MASS Triage Scenario V 3 0 2007 ADLS

® MASS Triage Scenario V 3. 0 β 2007 ® ADLS is a registered trademark of the American Medical Association

Objectives During a facilitator led mass casualty scenario-based discussion you will: • Discuss DISASTER paradigm • List components of MASS triage • Identify victim triage categories V 3. 0 β 2007 2

Triage “Tabletop” V 3. 0 β 2007 3

Triage Scenario • Shooting incident at a local shopping center – Multiple gunshots were fired – You are first at the scene – 10 victims • What do you do? V 3. 0 β 2007 4

Is Need > Resources? • D- Detect – Is this a disaster / MCI? (need>resources) • I- Incident Command – Who is in charge? (incident commander) Who will you contact? • S- Scene Safety/Security – Is it safe enough to enter? • A- Assess Hazards – Active shooter? Secondary device? Further penetrating trauma • S- Support – Law enforcement, EMS, Medical Control, Trauma Center, etc. . • T- Triage/Treatment – 10 victims • E- Evacuation – What vehicles are available? What route is safe? • R- Recovery V 3. 0 β 2007 5

D-I-S-A-S-T-E-R Paradigm Triage M. A. S. S. Triage System M – Move A – Assess S – Sort S – Send V 3. 0 β 2007 6

MASS Flow Chart V 3. 0 β 2007 7

Step 2: M. A. S. S Triage • Move • What are the two action steps? • Assess • Who are you going to approach first? • Sort • How will you categorize your patients? • Name three variables impacting decision making? • Send V 3. 0 β 2007 • When and what transportation methods are available? 8

MASS Triage • Move – Two walk – Three move • Assess – Five do not move • Sort – IDME categories • Send V 3. 0 β 2007 9

MASS Triage • Move – Two walk (Minimal Group) – Three move (Delayed Group) • Assess – Five do not move (Immediate Group) • Sort – IDME categories • Send V 3. 0 β 2007 10

Triage Status Category Immediate Delayed Minimal Expectant DEAD V 3. 0 β 2007 Group 5 3 2 11

MASS: Immediate Group Unable to “MOVE” • 29 yr male Immediate – GSW to left chest, awake in severe respiratory distress • 8 yr female Expectant – GSW to head (through and through) RR=4, HR=101 • 50 yr male Dead – GSW to abdomen & chest, RR=0, HR=0, not moving • 40 yr female Immediate – GSW to neck with gurgling respirations, marked respiratory distress • 16 yr male Immediate Vs Expectant – GSW right chest, No respiratory effort, HR=130 thready 12 V 3. 0 β 2007

MASS: Delayed Group Able to “MOVE”, not walk • 14 year male Immediate Delayed – GSW to R upper arm, active massive **after pressure dressing hemorrhage, good pulses • 65 year male Immediate – No obvious GSW, c/o severe chest pain, diaphoretic, and SOB • 22 year female Delayed – GSW to R leg, good pulses, no active bleeding, normal VS V 3. 0 β 2007 13

MASS: Minimal Group Able to “MOVE”, can walk • 29 yr male Minimal – Superficial “scratch” wound to L arm, no deeper penetration • 37 yr male Delayed – GSW to left hand, exposed muscle, tendon and bone fragments, capillary refill < 2 sec V 3. 0 β 2007 14

Triage Status Category Immediate Delayed Minimal Expectant DEAD V 3. 0 β 2007 Group SORT 5 3 2 4 -5* 2 1 1 -2* 1 15

SORT: Immediate • 29 yr male Delayed – GSW to left chest, awake in severe respiratory distress: Needle decompression of L chest successful, VSS • 40 yr female Dead • 14 year male Delayed – GSW to neck with gurgling respirations, marked respiratory distress: Airway management unsuccessful, profuse bleeding occurred, pt now apneic and pulseless – GSW to R upper arm, active massive hemorrhage, good pulses: Now well controlled, no active bleeding, VSS • 65 year male Immediate – No obvious GSW, c/o severe chest pain, diaphoretic, and SOB: Symptoms continue V 3. 0 β 2007 16

SORT: Delayed • 22 year female Delayed – GSW to R leg, good pulses, no active bleeding, normal VS: Splinted leg, VSS • 37 yr male Immediate – GSW to left hand, exposed muscle, tendon and bone fragments, initial capillary refill < 2 sec: Now L hand is pulseless and cyanotic V 3. 0 β 2007 17

SORT: Minimal • 29 yr male Minimal – Superficial “scratch” wound to L arm, no deeper penetration: No clinical change, desires to leave and go home V 3. 0 β 2007 18

SORT: Expectant • 16 yr male Dead – GSW right chest, No respiratory effort, HR=130 thready: Now no palpable pulse, no respiratory effort • 8 yr female Immediate? – GSW to head (through and through) RR=4, HR=101: RR=6 -8, HR=100 V 3. 0 β 2007 19

Triage Status Category Immediate Delayed Minimal Expectant DEAD V 3. 0 β 2007 Group SORT 5 3 2 SORT 4 -5* 2 1 1 -2* 3 3 1 0 1 3 20

Summary Now you can: During a facilitator led mass casualty scenario-based discussion you can • Discuss DISASTER paradigm • List components of MASS triage • Identify victim triage categories V 3. 0 β 2007 21

Questions? V 3. 0 β 2007 22