(English captions by Trisha Paul, University of Michigan.)
In this session, we shall talk about mass casualty incidents.
A mass casualty incident is any incident where the number of injured overwhelm the capabilities
of the first arriving units.
They usually involve trauma but could be acute radiation, biological weapons, or poisoning
from alcohol.
It could be bomb blasts, it could be transportation crashes.
They involve road traffic injuries, collapsed buildings, which are occurring every day.
Three things are particularly important in lessening injuries and deaths in mass casualty
incidents.
One is immediate search and rapid triage.
Two, immediate first aid treatment.
And three, transport to the nearest medical centre.
Read the story on the bus collision.
What things went wrong in that scenario?
After the incident, it is important to be composed; search and rescue should be done
methodically.
Stop, look, listen, and think, and call for help!
Choose a team leader.
Usually security personnel are needed to secure the incident site, Zone 1 or Ground Zero as
it is called in court.
Wear protective gadgets including gloves and helmet.
Select a medical incident commander to manage triage, treatment and transport, the 3Ts.
These are very important in mass casualty incidents.
Triage, treatment, and transport the patient.
Some ambulances are able to sustain lives that require advanced support.
Call for an ambulance.
Triage is a French term meaning pick and sort, or select and categorize.
It involves: classifying victims in order to assign priorities for medical care and
transportation, urgency of the case handling to increase victims' likelihood of survival.
The aim is to provide the greatest good for the greatest number of people injured.
Triage categories.
Triage uses agreed colors to communicate amongst personnel.
Triage ribbons or cards can be used, although in resource constrained countries, you may use
other coding systems.
It tells intervention teams the priority level with which to handle each affected person.
This is an example of a color coded triage card.
Triage categories include those injured or affected persons that need immediate care,
those that need delayed care, those that need minor care, and those that can be classified
as deceased.
The Red Coded are first priority at the mass casualty incident.
Immediate care should be started.
They have a compromised airway, or are in shock, and need immediate resuscitation.
The Yellow Coded are the second priority.
Urgent care is needed.
They can deteriorate to Red category in a short time.
They are in impending shock.
The Green Coded are the third category and include all walking wounded.
Care can come later.
However, they need monitoring for any sign of deterioration.
The Black Coded are either dead or hopelessly wounded.
They should not take priority time and resources.
Concentrate on those that can be saved.
How To Triage.
Begin by assessing all non-moving patients where they lie.
Use START Triage.
START, meaning Simple Triage And Rapid Treatment, where treatment here refers to first aid treatment
and follow up treatment.
Triage can be performed by any individual including non-health workers.
Because of the scarcity of manpower, all who can should participate in triage.
Triage Techniques: We consider three main aspects: respiration, blood circulation, and
consciousness.
Under respiration, we check: Are they breathing?
And if they are breathing, what are their breaths per minute?
These are important criteria that can help us decide whether someone needs immediate
care or delayed care.
Under Blood Circulation, we check: Is there a pulse?
If there is a pulse or if there is no pulse, how is the perfusion of blood into the tissues?
Three, Consciousness.
Are they conscious?
Or, what is their Mental status?
All these 3 areas of assessment should take less than one minute per patient.
Checking for Respiration.
If there is no respiration or they are not breathing, open the airway and clear the airway
by stretching the neck and clearing anything that may be in their mouth.
If there is still none, label as black.
If the respiration is restored, label as red.
If the respiration rate was initially present and the breathing rate was above 30 beats
per minute or a visibly faster rate, label as red.
However, if the breathing rate is below 30 in the initial breathing, then go to the next
stage of assessment and that is the circulation, or the perfusion.
Blood circulation is the same as perfusion.
Check if the radial pulse is present, and if it is not present, or the capillary refill
is greater than 2 seconds, label as RED.
If the radial pulse is present and normal or the capillary refill is less than or equal
to 2 seconds, then that means that circulation is ok.
For some patients, if they have passed the respiration test and they have also passed
the circulation test, we need to check the mental status.
If the mental status cannot follow simple commands, then they are unconscious or have
an altered level of consciousness.
These are labeled as Red.
If they can follow simple commands on their first or previous test, that is respiration,
circulation, then label as Yellow if they are unable to walk or Green if they are walking.
This is the summary algorithm.
Take time to look at it.
Summary.
Triage is the single most important decision involving management of mass casualty incidences.
Triage evaluation involves airway and breathing, that is, respiration, checking the circulation,
and checking the mental status.
However, after the Triage, the Triage teams need to hand over the serious cases to the first aid
treatment teams. Later on, we shall look, in another session, we shall look at first
aid treatment. Medical facilities are encouraged to develop mass casualty plans for their facilities
based on operating capacity and resources. District committees and local authorities
should identify key players in search and rescue and in first aid.
Thanks for listening.