I hate doing this, but

[Household6]

[help me with my homework?] At least by now, you guys should know I'm not just being a lazy ***, my problem is that I just don't have a study buddy..

This is where my CLS training is conflicting with my EMT training. :angry:

In an MCI, which of the following patients would have the lowest priority for treatment and transport:

A) A 23-year-old female is appx 8 months pregnant. She is not breathing and does not have a pulse.

B) A 40-year-old female does not appear to have any physical injuries, but she is badly disturbed by the incident and is wandering around crying hysterically.

My CLS training tells me they both have the low priority. The 23-year-old, because she's dead. Ambulances don't transport dead people, right? Right.

My CLS training also tells me that the 40-year-old is shell shocked, needs to back to her FOB and find a Chaplain, not a BLS ambulance. There's not much an EMT can do to treat a crying, hysterical woman.. I suppose she could be transported.

So I'm going to select A) as having the lowest priority.

The 40-year-old woman has T&T priority, because it states she has "no VISIBLE injuries".. She may have head or internal injuries and should be transported to ED for an exam? I think they're trying to write the questions to be tricky...

Is there any reason why the hysterical woman should have the lower priority? If you got this far, I appreciate it.. Thanks for your time.

PS, I'm really not being lazy, I promise.

 

[chaz90]

You're right in your thinking so far. They're just messing with you regarding the youth and pregnancy of the dead patient. In an MCI, dead is dead and will be dealt with later. The hysterical lady does have a higher transport priority, even if it is still low.

 

[DesertMedic66]

I can't give you an answer biased on just that information alone. Technically in my system the pregnant female would be labeled Morgue and the female walking around would be considered Minor and may not even want to go to the hospital.

However if the pregnant female is the only one who is critical/immediate we would most likely transport in the hopes that the hospital can save the baby (not sure on if they could or not). If the female is not the only critical/Immediate patient then she will be marked as morgue.

A MCI for us is 5+ patients, more patients than resources at the time, and/or at the judgement of the on scene crews.

 

[Achilles]

No pulse does not mean dead. I could have an artificial heart and not have a pulse.

 

[chaz90]

No pulse does not mean dead. I could have an artificial heart and not have a pulse.

Oh, come on. An assist device would likely be visible, plus this lady is apneic. Reposition the airway and move on. I know it's more difficult in real life, but for the purpose of testing this is simple. Not breathing after repositioning in an MCI= Dead.

 

[Household6]

I can't give you an answer biased on just that information alone. Technically in my system the pregnant female would be labeled Morgue and the female walking around would be considered Minor and may not even want to go to the hospital.

However if the pregnant female is the only one who is critical/immediate we would most likely transport in the hopes that the hospital can save the baby (not sure on if they could or not). If the female is not the only critical/Immediate patient then she will be marked as morgue.

A MCI for us is 5+ patients, more patients than resources at the time, and/or at the judgement of the on scene crews.

The bolded is exactly what is making me spend extra time pondering. If she's walking around, she's getting Green-Tagged, and I'm moving on..

 

[DesertMedic66]

No pulse does not mean dead. I could have an artificial heart and not have a pulse.

Per the START triage if the patient is not breathing we reposition the airway. If still no breathing the patient is marked as Morgue regardless of pulse or not. The START system uses Radial pulse or Cap refil.

I doubt for school scenarios they are going to be thinking of a patient who has an LVAD type device.

 

[Sublime]

Oh, come on. An assist device would likely be visible, plus this lady is apneic. Reposition the airway and move on. I know it's more difficult in real life, but for the purpose of testing this is simple. Not breathing after repositioning in an MCI= Dead.

Right. The answer is simple, this is an easy test question... and you got it right OP. Don't over think these things.

 

[Handsome Robb]

I have an argument...Since she's (pregnant 23 year old) dead and we aren't going to treat her which would make her the lowest priority. The wandering women, while a green-tag (presuming she's oriented) is still higher priority because she requires assessment and potentially treatment. Just my opinion.

Per the START triage if the patient is not breathing we reposition the airway. If still no breathing the patient is marked as Morgue regardless of pulse or not. The START system uses Radial pulse or Cap refil.

I doubt for school scenarios they are going to be thinking of a patient who has an LVAD type device.

Do you guys use the START tags too? Our tags are cool but they are tri-fold tags and you have to take them out of this little plastic sleeve and it's kinda a pain in the ***.

Even if she has an LVAD she's apneic. If repositioning her airway doesn't work black tag her and move on like others have said.

 

[DesertMedic66]

I have an argument...Since she's (pregnant 23 year old) dead and we aren't going to treat her which would make her the lowest priority. The wandering women, while a green-tag (presuming she's oriented) is still higher priority because she requires assessment and potentially treatment. Just my opinion.



Do you guys use the START tags too? Our tags are cool but they are tri-fold tags and you have to take them out of this little plastic sleeve and it's kinda a pain in the ***.

Even if she has an LVAD she's apneic. If repositioning her airway doesn't work black tag her and move on like others have said.

We are using a different kind of START Triage tags than some places. We are in the process of trying to make them universal statewide and start a triage tag Tuesday (on Tuesdays we would use the tags to get employees and hospital staff familiar with them.

The tags are pretty good for the most part and it works with a system the hospitals in our area have. The one downside of them is you can only retriage someone to a worse level (delayed to immediate, etc). If we need to retriage someone to a less critical level we have to use a new tag.

It's a very confusing system when you don't know how it works. Once you know the whole process it is a very good way with easy patient accountability.

Ill see if I can find our tags on google:

This is pretty much it. There are just a couple of small differences.

 

[Ace 227]

OP, I understand where you might feel confused. As having taught a fair amount of CLS classes, you are not wrong in your thinking that the pregnant female would be a black tag and not transportable. However, in the field, I guarantee we transport the pregnant female before a walking, talking, hysterical patient.

The hysterical patient would get a quick once-over by a cop, EMT, or firefighter, tagged GREEN, and we would make our primary concern the pregnant female. Remember, when resources allow, black tags become red tags. At least, thats what I was taught in 68W school.

 

[rmabrey]

[help me with my homework?] At least by now, you guys should know I'm not just being a lazy ***, my problem is that I just don't have a study buddy..

This is where my CLS training is conflicting with my EMT training. :angry:



My CLS training tells me they both have the low priority. The 23-year-old, because she's dead. Ambulances don't transport dead people, right? Right.

My CLS training also tells me that the 40-year-old is shell shocked, needs to back to her FOB and find a Chaplain, not a BLS ambulance. There's not much an EMT can do to treat a crying, hysterical woman.. I suppose she could be transported.

So I'm going to select A) as having the lowest priority.

The 40-year-old woman has T&T priority, because it states she has "no VISIBLE injuries".. She may have head or internal injuries and should be transported to ED for an exam? I think they're trying to write the questions to be tricky...

Is there any reason why the hysterical woman should have the lower priority? If you got this far, I appreciate it.. Thanks for your time.

PS, I'm really not being lazy, I promise.

While I agree that your reasoning is correct as far as selecting the proper answer.

There is something that can be done for the hysterical woman by an EMT, and that is remover her from the situation causing the angst.

Now going back to the pregnant woman, I know NYC is no longer black tagging peds in an MCI (I think it was NYC, it was a topic at the eagles conference)* pregnant woman isnt exactly a peds but I guess an argument could me made for transport.

*fitting into that topic, "if you can walk, you're green" also doesnt work. I believe this came out of NYC as well.

 

[chaz90]

Now going back to the pregnant woman, I know NYC is no longer black tagging peds in an MCI (I think it was NYC, it was a topic at the eagles conference)

Really? That's interesting. Much as I hate to even imagine it, what would they do in an MCI mostly involving children? I mean, see Sandy Hook. Sadly, I don't think any kids were transported out of there.

 

[abckidsmom]

While I agree that your reasoning is correct as far as selecting the proper answer.

There is something that can be done for the hysterical woman by an EMT, and that is remover her from the situation causing the angst.

Now going back to the pregnant woman, I know NYC is no longer black tagging peds in an MCI (I think it was NYC, it was a topic at the eagles conference)* pregnant woman isnt exactly a peds but I guess an argument could me made for transport.

*fitting into that topic, "if you can walk, you're green" also doesnt work. I believe this came out of NYC as well.

That's good if it trickles down. Some of the sickest patients are the ones with just agitated behavior, can't sit still, doesn't follow commands hysteria. Often it comes out that that is hypoxia, in the form of PE or some other major thing. In the MCI setting, the hysterical woman that you don't attend to is way more of a liability than the dead pregnant girl on the ground. To fail to attend to the pregnant one is defensible, not so on the other lady.

I would say that the higher priority patient is the hysterical woman with no visible injuries.

 

[EpiEMS]

Dead is dead, pregnant or not, much as it pains me to say it.
Triage is cold and calculating because it aims to save as many lives and preserve as much function for those who are able to be treated.

 

[Christopher]

My CLS training tells me they both have the low priority. The 23-year-old, because she's dead. Ambulances don't transport dead people, right? Right.

We use SMART, which places a modifier on START's Red such that if there is ANY sign of life they are Expectant rather than Black. So if this pregnant lady was not breathing even after re-positioning but had a faint pulse or perhaps agonal breathing, they would be Expectant rather than Black.

This helps you separate the mostly-dead from the all-dead and makes the decision easier for these borderline folks.

The levels under SMART are:

Green
Yellow
Red
Expectant (Red with a Blue corner folded down)
Black

Attended to, during secondary triage, in this order under our protocols:

Red
Yellow
Expectant
Green
Black

 

[Household6]

We use SMART, which places a modifier on START's Red such that if there is ANY sign of life they are Expectant rather than Black. So if this pregnant lady was not breathing even after re-positioning but had a faint pulse or perhaps agonal breathing, they would be Expectant rather than Black.

This helps you separate the mostly-dead from the all-dead and makes the decision easier for these borderline folks.

The levels under SMART are:

Green
Yellow
Red
Expectant (Red with a Blue corner folded down)
Black

Attended to, during secondary triage, in this order under our protocols:

Red
Yellow
Expectant
Green
Black

You use the Miracle Max Triage system... (Please tell me someone else gets that?)

This thread turned out to be exactly what I was looking for. I don't want my peers on the forum to give me answers, I want to discuss the hows the whys. This is also extremely helpful to find how bigger urban companies work. Thanks everybody.:wub: