(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.