Triage principios y análisis, clasificación

Análisis de triage

1. Centre for Trauma, Conflict &
Catastrophe
Jim 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 Dominique
Larrey
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 2
nd
or 3
rd
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
Priority Colour Label
Immediate Red P1 T1
Urgent Yellow P2 T2
Delayed Green P3 T3
Expectant Black/green T4
Dead White/black T0

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 & Place
Different Environments

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

24. Triage & Documentation

25. Undressing
Tent
Male
Decon Tent
Decon
Shed
A+E
Control
Room
Ramp to
Underground
Carpark
Cage f or
Clothing
Blankets
Gowns
etc
DSO
7
Majax
Storeroom
Pump
Store
Pharmacy
Diesel
Store
A+EA+E
Generator
Decon Saf ety
Of f icer
Staf f in PPE
FCTFilter Change Team
Grafton
Way
Entry f or
Ambulances
DSO
Dressing Tent
Undressing
Tent
Female
M M
Entry f or
Pedestrians
A+EA+E M
S
S
S
S
V
V
Security (no PPE)
M
Ambulance
Not to scale
VValuables
Boots, glov es
paper gowns
etc f or ‘disposal’
‘Clean’ route
‘Dirty ’ route
Clean area f or
changing f ilters
& remov ing suits
Ramp to
Underground
CarparkA+E
Waste
Water
Container
A+E
Cones and
Barrier Tape
Chain

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

28. Triage
WALKING
BREATHING
RESPIRATORY
RATE
CAPILLARY
REFILL
PRIORITY 3
(delayed)
DEAD
PRIORITY 1
(immediate)
PRIORITY 2
(urgent)
N
N
Y
< 10
> 30
10 to 29
2 sec
< 2 sec
After airway opening
Y

29. Triage
Undertriage
Overtriage

30. Training & Exercises

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