# If you have had to really do triage, raise your hand, er, cursors..



## mycrofft (Oct 30, 2008)

Out on the edge, or at least out of the ER, or in the ER and swamped...anyone want to share about actual triage experience? 

Thoughts about teaching it?
Preparing for it?
What worked as far as marking, passing on info, etc.
What about the "MIDE" versus "IDME" divide?

(Exercise and planning experience welcome, but please state if actual or exercise experience).


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## rjz (Oct 31, 2008)

*hand raised*

I have had 3 seperate times where we did triage in real life. All three times it fell apart and never really seemed to take off and work like it does in training. One time we had a seasonal fire guy very upset at us ambulance folk because "we let him die." Referrign to a pt. who was not able to maintain their own airway but still had a pulse. I have deployed tags and all they have seemed to serve is cause confusion as rankings change, and the little tabs accidently get ripped off. There is also an aspect of mis-triage were someone is triage immediate but is really delayed etc. How do you fix that??? applying a new tag seems to cause more confusion. No matter what though all three times we got everyone off of scene and to a hospital. :blink::wacko:


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## flhtci01 (Nov 1, 2008)

I'll start by saying the most I have had to triage is 3-4 patients at once.

I have conducted training for a wilderness setting (ski patrol). I try to incorporate actual events that parallel industry events such as lift collapse or resort fire/explosion. I have used tabletop scenarios that involve about 20 patients.  These usually generate plenty of discussion including that status may change after initial assessment, during delays, etc. 

I have also done small scale training 5-10 patients in the outdoor setting.  We use surveyors tape.  They patients would then be transported to the ambulance staging area where they would be re-assessed.

Illinois has mandated the use of Smart cards.  I have not used them but think the card should accommodate status changes (up or down) without a problem.


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## mycrofft (Nov 1, 2008)

*Learning from exercises and real life*


My experience has been a coupe times on scene with plenty of transport available and not too critical, a few CERT exercises, and LOTS of mlitary from FD and medical aspect.
I think the "elephant in the room" with triage is that virtually every time a fiar exercise or real mass cas takes place, life's chaos and messiness emerge through our "plans", and the finer the plan the quicker it falls apart. The response is usually to blame the exercise or rack it up to some other way to save face. I have tried to teach people that it's going to fall apart and you will have to simplify, persevere and adapt, but that has gotten me uninvited.
(I tried the surveyor tape in a waistpack trick in chem gear, tape fouled, threw it away and stuck big labels hand-written in marker wearing big rubber gloves into the pt's chem suit pocket. Worked well.)


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## Epi-do (Nov 1, 2008)

I was on the first ambulance onscene to an apartment complex that was hit by a tornado earlier this summer.  It was total chaos.  We set up EMS at the clubhouse/rental office and quickly had a second ambulance there to assist us with triage.  We had 3 patients the minute we walked into the door, and over the course of the night ended up with another 15 or so.  Maintenence eventually came along and opened up a large office in the building that had been locked and we were able to move everyone requiring medical attention into that room, to seperate them from those that were just seeking shelter.  

We never did break out the triage tags, and that was brought up at our post-incident debriefing.  As a department, we walked away with several things that we need to improve upon, but overall everyone that required care was appropriately treated onscene until they could be transported to the hospital.

Because the magnitued of the incident, as well as the specifics of the event, are so varied from one event to the next, I don't think anyone can ever truly be fully prepared.  Things will come up that were never thought of in training and you have to be able to think on your feet and adapt.  

We used START triage to sort through all of our patients, and it seemed to work well for us.  Everyone had a good grasp of how the system works, so from that aspect, things went well.  It was the logistics of everything that seemed to be challenging.

Now that I have had one mass casualty incident under my belt, I feel as if I will be better prepared for the chaos whenever I find myself at another one.


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## Ridryder911 (Nov 1, 2008)

Worked a MCI of about 350 injured during the OKC bombing. MCI can be rehearsed and practiced and one can use those ideas to the best of their abilities, but in real life there are so many other variables it is hard to be prepared for the real thing. 

All one can do is the best they can do. 


R/r 911


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## mycrofft (Nov 1, 2008)

*Epi, Rid, thanks.*

One of the many incarnations of the devil I reserve special disdain for are the "triage experts" who get themselves into the overhead of exercises (or preparation for real life) and then then start pushing a personal fetish (casualty cards, treatment gizmos, stylized patient layout and movement between little plots of floor regarding changing triage categories) to the exclusion of common sense; and whoa to those who don't want to play their version of the game.


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## traumateam1 (Nov 2, 2008)

The most I have ever done (just two of us) was about 32 people. 
Nothing too major so no backup was needed, I looked after the 7 - 15 more "critical" patients, while my partner went and attended to the others, and had them escorted to me as he felt appropriate. 

It ended up with me going for a little swim with a patient.... h34r:


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## BEorP (Nov 2, 2008)

traumateam1 said:


> The most I have ever done (just two of us) was about 32 people.
> Nothing too major so no backup was needed, I looked after the 7 - 15 more "critical" patients, while my partner went and attended to the others, and had them escorted to me as he felt appropriate.
> 
> It ended up with me going for a little swim with a patient.... h34r:



No backup was needed with 7 - 15 "critical" patients and 32 patients in all? Please explain.


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## traumateam1 (Nov 2, 2008)

They weren't critical at all, they all just had heat related problems.. so I took care of the patients will a little more severe heat exhaustion, while my partner took care of the others.. it was nothing at all really.


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