MCI

Mass Casualty Incidents and Trauma Triage

While we as paramedics are equipped to deal with many different emergencies, our abilities are generally best directed at the care of a single patient. So what happens when you are the first on the scene of a major disaster like, for example, an explosion, or a highway pile-up? Well, now our priorities have to change a bit. As paramedics, we are still the first entry-point into the healthcare system; so our initial goals must change from treatment to triage. Instead of taking patients to emergent care, we have to bring the appropriate care to them. The method with which I was trained to manage MCIs is the SALT triage system. It stands for:

• SORT

• ASSESS

• Life saving interventions

• Transport

As the first unit on scene, you and your partner must take new roles. No longer are you attendant and driver; now you are triage officer and incident commander.

• Triage officer: Your job is to identify the number of patients and their degree of injury.

• Incident commander: Your job is to determine the additional resources needed on scene. This may include police, fire, and additional transport units.

Additional roles may be assigned to other allied emergency workers, such as traffic control, communications, and crowd control.

Triaging patients: This is probably the most important task, at least initially. We have to determine how critical each patient is in order to determine who is removed from the scene first. To do this we need to assess the patients on 3 criteria: Respirations, Pulse, and Mental status. We can then modify our triage based on other physiological factors.There is a fairly universal colour coding system for tagging each patient.

Field Triage Tag Categories:

• Black tag: Patients who are pulseless and apneic. These patients are triaged to the lowest priority. This may seem counter to everything you have been taught, but remember that our goal is to save as many patients as possible. We have to direct our resources to those people who we can still help.

• Red tag: Immediate. These are patients with life threatening injuries who require rapid transport . This includes patients who are unconscious, confused, tachypneic, tachycardic or bradycardic, hemorrhaging severely, in shock, or hypotensive.

• Yellow tag: Delayed. These patients are conscious, oriented and may have fractures or significant injury but do not present with signs of shock.

• Green tag: The walking wounded. Patients with minor injuries who are ambulatory on scene.

Treatment priority goes: First RED, second YELLOW, third GREEN.

As the first crew on scene we are not there to treat, we are there to sort. We begin by having anyone who can walk come to a staging area. Next we assess and categorize the remaining patients. While doing this we provide only life saving interventions such as BLS airway adjuncts, tourniquets, or rolling patients into recovery position. Once patients are sorted, the triage officer may be reassigned to assist in extrication and treatment with the additional resources that arrive. The incident commander is responsible for directing arriving ambulances to the red tag patients first, then yellow, then green. A patient log should be kept to track which patient leaves with which ambulance.