PRINSIP TRIAGE pada Kasus Bencana MasalPhoto used with permission of the Emergency Education Council of Maryland Region 5.

What is Triage?Triage sortirEvaluasi berdasarkan kebutuhan medis dan urgensi pada masing2 klien dalam waktu terbatas

Triage is a dynamic process and is usually done more than once.

Primary Disaster TriageTriage based on physiologyKemampuan pasien dalam menghadapi /mengkompensasi trauma atau injuri Bila gagal prioritas tinggi

Primary Disaster TriageThe most commonly used adult tool in the US and Canada is the START tool.The pediatric MCI primary triage tool most commonly used in the US and Canada is Jump START.

The Best Tool?No MCI primary triage tool has been validated by outcome data.Wiseman DB, Ellenbogen R, Shaffrey CI. Triage for the Neurosurgeon, Neurosurg Focus 12(3), 2002. Available on the Internet at www.medscape.com/viewarticle/431314

Triage Categories

NATO GuidelinesRedAirway obstruction, cardiorespiratory failure, significant external hemorrhage, shock, sucking chest wound, burns of face or neck

YellowOpen thoracic wound, penetrating abdominal wound, severe eye injury, avascular limb, fractures, significant burns other than face, neck or perineum

NATO GuidelinesGreenMinor lacerations, contusions, sprains, superficial burns, partial-thickness burns of < 20% BSA

BlackHead injury with GCS85% BSA, multisystem trauma, signs of impending death

START: Step 1Triage officer announces that all patients that can walk should get up and walk to a designated area for eventual secondary triage.

All ambulatory patients are initially tagged as Green.

START: Step 2Triage officer assesses patients in the order in which they are encounteredAssess for presence or absence of spontaneous respirationsIf breathing, move to Step 3If apneic, open airwayIf patient remains apneic, tag as BlackIf patient starts breathing, tag as Red

START: Step 3Assess respiratory rateIf 30, proceed to Step 4If 30, tag patient as Red

START: Step 4Assess capillary refillIf 2 seconds, move to Step 5If 2 seconds, tag as Red

START: Step 5Assess mental statusIf able to obey commands, tag as YellowIf unable to obey commands, tag as Red

MnemonicRPM302Can do

Photo used with permission of the Emergency Education Council of Maryland Region 5.

Whats your call?An adult kneels at the side of the road, shaking his head. He says hes too dizzy to walk.RR 20CR 2 secObeys commands

Whats your call?Adult female driver still in the bus, trapped by her lower legs under caved-in dash.RR 24Cap refill 4 secMoans with verbal stimulus

Whats your call?An adult male lies inside the bus.ApneicRemains apneic with jaw thrust

Whats your call?An adult male lies on the groundRR 20Good distal pulseObeys commands but cries that he cant move his legsOR

Key Points about MCI TriageMCI triage will never be logistically, intellectually, or emotionally easy

but we must be prepared to do it using the best of our knowledge and abilities.FEMA Photo Library

Key PointsThe physiology of adults and children differ; therefore different primary triage systems should be usedUse JumpSTART for infants through older childrenUse START for young adults and olderPrimary triage is just the first look at an MCI victim, similar to the primary/initial survey/assessment

**The word triage is based upon a French term that means to sort. In the emergency medical setting the triage process attempts to sort and prioritize patients according to their acute medical needs. This process is not meant to discover the fine details of a patients condition and needs but to grossly sort those seeking care based upon a limited history and physical assessment by triage personnel. Triage categorization may not be strictly dependent upon patient-specific information. Resource availability and time factors may influence triage decisions. For example, in normal Emergency Department triage, a patient who ordinarily would be triaged in an intermediate category when patients are being seen rapidly after triage may be classified as critical if the patient load is high and the patient is likely to be endangered by a longer wait if classified as intermediate. *Triage is a dynamic process. Every time we reevaluate a patient we are, in essence, re-triaging them. We add, subtract or maintain resources based upon our assessment of the progress of the patients condition. The same holds true in disaster triage. Additional information is acquired with each stage of triage. The additional information about patient condition and incoming information about resource availability may result in any patient being upgraded or downgraded in triage priority at any stage. Hopefully, no MCI patient will be medically assessed only once. *Primary MCI triage is similar to the primary survey (or initial assessment in the EMT-B curriculum) in that it focuses on physiology rather than actual injuries or medical illnesses. By assessing the most vital physiologic functions, primary triage helps to determine whether or not a patients systems are able to compensate for the acute insult. Those who are unable to maintain vital body functions on initial assessment are assigned higher priority. *The most commonly used adult primary MCI triage tool used in North America is the START tool. The most commonly used pediatric tool is JumpSTART. START and JumpSTART are also utilized in other countries around the world. Both tools will be discussed in depth in the START and JumpSTART session of this resource.

Other tools are used by some agencies for MCI primary triage but few are tailored specifically for the MCI setting. *No primary MCI triage tools, including START and JumpSTART, have been validated by clinical outcome data. Research is needed to determine how to best perform primary triage for patients of all ages and for various incident types.

Although not validated by research, START and JumpSTART have gained acceptance because they are based on physiology, are relatively simple to perform and provide at least a basic objective structure for the task of primary triage. *****************