Responding to Disasters: Triage (Nursing)

by Heide Cygan, DNP, RN

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    00:10 In this presentation, I'm going to discuss responding to disasters, specifically triage.

    00:17 I'm going to introduce the concept of mass casualty triage.

    00:21 This is the type of triage that occurs at the site of a disaster that's caused injury or death to a large number of people.

    00:29 A word that we hear often in relationship to disasters is casualty.

    00:33 A casualty is a human being who is injured or killed as a result of a disaster.

    00:40 If casualties number more than two people but fewer than 100 the disaster is characterized as a multiple casualty incident.

    00:49 In an event, with 100 or more casualties, this is referred to as a mass casualty event.

    00:55 Although, multiple casualty incidents may strain the health care system of a small or midsize community, a mass casualty incident can completely overwhelm even the largest of cities.

    01:06 So let's talk about mass casualty triage.

    01:10 Now, this triage is different than traditional emergency room or primary care triage.

    01:15 Mass casualty triage is used to decide who most urgently needs care.

    01:21 We also use mass casualty triage, to help us prioritize the use of very limited resources.

    01:28 This allows us to do the most good for the most amount of people.

    01:32 Now remember, we do triage because we don't have enough resources for everyone to get care at the exact same moment.

    01:39 Because of this, we need to determine who needs care first.

    01:43 Another thing to remember is that triage is not actually providing care.

    01:47 It's simply determining who needs care first.

    01:51 Mass casualty triage can be done by individuals with very limited training, you don't have to be a licensed medical professional.

    01:59 The individual who's doing triage, assesses casualties and determine who needs care the most.

    02:06 By doing so they categorize victims into four categories.

    02:09 Let's start first by looking at green, minimal.

    02:13 These are individuals who have very minimal injuries.

    02:16 They may require some basic first aid, but they do not need care immediately.

    02:20 And they may even be able to help with additional triage efforts.

    02:24 We often call these individuals the "walking wounded".

    02:29 Next, we have Delayed.

    02:31 These are individuals who have injuries that will surely need professional attention, but their care can be reasonably delayed without further damage occurring.

    02:42 Next, we have red or immediate.

    02:44 These are casualties who are injured and require immediate attention.

    02:48 Without immediate care, they may even die.

    02:53 The final category is black, or what we call expectant.

    02:57 These are casualties who have already passed away or will pass away no matter what type of care is given.

    03:04 So let's take a look at each of the categories again, starting first with our highest priority, the red category.

    03:11 Now remember, these are the highest priority patients, those who need care right away.

    03:16 Examples of injuries here could be chest wounds, individuals who are going into shock or maybe have open fractures, or second and third degree burns on the majority of their body.

    03:27 Our next priority is yellow or delayed.

    03:31 These are casualties who need care, but the care can be delayed.

    03:35 Examples of injury here include staple abdominal wounds, maybe a minor eye or CNS injuries such as a concussion.

    03:44 And then we have green, these are the walking wounded, those who will require very minimal care.

    03:49 Examples of injury here include minor burns, minor fractures, or minor bleeding.

    03:56 And then we have black or expectant, those who are unresponsive, or who are already deceased.

    04:04 Often oftentimes in a mass casualty triage event, those who are responding we'll set up tarps that represent each of those categories.

    04:13 Again, we see our highest priority individuals, they're in red, then yellow, then green, then Black.

    04:21 This is an example of a mass casualty triage tag.

    04:26 Now, during a mass casualty event, the individual who's conducting the triage will use a tag that looks like this to make notes about each individual that they assess.

    04:36 As you can see, there's a place on the top of the tag that provides the opportunity to share some details about the injury.

    04:44 On the bottom, we see the colors that we just talked about that indicate the priority level of care that these individuals need.

    04:53 The tag that we see in front of us right now has green at the bottom.

    04:57 That means that somebody who has this tag on their body would not be a priority.

    05:03 If you were to tear off that green part what we'd have left on the bottom is the yellow.

    05:08 This means this individual would fall into the delayed category.

    05:14 Take off that.

    05:15 And we have an individual who has the highest priority, they need immediate attention.

    05:20 And then finally, this is what it would look like if an individual or casualty was categorized in the black category.

    05:29 Now that I've explained mass casualty triage, I want to point out that triage is screening.

    05:35 Again, it's not providing the care, it's truly screening to see what type of care is needed and who needs it first.

    05:42 So based on this, what level of prevention is mass casualty triage? If you said secondary prevention, you're correct.

    05:53 So let's take some time now to apply the levels of prevention to disaster management a little more thoroughly.

    06:00 We've determined that triage is screening and falls under secondary prevention.

    06:05 What about tertiary? What are some examples of tertiary prevention efforts as it relates to disaster management? Well, rather than screening casualties, you could be providing care to those casualties.

    06:20 That would be tertiary prevention.

    06:22 You could also work with communities to rebuild after a disaster occurs.

    06:28 What about primary prevention? What are some examples of primary prevention efforts as it relates to disaster management? These could be disaster preparedness efforts, you could work with communities to create evacuation plans that would go into place if a disaster occurs.

    06:50 Now it's important to understand the impact of triage.

    06:53 Don't forget about the people who perform triage during these traumatic events.

    07:00 Performing triage can be emotionally and physically demanding and draining.

    07:07 If you or someone you know has performed triage, be sure to take care of yourself, offer support, we know that PTSD has been reported from individuals who perform mass casualty triage.

    07:21 These events are traumatic.

    07:23 No one responds the same.

    07:25 That's why it's so important that after mass casualty triage is complete, the teams come together to debrief and reflect upon what happened.

    07:35 From there, you can put forth plans for ongoing mental health support.

    07:40 By working together as a team, we may be able to mitigate some of the impact that this has on those performing triage.

    07:48 This is so important for many reasons.

    07:51 Most of all, we need to be prepared when our communities need us again.

    About the Lecture

    The lecture Responding to Disasters: Triage (Nursing) by Heide Cygan, DNP, RN is from the course Emergency Preparedness (Nursing).

    Included Quiz Questions

    1. A multiple casualty event.
    2. A mass casualty event.
    3. A single casualty event.
    4. A multi-casualty event.
    1. Green
    2. Red
    3. Yellow
    4. Black
    1. Red
    2. Yellow
    3. Black
    4. Green
    1. Secondary
    2. Tertiary
    3. Primary
    4. Quarternary

    Author of lecture Responding to Disasters: Triage (Nursing)

     Heide Cygan, DNP, RN

    Heide Cygan, DNP, RN

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