Triage pptx microteacing.pptx triage pres

Triage

1. MICROTEACHING TOPIC : TRIAGE PREPARED BY :Nadish Manzoor 1 st year NPCC PRESENTED TO : Mrs. K Christy sharmila Professor & HOD Dept. Of MSN

2. General Objectives At the end of the class students will be able to gain knowledge regarding triage. Specific objectives: The students will be able to list down the aims of triage describe the equipments needed for triage explain the types of triage discuss about triage scale explain the alternative care facilities of triage list out the categories of triage explain the role of the triage nurse

3. INTRODUCTION Triage is the process of determining the priority of patients' treatments based on the severity of their condition. This rations patient treatment efficiently when resources are insufficient for all to be treated immediately. Triage may result in determining the order and priority of emergency treatment, the order and priority of emergency transport, or the transport destination for the patient. Triage may also be used for patients arriving at the emergency department, or to telephone medical advice systems, [3] among others.

4. AIMS: To ensure that patient are treated in the order of there clinical urgency. To ensure that treatment is appropriately and temiely . To allocate the patient to the most appropriate assessment and treatment area To gather information that facilitates the description of the departmental case mix.

5. EQUIPMENT REQUIREMENTS Emergency equipment Facilities for using standard precautions (hand-washing facilities, gloves) Adequate communications devices (telephone and/or intercom etc) Facilities for recording triage information

6. TYPES OF TRIAGE 1. Simple triage Simple triage is usually used in a scene of a "mass-casualty incident" (MCI), in order to sort patients into those who need critical attention and immediate transport to the hospital and those with less serious injuries. This step can be started before transportation becomes available. The categorization of patients based on the severity of their injuries can be aided with the use of printed triage tags or coloured flagging. Triage separates the injured into four groups: The deceased who are beyond help The injured who can be helped by immediate transportation The injured whose transport can be delayed Those with minor injuries, who need help less urgently

7. 2. Advanced triage In advanced triage, doctors may decide that some seriously injured people should not receive advanced care because they are unlikely to survive. Advanced care will be used on patients with less severe injuries. Because treatment is intentionally withheld from patients with certain injuries, advanced triage has ethical implications. It is used to divert scarce resources away from patients with little chance of survival in order to increase the chances of survival of others who are more likely to survive. In Western Europe, the criterion used for this category of patient is a trauma score of consistently at or below.This can be determined by using the Triage Revised Trauma Score (TRTS), a medically-validated scoring system incorporated in some triage cards.

8. 3. Continuous integrated triage Continuous Integrated Triage is an approach to triage in mass casualty situations which is both efficient and sensitive to psychosocial and disaster behavioural health issues that affect the number of patients seeking care (surge), the manner in which a hospital or healthcare facility deals with that surge (surge capacity) and the overarching medical needs of the event. Continuous Integrated Triage combines three forms of triage with progressive specificity to most rapidly identify those patients in greatest need of care while balancing the needs of the individual patients against the available resources and the needs of other patients. Continuous Integrated Triage employs: Group (Global) Triage (i.e., M.A.S.S. triage)[12] Physiologic (Individual) Triage (i.e., S.T.A.R.T.) Hospital Triage (i.e., E.S.I. or Emergency Severity Index However any Group, Individual and/or Hospital Triage system can be used at the appropriate level of evaluation.

9. 4. Practical applied triage During the early stages of an incident, first responders may be overwhelmed by the scope of patients and injuries. One valuable technique, is the Patient Assist Method (PAM); the responders quickly establish a casualty collection point (CCP) and advise; either by yelling, or over a loudspeaker, that "anyone requiring assistance should move to the selected area (CCP)". This does several things at once, it identifies patients that are not so severely injured, that they need immediate help, it physically clears the scene, and provides possible assistants to the responders. As those who can move, do so, the responders then ask, "anyone who still needs assistance, yell out or raise your hands"; this further identifies patients who are responsive, yet maybe unable to move.

10. Now the responders can rapidly assess the remaining patients who are either expectant, or are in need of immediate aid. From that point the first responder is quickly able to identify those in need of immediate attention, while not being distracted or overwhelmed by the magnitude of the situation. Using this method assumes the ability to hear. Deaf, partially deaf or victims of a large blast injury may not be able to hear these instructions. Labelling of patients Upon completion of the initial assessment by medical or paramedical personnel, each patient will be labeled with a device called a triage tag. This will identify the patient and any assessment findings and will identify the priority of the patient's need for medical treatment and transport from the emergency scene

11. TRIAGE SCALE The Australasian Triage Scale (ATS), formerly the National Triage Scale (NTS) The National Triage Scale (NTS) was implemented in 1993, becoming the first triage system to be used in all publicly funded EDs throughout Australia. In the late 1990s, the NTS underwent refinement and was subsequently renamed the Australasian Triage Scale (ATS). Department of Health and Ageing - Emergency Triage Education Kit

12. The ATS has five levels of acuity: Immediately life-threatening (category 1) Imminently life-threatening (category 2) Potentially life-threatening or important time-critical treatment or severe pain (category 3) Potentially life-serious or situational urgency or significant complexity (category 4) Less urgent (category 5). The ATS has been endorsed by the Australasian College for Emergency Medicine and adopted in performance indicators by the Australian Council on Healthcare Standards.

13. ALTERNATIVE CARE FACILITIES Alternative care facilities are places that are set up for the care of large numbers of patients, or are places that could be so set up. Examples include schools, sports stadiums, and large camps that can be prepared and used for the care, feeding, and holding of large numbers of victims of a mass casualty or other type of event. Such improvised facilities are generally developed in cooperation with the local hospital, which sees them as a strategy for creating surge capacity. While hospitals remain the preferred destination for all patients, during a mass casualty event such improvised facilities may be required in order to divert low-acuity patients away from hospitals in order to prevent the hospitals becoming overwhelmed.

14. CATEGORIES In advanced triage systems, secondary triage is typically implemented by paramedics battlefield medical personnel or by skilled nurses in the emergency departments of hospitals during disasters, injured people are s orted i nto five categories Red / Immediate: They require immediate surgery or other lifesaving intervention, and have first priority for surgical teams or transport to advanced facilities; they "cannot wait" but are likely to survive with immediate treatment. Yellow / Observation: Their condition is stable for the moment but requires watching by trained persons and frequent re-triage, will need hospital care (and would receive immediate priority care under "normal" circumstances).  Green / Wait (walking wounded): They will require a doctor's care in several hours or days but not immediately, may wait for a number of hours or be told to go home and come back the next day (broken bones without compound fractures, many soft tissue injuries).

15. White / Dismiss (walking wounded): They have minor injuries; first aid and home care are sufficient, a doctor's care is not required. Injuries are along the lines of cuts and scrapes, or minor burns.  Black / Expectant: They are so severely injured that they will die of their injuries, possibly in hours or days (large-area burns, severe trauma, lethal radiation dose), or in life-threatening medical crisis that they are unlikely to survive given the care available (cardiac arrest, septic shock, severe head or chest wounds); they should be taken to a holding area and given painkillers as required to reduce suffering.

16. Some crippling injuries, even if not life-threatening, may be elevated in priority based on the available capabilities. During peacetime, most amputations may be triaged "Red" because surgical reattachment must take place within minutes, even though in all probability the person will not die without a thumb or hand.

17. The Role of the Triage Nurse is to: 1. Undertake patient assessment and allocate the ATS category based on; Findings of the primary survey Risk assessment 2. Initiate appropriate nursing interventions and organisational guidelines (e.g. first aid and emergency interventions) to improve patient outcomes and secure the safety of patients and staff of the department; 3. Ensure continuous reassessment and management of patients who remain in the waiting room commensurate with their condition and time frames determined by the ATS category;

18. 4. Provide patient and public education where appropriate to facilitate health promotion and education injury prevention community resourcing and information 5. Act as the liaison for members of the public and other health care professionals

19. CONCLUSION Triage is used to categorized patient for priorities of treatment and it help that patient treated in the order of their clinical urgency and contribute information that help to define departmental acuity . triage colour category (red, yellow, green ,or black), depending on injury and severity and prognosis and triage category is identified by use of a coloured band or trauma / Disaster tag that is placed on the patient to document that triage has been done.

20. REFERENCES LEWIS,HEITKEMPER,DIRK SEN,O' BRIEN,BUCHER,MEDICAL SURGICAL NURSING,MOSBY PUBLICATIONS,PAGE NO:1796 "Merriam-Webster Online Dictionary". Retrieved 2008-12-05. "Transforming Triage Technology (National Research Council of Canada website)". Retrieved 2008-12-02.