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(English captions by Trisha Paul, University of Michigan.)

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In this session, we shall talk about mass
casualty incidents.

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A mass casualty incident is any incident where
the number of injured overwhelm the capabilities

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of the first arriving units.

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They usually involve trauma but could be acute
radiation, biological weapons, or poisoning

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from alcohol.

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It could be bomb blasts, it could be transportation
crashes.

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They involve road traffic injuries, collapsed
buildings, which are occurring every day.

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Three things are particularly important in
lessening injuries and deaths in mass casualty

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incidents.

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One is immediate search and rapid triage.

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Two, immediate first aid treatment.

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And three, transport to the nearest medical
centre.

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Read the story on the bus collision.

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What things went wrong in that scenario?

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After the incident, it is important to be
composed; search and rescue should be done

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methodically.

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Stop, look, listen, and think, and call for
help!

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Choose a team leader.

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Usually security personnel are needed to secure
the incident site, Zone 1 or Ground Zero as

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it is called in court.

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Wear protective gadgets including gloves and
helmet.

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Select a medical incident commander to manage
triage, treatment and transport, the 3Ts.

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These are very important in mass casualty
incidents.

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Triage, treatment, and transport the patient.

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Some ambulances are able to sustain lives
that require advanced support.

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Call for an ambulance.

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Triage is a French term meaning pick and sort,
or select and categorize.

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It involves: classifying victims in order
to assign priorities for medical care and

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transportation, urgency of the case handling
to increase victims' likelihood of survival.

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The aim is to provide the greatest good for
the greatest number of people injured.

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Triage categories.

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Triage uses agreed colors to communicate amongst
personnel.

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Triage ribbons or cards can be used, although
in resource constrained countries, you may use

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other coding systems.

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It tells intervention teams the priority level
with which to handle each affected person.

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This is an example of a color coded triage
card.

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Triage categories include those injured or
affected persons that need immediate care,

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those that need delayed care, those that need
minor care, and those that can be classified

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as deceased.

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The Red Coded are first priority at the mass
casualty incident.

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Immediate care should be started.

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They have a compromised airway, or are in
shock, and need immediate resuscitation.

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The Yellow Coded are the second priority.

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Urgent care is needed.

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They can deteriorate to Red category in a
short time.

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They are in impending shock.

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The Green Coded are the third category and
include all walking wounded.

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Care can come later.

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However, they need monitoring for any sign
of deterioration.

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The Black Coded are either dead or hopelessly
wounded.

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They should not take priority time and resources.

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Concentrate on those that can be saved.

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How To Triage.

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Begin by assessing all non-moving patients
where they lie.

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Use START Triage.

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START, meaning Simple Triage And Rapid Treatment,
where treatment here refers to first aid treatment

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and follow up treatment.

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Triage can be performed by any individual
including non-health workers.

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Because of the scarcity of manpower, all who
can should participate in triage.

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Triage Techniques: We consider three main
aspects: respiration, blood circulation, and

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consciousness.

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Under respiration, we check: Are they breathing?

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And if they are breathing, what are their
breaths per minute?

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These are important criteria that can help
us decide whether someone needs immediate

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care or delayed care.

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Under Blood Circulation, we check: Is there
a pulse?

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If there is a pulse or if there is no pulse,
how is the perfusion of blood into the tissues?

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Three, Consciousness.

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Are they conscious?

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Or, what is their Mental status?

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All these 3 areas of assessment should take
less than one minute per patient.

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Checking for Respiration.

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If there is no respiration or they are not
breathing, open the airway and clear the airway

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by stretching the neck and clearing anything
that may be in their mouth.

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If there is still none, label as black.

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If the respiration is restored, label as red.

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If the respiration rate was initially present
and the breathing rate was above 30 beats

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per minute or a visibly faster rate, label
as red.

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However, if the breathing rate is below 30
in the initial breathing, then go to the next

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stage of assessment and that is the circulation,
or the perfusion.

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Blood circulation is the same as perfusion.

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Check if the radial pulse is present, and
if it is not present, or the capillary refill

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is greater than 2 seconds, label as RED.

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If the radial pulse is present and normal
or the capillary refill is less than or equal

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to 2 seconds, then that means that circulation
is ok.

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For some patients, if they have passed the
respiration test and they have also passed

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the circulation test, we need to check the
mental status.

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If the mental status cannot follow simple
commands, then they are unconscious or have

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an altered level of consciousness.

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These are labeled as Red.

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If they can follow simple commands on their
first or previous test, that is respiration,

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circulation, then label as Yellow if they
are unable to walk or Green if they are walking.

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This is the summary algorithm.

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Take time to look at it.

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Summary.

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Triage is the single most important decision
involving management of mass casualty incidences.

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Triage evaluation involves airway and breathing,
that is, respiration, checking the circulation,

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and checking the mental status.

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However, after the Triage, the Triage teams need to
hand over the serious cases to the first aid

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treatment teams. Later on, we shall look,
in another session, we shall look at first

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aid treatment. Medical facilities are encouraged
to develop mass casualty plans for their facilities

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based on operating capacity and resources.
District committees and local authorities

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should identify key players in search and
rescue and in first aid.

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Thanks for listening.