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MASS Triage Scenario

MASS Triage Scenario. Objectives. During a facilitator led mass casualty scenario-based discussion you will: Discuss DISASTER paradigm List components of MASS triage Identify victim triage categories. Triage “Tabletop”. Triage Scenario. Shooting incident at a local shopping center

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MASS Triage Scenario

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  1. MASS Triage Scenario

  2. Objectives During a facilitator led mass casualty scenario-based discussion you will: • Discuss DISASTER paradigm • List components of MASS triage • Identify victim triage categories

  3. Triage “Tabletop”

  4. Triage Scenario • Shooting incident at a local shopping center • Multiple gunshots were fired • You are first at the scene • 10 victims • What do you do?

  5. 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

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

  7. MASS Flow Chart

  8. Step 2: M.A.S.S Triage • Move • What are the two action steps? • Assess • Who are you going to approach first? • Sort • How will you categorize your patients? • Name the three variables impacting decision making? • Send • When and what transportation methods are available?

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

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

  11. Triage Status Category Group Immediate 5 Delayed3 Minimal 2 Expectant DEAD

  12. 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

  13. 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

  14. MASS: Minimal GroupAble to “MOVE”, can walk • 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

  15. Triage Status Category Group SORT Immediate 5 4-5* Delayed32 Minimal 2 1 Expectant 1-2* DEAD  1

  16. SORT: Immediate Delayed • 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 Dead Delayed Immediate

  17. 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

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

  19. 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?

  20. Triage Status Category Group SORT SORT Immediate 5 4-5* 3 Delayed32 3 Minimal 2 1 1 Expectant 1-2* 0 DEAD  1 3

  21. Summary Now you can: During a facilitator led mass casualty scenario-based discussion you can • Discuss DISASTER paradigm • List components of MASS triage • Identify victim triage categories

  22. Questions?

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