the art of triage

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Veneficus

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Over the years I have seen just about every gadget and gizmo related to triage.

Most of them were clearly designed by people who have no idea how MCI response actually goes down in real life.

So what are you supposed to use?

What do you actually use?

If it is a gadget or gizmo does it allow retriage?

Does it have enough room to write/convey important information?

Where do you keep these things?

When was the last time you actually used one?

Was there ever one you were supposed to use but it wasn't available when you were triaging?

What other dirt do you have on this topic?
 
Both of the last 911 agencies I've been with had simple colored paper tags that you ripped off the appropriate color for the patient and moved on. Both stored them on the trucks in a compartment in the box. Yes, you can write info.


However, my biggest MCI being 9 people, I've never used them.
 
re

each of our units has a MCI box. Each box contains the run of the mill triage tags, tarps of each color and vest with MCI supplies and helmets. Ive only been involved with 6 patients at the most in a single incident so far, so haven't had to use any of the stuff in all these years.. But were ready the day the greyhound full of grannies on the way to a casino goes over the bank :mellow:
 
We use the SMART triage tags.

tag.jpg


Plenty of space to write on.

Allows for retriage since you just fold it not actually tear it.

These tags are a total pain in the *** to get back into the little sleeve they come in.

We had a MCI drill on Thursday, so I used them on Thursday. Not a real event but still used them nonetheless.

They are in an MCI bag in the cab of the ambulance.

I feel pretty comfortable with MCI command and operations. We've used it a lot recently in our area and do 1-2 full scale drills per year.
 
We use colored triage tags. Rip it off. All trash goes in your left pocket things you need to keep go in the right. All tags are numbered so you can keep track of what patient is in what condition, what hospital they went to, their personal belongings.

On the tags there is patient info everything from Hazmat to vitals.

We also carry laminated paper for Med Com. It allows us to keep track of what hospital has beds open for immediate, minor, etc. also have dry erase markers to write on the paper.

The only electronic thing we use for an MCI are radios and cellphones.

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I have no idea what we use. Im assuming its in the trauma cabinet. But ive never had to break that seal.
 
firefite said:
We use colored triage tags. Rip it off. All trash goes in your left pocket things you need to keep go in the right. All tags are numbered so you can keep track of what patient is in what condition, what hospital they went to, their personal belongings.

On the tags there is patient info everything from Hazmat to vitals.

We also carry laminated paper for Med Com. It allows us to keep track of what hospital has beds open for immediate, minor, etc. also have dry erase markers to write on the paper.

The only electronic thing we use for an MCI are radios and cellphones.

6c002307-dc46-fae2.jpg
Click to expand...

so when you have to retriage, do they get a new tag?
 
Veneficus said:
so when you have to retriage, do they get a new tag?
Click to expand...

Ideally they won't have to get retriaged. That is one of the flaws to the system. We can't use another tag because that will leave us with 6 patients but yet 7 ID tags in the ICs pocket which is not good.

So basically once they are triaged they stay at that "level" or they can go into a more critical "level". But they can't get retriaged into a less critical "level".
 
firefite said:
Ideally they won't have to get retriaged. That is one of the flaws to the system. We can't use another tag because that will leave us with 6 patients but yet 7 ID tags in the ICs pocket which is not good.

So basically once they are triaged they stay at that "level" or they can go into a more critical "level". But they can't get retriaged into a less critical "level".
Click to expand...

That doesn't seem like a flaw, it seems like a fail.
 
We use colored tape and the tags above. They are the simplest way to have something attached to the patient to write on, and we change the color of the tape if they need to be retriaged.

The biggest incident I personally was in charge of had 21 green patients. This took about 1.5 hours for our rural system to get everyone taken care of and transported. (Ride malfunction at the fireman's fair.)

I have worked with other agencies for their active shooter drills, and noted that in (simulated) real life, triaging takes a lot longer than you think, you fumble with the stuff way more than you would think, and in general it's easy for an event with multiple red patients make you lose focus.

These things should be drilled and practiced, and crews should imagine in advance how things might go. It makes for smoother movements when the time comes.
 
firefite said:
Ideally they won't have to get retriaged. That is one of the flaws to the system. We can't use another tag because that will leave us with 6 patients but yet 7 ID tags in the ICs pocket which is not good.

So basically once they are triaged they stay at that "level" or they can go into a more critical "level". But they can't get retriaged into a less critical "level".
Click to expand...

Veneficus said:
That doesn't seem like a flaw, it seems like a fail.
Click to expand...

I've found that almost universally, we as EMS providers tend to overtriage people than undertriage them. Our fire first responders will get on the scene of accidents a few minutes ahead of us and tell us there are two yellow patients and a green one, and we get on scene to find that the green patient is completely uninjured, while the yellow ones are just basic injuries.

On the first lap, people just don't tend to actually triage appropriately.
 
We use triage tags with colored plastic wrap. In the plastic wrap you can find plug-in cards, stickers, and protocols. The triage tags are here in the federal state uniform. You can find the triage tags in all Emergency Vehicles. For large incidents, we also write entrance and exit lists of patients. For the entrance and exit lists we take the stickers from the triage tags.

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Veneficus said:
That doesn't seem like a flaw, it seems like a fail.
Click to expand...

It starts to get extremely confusing for how we run our system if we have to retriage people. Ideally 4 people are keeping track of patients and how many are in each level. So if one person changes levels then it has to be communicated to all 4 people so their records are the same. Plus the patients tag has to be handed to the IC so he/she can keep the accurate tags.

The system we use works great in training and in the real world (I've had to use it once) as long as no one gets retriaged. Right after they are triaged they get moved to the treatment area. As soon as a transporting ambulance gets on scene the most critical patient gets moved out first and then repeated.

All patients who do not want to get transported don't have to sign any AMAs or refusals.
 
Greetings from your local Simpleton!

Can you tell from this thread that perhaps it would be best to standardize the practice...as simply as possible and make it's as Universal as possible?

I'm thinking sweat/waterproof Magic Marker, one side Black, other side Red (for re-triage, you won't need more than one re-triage) and a no-brainer 1 2 3 X or A B C X code, and if you want to get fancy, maybe a razor to get the hair off the forehead for visibility.

Let's face it; in a real mess you're going to have multi-based agencies, there should be absolutely zer0 confusion on scene.

(Gimme a second while I patent the design and get this to market!)
 
From my experience, brings a unified system only benefits.
A Uniform Triage System Easily to train for Personnel.
It brings in the use less confusion about the whereabouts of patients.
You can work faster, without you constantly have to explain how it works.
By unified system one retains a better overview of current numbers of patients, because the data come together again at a point.
 
Re: Mci

abckidsmom said:
I've found that almost universally, we as EMS providers tend to overtriage people than undertriage them. Our fire first responders will get on the scene of accidents a few minutes ahead of us and tell us there are two yellow patients and a green one, and we get on scene to find that the green patient is completely uninjured, while the yellow ones are just basic injuries.

On the first lap, people just don't tend to actually triage appropriately.
Click to expand...

9 Line MEDEVAC:

Line 3. Number of patients by precedence:
A - Urgent
B - Urgent Surgical
C - Priority
D - Routine
E - Convenience

Casualties/Patients are very often over classified. Personally I think the over classification is the fear of under classifying and causing more harm and not enough drilling on MCIs.
 
firetender said:
Let's face it; in a real mess you're going to have multi-based agencies, there should be absolutely zer0 confusion on scene.
Click to expand...

We have a county-wide MCI plan. If anyone would like to see it let me know and I will PM you a link to it.

Triage is standardized state-wide when it comes to equipment and procedures.

As most of you know my area has had quite a few MCIs this year so all our crews are pretty familiar with how they work and what needs to be done.
 
officially, the State DOH has their own version of triage tags, has the guidlines at the top, and colored tags at the bottom.

realistically, one black sharpie,write 1, 2, 3 on the forehead
 
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