WEBVTT 00:00:01.000 --> 00:00:04.000 (English captions by Trisha Paul, University of Michigan.) 00:00:05.000 --> 00:00:11.000 In this session, we shall talk about mass casualty incidents. 00:00:11.000 --> 00:00:19.000 A mass casualty incident is any incident where the number of injured overwhelm the capabilities 00:00:19.000 --> 00:00:22.000 of the first arriving units. 00:00:22.000 --> 00:00:29.000 They usually involve trauma but could be acute radiation, biological weapons, or poisoning 00:00:29.000 --> 00:00:29.000 from alcohol. 00:00:29.000 --> 00:00:35.000 It could be bomb blasts, it could be transportation crashes. 00:00:35.000 --> 00:00:45.000 They involve road traffic injuries, collapsed buildings, which are occurring every day. 00:00:45.000 --> 00:00:51.000 Three things are particularly important in lessening injuries and deaths in mass casualty 00:00:51.000 --> 00:00:53.000 incidents. 00:00:53.000 --> 00:00:56.000 One is immediate search and rapid triage. 00:00:56.000 --> 00:01:00.000 Two, immediate first aid treatment. 00:01:00.000 --> 00:01:10.000 And three, transport to the nearest medical centre. 00:01:10.000 --> 00:01:16.000 Read the story on the bus collision. 00:01:16.000 --> 00:01:21.000 What things went wrong in that scenario? 00:01:21.000 --> 00:01:30.000 After the incident, it is important to be composed; search and rescue should be done 00:01:30.000 --> 00:01:31.000 methodically. 00:01:31.000 --> 00:01:39.000 Stop, look, listen, and think, and call for help! 00:01:39.000 --> 00:01:41.000 Choose a team leader. 00:01:41.000 --> 00:01:50.000 Usually security personnel are needed to secure the incident site, Zone 1 or Ground Zero as 00:01:50.000 --> 00:01:53.000 it is called in court. 00:01:53.000 --> 00:01:58.000 Wear protective gadgets including gloves and helmet. 00:01:58.000 --> 00:02:08.000 Select a medical incident commander to manage triage, treatment and transport, the 3Ts. 00:02:08.000 --> 00:02:11.000 These are very important in mass casualty incidents. 00:02:11.000 --> 00:02:19.000 Triage, treatment, and transport the patient. 00:02:19.000 --> 00:02:25.000 Some ambulances are able to sustain lives that require advanced support. 00:02:25.000 --> 00:02:28.000 Call for an ambulance. 00:02:28.000 --> 00:02:35.000 Triage is a French term meaning pick and sort, or select and categorize. 00:02:35.000 --> 00:02:39.000 It involves: classifying victims in order to assign priorities for medical care and 00:02:39.000 --> 00:02:48.000 transportation, urgency of the case handling to increase victims' likelihood of survival. 00:02:48.000 --> 00:02:58.000 The aim is to provide the greatest good for the greatest number of people injured. 00:02:58.000 --> 00:03:00.000 Triage categories. 00:03:00.000 --> 00:03:06.000 Triage uses agreed colors to communicate amongst personnel. 00:03:06.000 --> 00:03:13.000 Triage ribbons or cards can be used, although in resource constrained countries, you may use 00:03:13.000 --> 00:03:15.000 other coding systems. 00:03:15.000 --> 00:03:23.000 It tells intervention teams the priority level with which to handle each affected person. 00:03:23.000 --> 00:03:30.000 This is an example of a color coded triage card. 00:03:30.000 --> 00:03:38.000 Triage categories include those injured or affected persons that need immediate care, 00:03:38.000 --> 00:03:44.000 those that need delayed care, those that need minor care, and those that can be classified 00:03:44.000 --> 00:03:47.000 as deceased. 00:03:47.000 --> 00:03:54.000 The Red Coded are first priority at the mass casualty incident. 00:03:54.000 --> 00:03:58.000 Immediate care should be started. 00:03:58.000 --> 00:04:06.000 They have a compromised airway, or are in shock, and need immediate resuscitation. 00:04:06.000 --> 00:04:10.000 The Yellow Coded are the second priority. 00:04:10.000 --> 00:04:11.000 Urgent care is needed. 00:04:11.000 --> 00:04:16.000 They can deteriorate to Red category in a short time. 00:04:16.000 --> 00:04:21.000 They are in impending shock. 00:04:21.000 --> 00:04:28.000 The Green Coded are the third category and include all walking wounded. 00:04:28.000 --> 00:04:30.000 Care can come later. 00:04:30.000 --> 00:04:35.000 However, they need monitoring for any sign of deterioration. 00:04:35.000 --> 00:04:40.000 The Black Coded are either dead or hopelessly wounded. 00:04:40.000 --> 00:04:43.000 They should not take priority time and resources. 00:04:43.000 --> 00:04:47.000 Concentrate on those that can be saved. 00:04:47.000 --> 00:04:49.000 How To Triage. 00:04:49.000 --> 00:04:58.000 Begin by assessing all non-moving patients where they lie. 00:04:58.000 --> 00:05:00.000 Use START Triage. 00:05:00.000 --> 00:05:09.000 START, meaning Simple Triage And Rapid Treatment, where treatment here refers to first aid treatment 00:05:09.000 --> 00:05:12.000 and follow up treatment. 00:05:12.000 --> 00:05:17.000 Triage can be performed by any individual including non-health workers. 00:05:17.000 --> 00:05:23.000 Because of the scarcity of manpower, all who can should participate in triage. 00:05:23.000 --> 00:05:33.000 Triage Techniques: We consider three main aspects: respiration, blood circulation, and 00:05:33.000 --> 00:05:34.000 consciousness. 00:05:34.000 --> 00:05:38.000 Under respiration, we check: Are they breathing? 00:05:38.000 --> 00:05:41.000 And if they are breathing, what are their breaths per minute? 00:05:41.000 --> 00:05:48.000 These are important criteria that can help us decide whether someone needs immediate 00:05:48.000 --> 00:05:51.000 care or delayed care. 00:05:51.000 --> 00:05:54.000 Under Blood Circulation, we check: Is there a pulse? 00:05:54.000 --> 00:06:04.000 If there is a pulse or if there is no pulse, how is the perfusion of blood into the tissues? 00:06:04.000 --> 00:06:05.000 Three, Consciousness. 00:06:05.000 --> 00:06:07.000 Are they conscious? 00:06:07.000 --> 00:06:09.000 Or, what is their Mental status? 00:06:09.000 --> 00:06:21.000 All these 3 areas of assessment should take less than one minute per patient. 00:06:21.000 --> 00:06:23.000 Checking for Respiration. 00:06:23.000 --> 00:06:30.000 If there is no respiration or they are not breathing, open the airway and clear the airway 00:06:30.000 --> 00:06:37.000 by stretching the neck and clearing anything that may be in their mouth. 00:06:37.000 --> 00:06:41.000 If there is still none, label as black. 00:06:41.000 --> 00:06:45.000 If the respiration is restored, label as red. 00:06:45.000 --> 00:06:52.000 If the respiration rate was initially present and the breathing rate was above 30 beats 00:06:52.000 --> 00:06:59.000 per minute or a visibly faster rate, label as red. 00:06:59.000 --> 00:07:06.000 However, if the breathing rate is below 30 in the initial breathing, then go to the next 00:07:06.000 --> 00:07:14.000 stage of assessment and that is the circulation, or the perfusion. 00:07:14.000 --> 00:07:21.000 Blood circulation is the same as perfusion. 00:07:21.000 --> 00:07:28.000 Check if the radial pulse is present, and if it is not present, or the capillary refill 00:07:28.000 --> 00:07:34.000 is greater than 2 seconds, label as RED. 00:07:34.000 --> 00:07:42.000 If the radial pulse is present and normal or the capillary refill is less than or equal 00:07:42.000 --> 00:07:46.000 to 2 seconds, then that means that circulation is ok. 00:07:46.000 --> 00:07:53.000 For some patients, if they have passed the respiration test and they have also passed 00:07:53.000 --> 00:08:01.000 the circulation test, we need to check the mental status. 00:08:01.000 --> 00:08:14.000 If the mental status cannot follow simple commands, then they are unconscious or have 00:08:14.000 --> 00:08:17.000 an altered level of consciousness. 00:08:17.000 --> 00:08:19.000 These are labeled as Red. 00:08:19.000 --> 00:08:26.000 If they can follow simple commands on their first or previous test, that is respiration, 00:08:26.000 --> 00:08:38.000 circulation, then label as Yellow if they are unable to walk or Green if they are walking. 00:08:38.000 --> 00:08:42.000 This is the summary algorithm. 00:08:42.000 --> 00:08:55.000 Take time to look at it. 00:08:55.000 --> 00:08:56.000 Summary. 00:08:56.000 --> 00:09:02.000 Triage is the single most important decision involving management of mass casualty incidences. 00:09:02.000 --> 00:09:13.000 Triage evaluation involves airway and breathing, that is, respiration, checking the circulation, 00:09:13.000 --> 00:09:16.000 and checking the mental status. 00:09:16.000 --> 00:09:25.000 However, after the Triage, the Triage teams need to hand over the serious cases to the first aid 00:09:25.000 --> 00:09:35.000 treatment teams. Later on, we shall look, in another session, we shall look at first 00:09:35.000 --> 00:09:41.000 aid treatment. Medical facilities are encouraged to develop mass casualty plans for their facilities 00:09:41.000 --> 00:09:47.000 based on operating capacity and resources. District committees and local authorities 00:09:47.000 --> 00:09:53.000 should identify key players in search and rescue and in first aid. 00:09:53.000 --> 00:09:57.000 Thanks for listening.