Mass casualty overview
name an example of a mass casualty incident
shoot shooting
sink hole
bomb
massive car accident
What is step one of the Start triage protocol?
A. Yelling if you can hear me, move over to this area to determine our green.
B. Mental status: determine if they are conscious, can follow commands, and are A&O
C. Breathing: What is their Respiratory Rate above or less than 30
D. Airway: is the patient breathing on their own?
A. Yelling if you can hear me, move over to this area to determine our green aka our walking wounded.
The next steps would be:
D Airway
C. Breathing
B. Mental Status
You are triaging a college shooting. You are running the mass casualty since you are there on scene first with the most experience. what is the first step of the start triage.
A. Make sure that we assess the most critical patients first
B. Call out for anyone who can move to get up and move to a disclosed location
C. Send first responders into an unstable building to begin triaging
D. assess patients for mental status including A&O status
B. The first step is to divide the walking wounded from the critically ill!
how do you define a patient as white in a triage situation?
very minor injuries that could potentially become part of the medical team if needed
your patient has an aortic rupture or a ruptured diaphragm. What tag are you giving them?
what is the most important thing to assess before beginning a triage?
Make sure the scene is safe
What is step 2 of the jumpstart protocol and how does it work?
A. Are they breathing. Yes --> move on to respiratory rate. No--> instant Black tag
B. Are they breathing. Yes--> move on the Respiratory rate. No --> give 2 rescue breaths and chin tilt. If they begin breathing --> red
C. Are they breathing. Yes --> yellow No --> begin CPR if not pulse and tag as red
D. Are they breathing. Yes--> move on to Respiratory rate. No--> give a chin tilt or jaw thrust. if they begin breathing --> red if they do not --> black
D. Are they breathing? Yes --> move on to RR. No --> give a chin tile or jaw thrust. if they begin breathing --> red. If they do not --> black even if they still have a pulse.
Tag this patient appropriately. Mr jones is a 30 year old male. He was involved in a mass casualty car accident. He is not able to move. when assessed he is not breathing but after a chin tilt he begins breathing again.
A. Black
B. yellow
C. green
D. Red
Red.
Green would be if he was able to move and walk to a disclosed location
yellow would be if he was spontaneously breathing.... then we could continue down the algorithm
Black would be if he didn't regain his breathing.
How do you define a patient as black in a triage situation
A patient who is dead, expected to die, or has injuries that are so extensive that they will not be able to survive without he resources we have right now
Your patient has a clavicle fracture and a pelvic fracture. What are you tagging them?
Red
how are treating patients different in a hospital setting vs a mass casualty?
in the hospital we have an endless amount of resources and will take care of the sickest person first regardless of their disease. In mass casualty, we an only treat the people that have the best chance of survival so if they have massive injuries, we will leave them for other and tag them as black
Which correctly describe the step to complete after triaging the green tags and assessing airway?
A. Circulation: Cap refill less than 2 seconds --> go to next step, over 2 seconds --> red
B. Circulation: cap refill less than 2 seconds --> red. over 2 seconds --> go to next step
C. Breathing: Respiratory rate less than 30? --> go to next step, RR over 30 --> Red
D. Breathing: Respiratory rate more than 30? go to next step, RR less than 30 --> Red
C. Breathing: RR less than 30 --> go to the next step, RR more than 30 --> RED
- normal RR is 12 -20. Less than 30 demonstrates that we are getting adequate oxygenation and a normal WOB. more than 30 RR means that we have an increased WOB and tachypnea signaling the need for increase oxygenation and should be taken care of right away as a red tag
Maribella is a 26 yr old female involved in a mall shooting. After the scene was secure you have made it to her to triage. Assign her the appropriate tag. She has a gunshot wound to the LLQ. She is breathing spontaneously with a RR of 28. Her cap refill is 6 seconds.
Red.
Although she was breathing spontaneously and had a RR less than 30, her Cap refill above 2 seconds makes her critical.
how do you define a patient as red in a triage situation
Will die without immediate treatment but still have a great chance of survival without using too many supplies
Your patient has a R shoulder dislocation and a laceration to the forehead. Also has a broken nose. What are you rating this person
Yellow
how do we determine which patients we go to first in a mass casualty situation?
We actually go to whoever is closest and triage and them move on systematically.
After deterring our green tags, assessing airway and breathing? Which correctly matches step 4 in the start triage algorithm?
A. Mental status eval: A&O x4 and follows commands --> yellow, unconscious or confused --> Red
B. Mental status eval: conscious and confused --> yellow, unconscious --> red
C. Circulation: capillary refill less than 2 seconds --> continue on to the next step, over 2 seconds --> instantly red
C. Circulation: capillary refill less than 2 seconds --> yellow, over 2 seconds --> Black
C. Circulation AKA perfusion is the next step after determining if airway and breathing are okay. if the capillary is less than 2 seconds then we have adequate perfusion and we can move on to the next step. If we are above 2 seconds we are not perfusing well and are instantly red and critical
Shaquanda is a 19 year old female. She was involved in a building collapse. Assign her the correct tag. upon assessment she has seesaw breathing and blood pooling from a penetrating wound to the R thoracic cavity. She is breathing when you assess her.
BLACK
this patient does not have a large enough chance of survival for us to allocate resources to her.
How do you define a patient as yellow in a triage situation
they can continue to be monitored while still triaging others, they have the potential to deteriorate but will not need emergency hospital care. They will still need to go but not immediately
Your patient has raccoon eyes and cerebrospinal fluid leaking from their nose and head. They have a clavicular fracture. What are you tagging them in triage?
Red
After each patient has been triaged what do we place on them so people know they have been triaged?
We place a triage tag and circle a color
What is the final step of triaging in the start triage model?
A. Mental status --> A&O x4 = yellow... confused = red
B. Mental status --> A&O x4 and conscious --> green ..... unconscious --> red
C. Mental status --> A&O x4 and conscious --> yellow unconscious or confused --> red
D. Mental status --> A&O x4 and conscious ---> Red... Unconscious ---> Black
C. Mental status --> A&O x4 and conscious --> yellow. Unconscious or confused --> Red
The last step is to assess mental status. If the patient is A&O x4 and conscious and can follow commands then they re considered to be yellow meaning that based on all the assessment data airway, breathing, circulation, and mental status they are stable enough to get medical care at some point but are not considered critical like a unconscious or disoriented person is.
Jason was involved in a massive 60 car pile up on the 101. He has a broken femur and is bleeding for a head laceration. he is pulled out of his car and has his own work of breathing. RR of 28, cap refill of 1 second, and is able to follow commands.
Yellow. Based on the algorithm his injuries although major and in need of attention are still something that is manageable for a triage team. this patient has an airway --> has a RR less than 30 --> has a cap refill less than 2 --> and has the ability to follow commands and is A&O.
How do you define a green patient in a triage situation?
The walking wounded. They need medical care at some point but are relatively stable
Your patient has a flail chest and no sensation to either legs based on reflexes. They are unconscious and have a pulse. They have an open femur fracture with an estimated blood loss of 2L.
Black. Chance of survival for this patient are relatively low