MCI Triage Scenario

karantzalis

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Found this on reddit and thought it was a good scenario to post here.

Scenario: Active shooting with at least 12 victims. Youngest injured victim is 15 years old, rest are all above age 20. Nearest peds trauma center is 20 miles away. Nearest level I trauma center is 30 miles in the other direction. No landing zones nearby for hems. ALS is 20 minutes away. Only 2 BLS rigs available for transport.

Victims are brought to staging area with the following stats:

4 out of 12 were triaged expectant/DEO.
5 of them tagged as immediate.
1 tagged as delayed.
2 tagged as minimal.

Patient 1:
Red-tagged/immediate
15 yom with GSW x2 to the chest
Unresponsive.
BP 74/45, RR 10 after repositioning airway

Patient 2:
Red-tagged/immediate
21 yof with GSW x3 to abdomen RUQ, right shoulder, right arm
Heavy bleeding on scene, cold/clammy skin.
Tourniquet applied to right arm.
BP 90/60, HR 120, RR 40, CAOx4.

Patient 3:
Red-tagged/immediate.
40 yom with GSW to pelvis.
Talking but confused
BP 150/85, HR 190, RR 32, CAOx2.

Patient 4:
Red-tagged/immediate.
56 yof with GSW to right ankle.
Tourniquet applied to right leg.
BP 132/74, HR 100, RR 35, CAOx4

Patient 5:
Red-tagged/immediate
45 yom with GSW x2 to head and neck
Heavy bleeding on scene, cold/clammy skin
Unresponsive
BP 60/30, HR 122, RR 10

Patient 6:
Yellow-tagged/delayed
34 yof with GSW to left calf
Bleeding is a slow ooze
Tourniquet applied to left leg
BP 150/85, HR 118, RR 20, CAOx4

Do you re-triage these patients once they’re brought into the staging area? If so, do any of the patients’ tag color change?

Who do you take first? To which hospital?

What interventions do you take when another patient is being transported?
 

DrParasite

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sure, retriage them. maybe #4 is going to a yellow. if his RR drops from 35 to 28.

I'm taking the patient 1 and 2 to the ped's trauma center (one of the cot, one of the bench). I might have patient 6 come with us, and have her hold pressure to her own gsw.

second transport unit can take 3, and 5, and maybe 4. go to the adult trauma center.

do I have mutual aid BLS available? what about fire/first responders who can come for a ride? extra hands are def gonna help.

if it's just two BLS crew, with 2 emts, this is gonna suck. meet the ALS line of sight if you can, but these patients need bright lights and cold steel to fix the damage. do your ABCs, and try to keep everyone alive until you get to the ER.
 
OP
K

karantzalis

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sure, retriage them. maybe #4 is going to a yellow. if his RR drops from 35 to 28.

I'm taking the patient 1 and 2 to the ped's trauma center (one of the cot, one of the bench). I might have patient 6 come with us, and have her hold pressure to her own gsw.

second transport unit can take 3, and 5, and maybe 4. go to the adult trauma center.

do I have mutual aid BLS available? what about fire/first responders who can come for a ride? extra hands are def gonna help.

if it's just two BLS crew, with 2 emts, this is gonna suck. meet the ALS line of sight if you can, but these patients need bright lights and cold steel to fix the damage. do your ABCs, and try to keep everyone alive until you get to the ER.
Why take patient 2 to peds if they are above the age limit?
 

DrParasite

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Why take patient 2 to peds if they are above the age limit?
Great question!!! I will direct you to the Journal of the American Academy of Pediatrics for the answer:
https://pediatrics.aappublications.org/content/140/3/e20172151, particularly the late adolescence timeframe.

I will also say it depends on your local trauma center's age policies.

I would ask you why would you not take them to the ped trauma center? you have two transport units, no mention of mutual aid, HEMS is unavailable (due to no LZs, unless you want to drive to an LZ and land 4 helicopters, which would be ok). So you only have two vehicles to transport, and one should go to the ped's trauma center; are you really going to put 5 patients in the other BLS truck, bang on the back door, and say good luck? Keeping any of these patients on scene is not going to be helpful, so best take them to a place where they can get the best stabilization for their wounds, even if they need to be CCT to another hospital once they are stable.

and it appears this actually was on reddit.
https://www.reddit.com/r/TacticalMedicine/comments/olk8vs https://www.reddit.com/r/ems/comments/ol32wy
 

johnrsemt

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A Peds Trauma center can and does take adults in a MCI situation, just like an adult Trauma center will take Peds patients.

Better to split the patients than to dump them all on 1 ED.

But you should have a LZ someplace close, if you can get an ambulance in on a 2 lane road, you can get a bird down in an intersection, or a parking lot (church, school, etc.)
 

johnrsemt

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Also; you wouldn't have any VS except RR on any of the patients on the 1st go around of triage.

Pt #4 and #6 can both wait for 3rd transport unit to arrive: the only reason #4 is Red is her RR, and it is high because of either she was shot, or pain of the tourniquet. (or both)
 

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