The concept of “triage” has been much in the news. Since emergency medicine is one of my hobbyhorses, I’ll ride it for a while.
Triage is a French word that means “sorting.” It comes into play any time your resources are overwhelmed.
In any emergency involving casualties there will be some who will get better even if you do nothing, and some who will die even if you do everything. Between those two extremes there will be a number who will get better if you do the right things right now but will die if you don’t. The purpose of triage is to find those people so your limited resources can go to them.
Green — Minor. This person can wait.
Yellow — Delayed. Is treated ahead of Green tags.
Red — Immediate. Treat and ship these people right now.
Black — Deceased. No treatment required or desired.
The tags have colored strips on the bottom with perforations. If you don’t tear anything off, the bottom is green. Tear off that strip, the tag becomes yellow. Then red. Then black. You see the progression?
First step. There you are, a sole rescuer, facing a scene of disaster. Turn to a bystander, look directly into his eyes, point to him, and say “You! Call 9-1-1 now. Get help. Come back and tell me when you’ve done it. Okay?” When that person says “Okay!” and trots off… you go to step two. (If there is no bystander, call it in yourself. Nothing you can do else is more important than getting more help rolling.)
Now: with lungs of iron and a voice of brass, shout “Yo! Listen up! Everybody go to [name and description of safe area nearby]!”
Everyone who moves to that area is a Green Tag. They’re the walking wounded. You’ll get to them when you can. (Note: They’re also a resource.)
Now, if and only if it is safe to do so, enter the area where the rest of the casualties are. (If it isn’t safe there’s no point in going in. All it’ll mean is one more casualty and one less responder. You’ve made the situation worse.)
Go up to each person who didn’t walk out. You’ll be spending about 30 seconds with each one.
1. Is the person breathing? Yes/No. If Yes, go to step 3.
2. If the person is not breathing, open their airway. (Tilt head, jaw thrust, scoop out foreign material, as appropriate.) Is the patient breathing now? If yes, Red Tag. If no, Black Tag. Move on.
3. Is the patient breathing more than 30 times per minute? If yes, Red Tag. Move on. If no, go to 4.
4. Squeeze the patient’s fingernail until the nailbed blanches. Let go and count how long it takes to darken again. If greater than two seconds, Red Tag. Move on. If less than two seconds, go to 5.
5. Ask the patient his/her name and what happened. If the patient does not reply or answers inappropriately, Red Tag. If the patient answers appropriately, Yellow Tag. Move on.
That’s it! Keep a tally of how many and what kind you have and where they are. If you have triage tags, that’s great. If not, and you can mark them in some other way (strips of colored cloth, colored surveyor’s tape) that’s great. Or, you can take your Sharpie Marker and write the Roman numeral I on the forehead of your Red tags, II on the foreheads of your Yellow tags, III on the foreheads of your Green tags (if they stand still for it) and the Arabic number 0 on the foreheads of your Black tags. If you can’t do any of those things — when help arrives tell the person is charge what you’ve found.
If a patient is going into shock, you can direct a bystander or a Green tag to treat that person for shock (elevate feet, keep warm). If a patient is bleeding heavily, you can direct a bystander or a Green tag to control the bleeding (direct pressure). Don’t stop or delay to do these things yourself. You have more important things to do.
If you enter a building, draw (spray paint or Magic marker) a diagonal line on the wall beside the door where you entered. When you come out cross that diagonal line with another to form an X, and write on the wall the number of patients who are inside. Later rescuers, when they arrive, will know if they see a single diagonal line that someone went in but hasn’t come out. If they see an X, they’ll know that the room has been searched. If they don’t see any mark they’ll search the room themselves.
When more help arrives, go to the senior person, inform that person of what you know, and ask for an assignment.
Copyright © 2005 by James D. Macdonald
I am not a physician. I can neither diagnose nor prescribe. This post is presented for entertainment purposes only. Nothing here is meant to be advice for your particular condition or situation.
Triage for Fun and Profit by James D. Macdonald is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 United States License.
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