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Disaster Triage Part One: Becoming a Triage Leader

April 4, 2014 | 31 comment(s)

In just about any large-scale disaster, there will likely be a large number of people who will experience minor, critical, or life-threatening injuries. First responders may not reach your neighborhood for hours, or even days. So if a disaster happened in your area, injuring dozens of people, what would you do?

You and your neighbors will have to select a triage leader and set up a triage area where the injured can receive treatment until medics arrive. In disasters like earthquakes, hurricanes, or tsunamis a triage could last for days or weeks.

Disaster Triage (part one): Becoming a Triage Leader

Photo Courtesy of Otis Historical Archives Nat'l Museum of Health and Medicine

The goal of disaster triage is to separate people into groups ranging from minor injuries to those who are deceased. You must ‘sort’ these people into specific areas as quickly and efficiently as possible so they can receive the help they need.

The purpose of this article is to help you perform the role of ‘triage leader’ to the best of your abilities before medical experts arrive.

Your role as the triage leader

First, let’s look at your role as triage leader. You must understand that Triage is not treatment. It’s only a means of sorting people into appropriate areas, which takes limited medical skill. However, a triage situation is just one reason why everyone should get some sort of medical training (CPR, basic first aid, or Community Emergency Response Team [C.E.R.T] training). These classes are available just about anywhere.

If you do not have an extensive amount of medical training, no one expects you to be perfect. Your instincts, calmness, and direction can get you (and those who have volunteered to help you) through a disaster situation, whether you have medical training or not. The main purpose of disaster triage is to do the greatest amount of good for the greatest number of people in the shortest amount of time.

Once you’ve sorted everyone, others can be assigned to take care of victims in the different groups . When medics arrive, they will assume the role of triage, and you can assist them in any way they deem necessary.

Three main objectives you must be aware of as a triage leader:

1. Safety- If the area you plan to use as your triage area is not safe, move it to a place that is. In inclement weather, make sure you can find a building or shelter that is not damaged, and won’t cause further injury to anyone.

2. Surroundings- Be continually aware of your surroundings. Stop, look, and listen. Look for any overhead or adjacent dangers around you. Ideally, you want to find a spot that’s large enough to handle the number of victims you have and that will be safe for the duration of the disaster. Don’t let your guard down. Continually monitor the area for safety concern. Just because an area has been deemed safe at first, it doesn’t mean it can’t become a danger at a later time.

3. Victims- Call out to any victims in your area and ask them if they are able to come to the sound of your voice. Based on their responses, you can start to triage these victims and sort them appropriately. Have the un-injured spread out and tell others of your triage location. Have them help the injured get to your triage area. Assigning the un-injured this task will give them a way to help, if they are looking for one.

If you become the triage leader, you’re going to have to make some very difficult decisions. You’ll have to put your personal feelings and emotions away and stay focused on the task at hand. The people you will have to triage may be strangers, neighbors, or even family and friends.

You can’t get personally involved and forget your role; if you do, you may delay treatment to other victims whose conditions may worsen. By providing quick triage and rapid treatment, many lives could be saved.

Triage Categories

During medical triage, victims’ conditions need to be evaluated quickly (20 to 30 seconds per person.) Victims can be marked with anything you have available—tape, markers, strips of cloth or other materials you can find that will distinguish their level of triage. After marking them, you can prioritize them into one of the following four categories:

•  Immediate (I):  The victim has life-threatening injuries (airway, bleeding, or shock) that demand immediate attention to save his or her life; rapid, lifesaving treatment is urgent, and they should be the first ones sent to the hospital when first responders arrive. These victims are marked with a red tag or labeled “I”

•  Delayed (D):  Injuries do not jeopardize the victim’s life. The victim may require professional care, but treatment can be delayed. They have severe bleeding that can be stopped and maintained, and severe limb injuries that will require hospitalization or possibly surgery. These victims are marked with a yellow tag or labeled “D”.

•  Minor (M): Walking wounded and generally ambulatory. They may have cuts, scrapes, injured extremities or other minor injuries. These patients can even assist with those who may have more severe injuries. These victims are marked with a green tag or labeled “M”.

•  Dead (DEAD): No respirations after 2 attempts to open the airway. Because CPR is a one-on-one care and is labor intensive, CPR is not performed when there are many more victims than rescuers. There are going to be those who are obviously deceased because of their injuries. There are going to be those who are critically injured, and it may take lots of resources to possibly save them. You will have to make a decision as to whether or not you have the resources available to provide care that may or may not save their life. These victims are marked with a black tag or labeled “DEAD”.

One of the most important things you can do is set up the area for the dead in a location close to your triage zone, but away from the view of victims in the other three categories. It’s very emotional and difficult for those who are injured and being treated  to see those who have not made it through the disaster.

How to Assign Victims to Categories

 

 Evaluating a Victim During Triage

Remember that this needs to be done in 20 to 30 seconds per victim, and then move on to the next casualty. If patients need immediate treatment, such as stopping severe bleeding or opening their airway, have your volunteers take care of these tasks so that you can continue to sort victims into the appropriate areas.


This post was posted in Insight, First Aid and Sanitation and was tagged with First Aid, triage, emergency response

Comments

  • Sandy  |  April 8, 2014

    Excellent article! Thank you.

  • Gary  |  April 8, 2014

    Following this advice will likely get a lot of people killed un-necessarily and certainly get the person (s) performing Triage sued and/or criminally charged after the fact. Triage MUST be performed by someone with emergency medical training. Otherwise, they will have no idea of how to prioritize victims and will make tragic - probably life ending mistakes.

  • Linda Eastman  |  April 8, 2014

    I found this article very helpful. Thank you.

  • Raygina  |  April 8, 2014

    Great article. There's a good Samaritan law that prevents lawsuits against people trying to assist in an emergency so Gary, that's covered.

  • Larry  |  April 8, 2014

    If you wish to get this type of training it is free by joining your local CERT team which many counties have formed for dealing with local disasters. You can also get training in search and rescue , security, communications and other areas. Be a volunteer today...they need you.

  • linda landry  |  April 8, 2014

    you need to allow us bigger printing for such articles

  • Linda Hunt  |  April 8, 2014

    Very good article, and well-written. I'm printing this and adding it to my first-aid kit, and also realize I'd better brush up on my EMT training! Thank you for the excellent information.

  • AMS  |  April 8, 2014

    It is tragic that we are at a point where we are scared to help people for fear that we will be sued - even if they're bleeding to death. We should help people whenever and wherever possible - sometimes, even without 'training', it just comes down to Good Sense on our part ---and Love, Charity and Good Will. Love your neighbor enough to try to help them.
    ams*;*

  • Jo  |  April 8, 2014

    The first two steps before beginning any triage are
    1) Stop, take a deep breath, and take your own pulse. This will help to clear your own head and allow you to focus
    2) Tell any walking wounded to move away to a designated nearby area. This allows those who can to triage themselves. These people are green tagged as minor. Some are also invaluable as assistants. Those that are capable can monitor the injured, maintain pressure to control bleeding, whatever is needed.

  • Mike M  |  April 8, 2014

    Gary,
    Remember the old phrase "When seconds count, proper help is merely minutes away." Are you going to wait for EMT's to arrive when it might be days or weeks before they get there?

  • WolfBrother  |  April 8, 2014

    Interesting article - first responder triage has to happen.

    The big problem will be getting people to listen to you.



  • Gary  |  April 8, 2014

    A few points to consider: First off, it is my understanding that Good Samaritan laws do not protect you from gross negligence. They typically only serve to protect you IF you have some type of training AND do not exceed your training level. For example, an EMT performing an emergency tracheotomy has exceeded their level of training and is therefore liable. An ER doc doing the same procedure is covered.
    I do not advocate doing nothing until EMTs arrive. I do advocate getting training and BEING the EMT....Prepping isn't all about collecting toys. It IS about learning and developing skills.

  • charles  |  April 8, 2014

    gary don't worry we wont ask for your help

  • Raygina  |  April 8, 2014

    http://en.wikipedia.org/wiki/Good_Samaritan_law#Implied_consent

    Some of us don't have the mental or physical ability to train as an EMT. Would you prefer me, who can use a tourniquet, or to wait for two days for a properly trained EMT?

  • Bill C.  |  April 8, 2014

    All of you have valid points. I believe I can qualify my comments as I received 4 years of medical training in preparation to become a Certified Paramedic. I was the 79th Paramedic Certified in America circa 1973.
    I have performed CPR on numerous during my lifetime. , I performed a roadside Tracheotomy on the side of I-75 in Ohio., and I was in the heart of Xenia in April 1974 with 1600 casualties and 33 fatalities. Talk about on the job training!
    Providing "BASIC CARE" under American Red Cross guidelines will allow you to be protected un der the Good Samaritan Law.. Don't try to deliver a baby without any knowledge on how to do it or perform other critical levels of care. I would suggest that each reader, Google, The Good Samaritan Law to fully understand its intent.
    All in All, I found this article, (Part One) to be very informative.

  • Deacon Jim   |  April 8, 2014

    Gary does make a good point: get the training, then the question of liability becomes moot. Those who have skills are more valuable than those who have things. That said, you need things too! Be prepared.

  • CAL  |  April 8, 2014

    A disaster means that there are more victims than can be helped. The system is overwhelmed. I think this article addresses that type of situation. Maybe help wont be coming for days. Maybe Gary, you are the only one who could help. Can you hold pressure on a bleeding wound. Wrap a couple of sticks around a broken arm to keep bone fragments from grinding around. If you knew no help was coming, I think you could and probably would. I would.

  • tom  |  April 8, 2014

    Jeez, Charles, why so snippy? Gary is spot on.

  • John  |  April 8, 2014

    This is the procedure we are taught in CERT -- Community Emergency Response Training -- sponsored by FEMA.

    In an emergency, you do what you can. If there is no CERT or EMT present, you do what you can.

    If you have a local CERT team go get the training. If you don't have one, see about creating one. We'll have SHTF sooner or later -- or major weather disasters or major fire disasters.

  • Sue  |  April 8, 2014

    Excellent article. I teach the medical sessions in the C.E.R.T. training and it is a great way to prepare for an emergency or disaster. I agree with Gary in that some training is needed for triage BUT .... in case of emergency/disaster, the sooned triage is started the better the outcome. You don't need to be an EMT to prepare, just a little training and knowledge and COMMON SENSE.

  • Farmer  |  April 8, 2014

    To Gary: Disaster Triage Part One: Becoming a Triage Leader - all bets are off in a situation where "First responders may not reach your neighborhood for hours, or even days." I guess it's best to play it safe and not do anything until the lawyers say "OK". Gary, the purpose of the article is to alert people about what to do when the government doesn't show up to solve the problem. Sorry, your overcautious statement doesn't help.

  • Gary  |  April 8, 2014

    Charles, you are missing the point. Without some form of training, you can kill people that might otherwise survive without your "help". It's about being part of the solution in an emergency rather than making things worse.

    Triage means to sort out and prioritize injured people who need care. You cannot do that competently without having some form of first responder or EMS training.

    "Normal" triage during a non-mass casualty event means devoting resources to the persons needing it the most.
    Mass casualty triage is the opposite - you are ruling out the people who will tie up the majority of resources (and are likely to die anyway) and focus on the persons who have a higher probability of survival if cared for.

    These decisions are literally life and death matters and anyone taking it upon themselves to make such decisions without knowing what they are doing is irresponsible beyond words.

    I will reiterate what I said in my previous post - get EMS training so that you can competently and efficiently triage and actually save people rather than finishing them off with your good intentions.

  • Bob  |  April 8, 2014

    Emergency Essentials... keep up the good work with articles like this one. Well written article on saving lives in times of disaster.

    If read in the context it is written, the article is complete; explaining situation, how to prepare for it , and what to do to best save lives in times of disaster. Emphasis on "save lives" and "disaster"!!

    Usually we don't get to know when or in what form a disaster will arrive. Hmmm... probably has something to do with it being a disaster and all that.

    Lives are saved by those who have the courage to act when the need arises. (Maybe one should first ask if the person being triaged is a lawyer named Gary - bad joke... but you get my point.)

    Much praise to Mike M, Jo, Ams,, Raygina and the others for countering the negative, out of context remark early in the blog with a spirit of humanity for our fellow human beings. Triage skills can be vital. God forbid; when/if the time comes, you will be glad you have the skills, and understand the concept of triage.

    Pity those who care more about lawsuits than life. I'm sure the lawyers will find some contingency business AFTER lives have been saved.

  • Farmer  |  April 8, 2014

    Gary, wait for the government to ride in and solve the problem. I'm sure they will arrive in the nic of time with a battery of lawyers ..... meanwhile, I won't watch my friends bleed out because of fear of the lawsuit. Cheers

  • Roberta S.  |  April 8, 2014

    Gary,
    You are not quite right about your understanding of the Good Samaritan Law. In an emergency situation assuming control is determined by need and ability. Whoever can assume that leadership position, when necessary, can make decisions for triage . Triage is an ongoing assessment. Dead do not revive, 2ndary triage moves patients up or down as stabilization increases or most probably decreases. Attempting to prevent death , where and when possible with available help must be prioritized. Traumas are dealt with to the best of ability with material and assistants at hand.... In any situation the rescuers are protected from litigation....ie moving an injured victim from a mv that may explode, and paralyzingly the victim is Not a litigious act... By all means we need training but in a emergency like the mud slide that just was in the news, or a tornado, hurricane, flood , avalanche, bombing etc. ANY ASSISTANCE IS FAR BETTER THAN NONE ...AND HOWEVER CASUAL IF ONE LIFE IS SAVED. EVERY EFFORT IS WORTH MAKING.

  • beprepared  |  April 9, 2014

    Gary,
    We state in the article that it's important to get medical training now before a triage situation occurs. Our purpose in putting this article out now is so that people can think--hey, I should probably get training in case I have to do this or so that I can help the triage leader. We're not at advocating that "it's totally fine to not have any training at all." We're advocating for people to start preparing now--get first aid training so that you can help in a situation like this. It's just a way to get people to think--"would I be prepared or qualified to help others if a situation came to this?" If you don't think you are, but you want to be of any help that you can during an emergency, get prepared now so you can be. Your local C.E.R.T or Red Cross can help you get this training. But if the situation comes where you don't have medical training and are made triage leader, I think the first thing to do is to ask others what type of medical experience they have and then to ask for help and use common sense and reasoning when needed to do the greatest good. That's all you can do, especially if others may not be willing to take on that role.

  • Susan  |  April 9, 2014

    I think the article is probably considering an after the SHTF situation when medical help may not be available for days and any help whatsoever is better than nothing. The key to the Good Samaritan Laws as I understand it is "good faith" on the part of the Samaritan. Of course you shouldn't attempt surgery on anyone as a layman, but any help you can give an injured person in a SHTF situation is better than none.

  • Gary  |  April 9, 2014

    OK, this is my last attempt : I don't give a rodent's rectum if the Good Samaritan Laws are in effect or not, whether someone will get sued or not. That part of my earlier post was merely addressing one person's comment. Quit focusing on stupid bunny trails.

    What I AM trying to get everyone to understand is that NO MEDICAL CARE AT ALL MAY, IN SOME INSTANCES, BE BETTER THAN CARE FROM UNTRAINED PERSONS. Simple case in point: A pelvic fracture. I have seen stupid people try to get an injured person up and on their feet, encouraging them to "walk it off". Doing this to a person who's pelvis is fractured can cause the iliac artery to be severed by sharp bone fragments, the result being that they bleed out in minutes....

    Again, my message is NOT to call your lawyer first and see if you are covered by the Good Samaritan Law. My message is NOT to call 911 and wait for EMS to arrive.

    My Message IS to get training so that you don't kill people with well intentioned ignorance.

  • Cal  |  April 9, 2014

    So you use common sense. If you don't have common sense, can't work under pressure then don't triage. If someone has pelvic pain, you don't ask them to walk. That is common sense. In any event, asking someone to walk who is complaining of pelvic pain is not triage. In triage, you look at someone who has pelvic pain and that would be someone you might categorize as in need of immediate care. Then you move on to the next victim. Triage is not treatment; it is deciding who to treat in which order. Triage allows you to use your limited resources to benefit as many injured as possible. So, when someone who knows what to do arrives, like me, you can say hey, this one has pelvic pain and Then I can wrap his pelvis in whatever is available, maybe a sheet. Maybe no one has any medical training on scene. Maybe there are 50 injured and 10 blankets. Knowing who is the most injured can help you decide who gets a blanket. Hypothermia is very bad for trauma victims. Anyway, this article is for people with an interest; if you are interested you learn more. If you have no interest then why discourage others. Someday, one of them might save your life.

  • Steve  |  April 10, 2014

    For Gary,

    Wow dude, chill out! If you don't care about what the laws etc are, than do us all a favor and shut it. It was a good article for someone to read and certainly gets others that may not have the training but want to help others a good refresher. There's an old saying 'some thing are better left unsaid' just give it a break already.

  • Rhea Henshaw  |  April 16, 2014

    Thank you for this article. It has inspired me to look into this type of training and other training as well to help out in a disaster. All you at Emergency Essentials are great.

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