mental status: Unresponsive to verbal commands • Likely low blood pressure or low oxygen level • Life-threatening injuries present • Expectantanddeadpatients may be in this group • Minor injuries may be present due to: • Ruptured ear drums, hearing impaired, chronically disabled • Limitations: not based upon individual assessment • Assess these people FIRST!

  20. D-I-S-A-S-T-E-R ParadigmMASS Triage Model “ASSESS” IMMEDIATE patients • Rapidly Assess ABC’s : • Is airway open? Open it manually • Is patient breathing? If not,EXPECTANTand go on • Is uncontrolled bleeding present? Assign direct pressure (do not hesitate to use tourniquet!) • Is likely fatal injury present? If yes,EXPECTANT • Correct immediate life threats • Accurate count of immediate patients • Is transport available for anyone now? …Move on!

  21. D-I-S-A-S-T-E-R ParadigmMASS Triage Model “SORT” • Everyone should be able to complete the “Move” and “Assess” steps of Triage • “Sort” requires a level of patient assessment skills beyond basic first aid / buddy aid • If you are unable to “Sort”, then assure that appropriate emergency medical services are enroute and continue to “move and assess”

  22. D-I-S-A-S-T-E-R ParadigmMASS Triage Model “SORT” - “ID-me”: I – Immediate D – Delayed M- Minimal E – Expectant D - DEAD “SORT” them based upon individual assessment, …continue lifesaving treatment

  23. D-I-S-A-S-T-E-R ParadigmMASS Triage Model “SORT” Immediate • Life or limb threatening injury • Usually persistent ABC problem • Examples: • Unresponsive, altered mental status, severe breathing trouble, uncontrollable bleeding, proximal amputations, turning blue, rapid and weak pulse…

  24. D-I-S-A-S-T-E-R ParadigmMASS Triage Model “SORT” Delayed: • Need definitive medical care, but should not worsen rapidly if initial care is delayed • Examples: • Deep cuts or open fractures with controlled bleeding and good pulses; finger amputations; abdominal injuries with stable vital signs…

  25. D-I-S-A-S-T-E-R ParadigmMASS Triage Model “SORT” Minimal: • “Walking Wounded” • Treated and released (preferably without transport) • Source of “volunteer” help • Examples: • Abrasions, contusions, minor lacerations, no apparent injury

  26. D-I-S-A-S-T-E-R ParadigmMASS Triage Model “SORT” Expectant • Severely injured with little or no chance of survival • Care resources not utilized initially • Comfort resources used as available • Remember death could be hours or days away! • Require reassessment and transport: • If alive after all immediate patients transported, resuscitate per available resources!

  27. D-I-S-A-S-T-E-R ParadigmMASS Triage Model • How to handle the dead patients: • Dead patients should not be moved • May aid in identification of the deceased • Evidence is important! • Finding and convicting perpetrators....and possibly... PREVENTING future attacks! • Excessive manipulation of human remains may destroy vital evidence

  28. D-I-S-A-S-T-E-R ParadigmMASS Triage Model “SORT” is dynamic! Reassess! • Who is left? • Expectant group could become new Immediategroup • “Most serious” injury present requires your immediate attention!

  29. D-I-S-A-S-T-E-R ParadigmMASS Triage Model • When all patients have been triaged and immediate life saving procedures complete: • Accurate count in each category • Advise incident commander/triage officer • Move all immediate to collection point • Prepare for immediate transport • Often marked with red flag/tarp

  30. D-I-S-A-S-T-E-R ParadigmMASS Triage Model “SEND” • Traditional syntax • Immediate→Delayed →Minimal →Expectant • Objective • Transport or release ALL living patients ASAP • Mission Focused • Send Minimal(s) with each Immediate (if unused space available in vehicle), etc… • Resourceful • Secondary treatment facilities for minimal pts (or on-scene treatment and release) • Utilize buses, taxis, trains, boats, etc..

  31. M.A.S.S Triage Key Principle of MASS Triage: • Group, then Sort! …then Transport!

  32. Medical Record • Triage Tags • Communication • History & Physical • Treatment • Contact information • Personal message Front Back

  33. Summary Now you can: • Define disaster triage • List components of MASS triage • Discuss importance and utilization of triage tags

  34. Questions?

  35. Triage “Tabletop”

  36. Triage Scenario • Shooting incident at a Local Sporting Event • Multiple gunshots were fired • You are first at the scene • 10 victims • What do you do?

  37. Is Need > Resources? • D- Detect • Is this a disaster / MCI? (need>resources) • I- Incident Command • Who is in charge? (incident commander) Who will you contact? • S- Scene Safety/Security • Is it safe enough to enter? • A- Assess Hazards • Active shooter? Secondary device? Further penetrating trauma • S- Support • Law enforcement, EMS, Medical Control, Trauma Center, etc.. • T- Triage/Treatment • 10 victims • E- Evacuation • What vehicles are available? What route is safe? • R- Recovery

  38. MASS Triage • Move • Two walk • Three move • Assess • Five do not move • Sort • IDME categories • Send

  39. MASS Triage • Move • Two walk (Minimal Group) • Three move (Delayed Group) • Assess • Five do not move (Immediate Group) • Sort • IDME categories • Send

  40. MASS: Immediate GroupUnable to “MOVE” • 29 yr male • GSW to left chest, awake in severe respiratory distress • 8 yr female • GSW to head (through and through) RR=4, HR=101 • 50 yr male • GSW to abdomen & chest, RR=0, HR=0, not moving • 40 yr female • GSW to neck with gurgling respirations, marked respiratory distress • 16 yr male • GSW right chest, No respiratory effort, HR=130 thready Immediate Expectant Dead Immediate ImmediateVs Expectant

  41. MASS: Delayed GroupAble to MOVE, notwalk • 14 year male • GSW to R upper arm, active massive hemorrhage, good pulses • 65 year male • No obvious GSW, c/o severe chest pain, diaphoretic, and SOB • 22 year female • GSW to R leg, good pulses, no active bleeding, normal VS Immediate -Delayed** **after pressure dressing Immediate Delayed

  42. MASS: Minimal GroupAble to “MOVE” out • 29 yr male • Superficial “scratch” wound to L arm, no deeper penetration • 37 yr male • GSW to left hand, exposed muscle, tendon and bone fragments, capillary refill < 2 sec Minimal Delayed

  43. Triage Status Category SORT Immediate 4-5* Delayed2 Minimal 1 Expectant 1-2* DEAD  1

  44. SORT: Immediate • 29 yr male • GSW to left chest, awake in severe respiratory distress: Needle decompression of L chest successful, VSS • 40 yr female • GSW to neck with gurgling respirations, marked respiratory distress: Airway management unsuccessful, profuse bleeding occurred, pt now apneic and pulseless • 14 year male • GSW to R upper arm, active massive hemorrhage, good pulses: Now well controlled, no active bleeding, VSS • 65 year male • No obvious GSW, c/o severe chest pain, diaphoretic, and SOB: Symptoms continue Delayed Dead Delayed Immediate

  45. SORT: Delayed • 22 year female • GSW to R leg, good pulses, no active bleeding, normal VS: Splinted leg, VSS • 37 yr male • GSW to left hand, exposed muscle, tendon and bone fragments, initial capillary refill < 2 sec: Now L hand is pulseless and cyanotic Delayed Immediate

  46. SORT: Minimal • 29 yr male • Superficial “scratch” wound to L arm, no deeper penetration: No clinical change, desires to leave and go home Minimal

  47. SORT: Expectant • 16 yr male • GSW right chest, No respiratory effort, HR=130 thready: Now no palpable pulse, no respiratory effort • 8 yr female • GSW to head (through and through) RR=4, HR=101: RR=6-8, HR=100 Dead IMMEDIATE?

  48. Triage Status Category SORT SORT Immediate 4-5* 3 Delayed2 3 Minimal 1 1 Expectant 1-2* 0 DEAD  1 3

  49. Summary Now you can: • Define disaster triage • List components of MASS triage • Discuss importance and utilization of triage tags • Identify victim triage categories for simulated triage scenario

  50. Questions?

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