Triage question

Sassafras

Sassafras

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I work for an IFT and while stopping for lunch today I looked out the window and noticed an MVI had just taken place. We drove over to see if they needed our assistance and no units were on the scene yet so at the instruction of the police officer there trying to begin setting up a safe scene he asked us to begin triage. Mom and baby were found sitting on the curb, driver of other car down the road a bit. All parties out of car before help arrived. Partner went with driver down the road and sent me to mom and baby.

Obviously we were outnumbered, and all were CAO upon initial impression. I began to assess the baby and try to attempt c-spine since she had bruising on her neck from the car seat straps. By that point the official responding units arrived. We transferred care, and they thanked us and we went on our way, however it prompted a question for me since I was somewhat out numbered, and wanted some input from the more seasoned BLS providers. In a situation like this who takes precidence? Mom is talking, baby crying vigorously so both pos patent airway, but how do you decide which patient to focus on or balance both at the same time?
 
START... you learned it in school, right?


Well, there's JumpSTART which, all other things being equal, says handle the peds with more care as adults are generally more able take care of themselves until help arrives.
 
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I'll have to review START again, we just skimmed it, but I remember more that black is as stable as they're getting so move on to reds yellows and greens LOL. But that's mass casualty and is 3 patients really considered mass casualty?
 
Sassafras said:
I work for an IFT and while stopping for lunch today I looked out the window and noticed an MVI had just taken place. We drove over to see if they needed our assistance and no units were on the scene yet so at the instruction of the police officer there trying to begin setting up a safe scene he asked us to begin triage. Mom and baby were found sitting on the curb, driver of other car down the road a bit. All parties out of car before help arrived. Partner went with driver down the road and sent me to mom and baby.

Obviously we were outnumbered, and all were CAO upon initial impression. I began to assess the baby and try to attempt c-spine since she had bruising on her neck from the car seat straps. By that point the official responding units arrived. We transferred care, and they thanked us and we went on our way, however it prompted a question for me since I was somewhat out numbered, and wanted some input from the more seasoned BLS providers. In a situation like this who takes precidence? Mom is talking, baby crying vigorously so both pos patent airway, but how do you decide which patient to focus on or balance both at the same time?
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Welcome to EMS, get used to being out numbered. :)

They all seem stable, mom and baby in one ambulance the other driver in another if possible and if they choose to go. Im leary of putting opposing drivers in the same car, im not a referee. If Ihave to I have to if I dont I dont.

If you were to arrive and one was critical you do your best until other units arrived. Usually the fire department can handle the stable ones if both you and your partner have to tend to a critical patient.
 
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Black tags are as stable as they'll ever get... with no chance at improvement. Any time you get beyond your ability to handle a certain number of patients, that is an MCI. When enough units arrive to handle that scene, you should be able to transition back to normal operations. For instance, I can handle a whole bunch of people with minor injuries. Give me a yellow or red tagged patient, and suddenly the number of patients that I can handle easily drops, and I'll have to do disaster triage instead.
 
Sassafras said:
But that's mass casualty and is 3 patients really considered mass casualty?
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Yep, consider it the same thing. You and your partner were not enough resources to handle three critical patients, so you need to triage. Think about yourself trying to treat two patients... More need than resources available = MCI. Once more units arrive it may not be an MCI anymore.

When you say you work black to green, are you talking about treatment?? You can't *really* assign triage codes until you triage them. We use START and JumpSTART but have some extra steps in there. I first ask anyone who can walk to "go over to that tree". This gets a lot of people who are stable out of the way. Then I ask "if you can raise an arm or a leg, do so." Then I START/JumpSTART everyone who doesn't answer - they will be your patients who are either blacks or reds; then go back to those who raised arms/legs, then to those who are in the stable area.
 
Manual c-spine is also not a priority on an MCI. It dedicates one rescuer to doing that task and nothing else. Were both mom and baby assessed to be the same triage level? If so I would treat the one with the more obvious injury first. When I have had mom + small child that are both green I usually focus on the mom and get her calm enough to get the child calmed down. Ever tried to treat a 4 year old while their mom is sitting there freaking out? 4yos can punch harder than you would guess.

I like START for the most part. I have found though that it doesn't work very well for certain types of MCIs. We had a fire at an apartment complex for the elderly/disabled. START went out the window as soon as we all looked at the scene. We ended up triaging based on resps per min + work of breathing, how black their face/nose/mouth was, and history underlying respiratory problems. Unorthodox, but it worked perfectly.
 
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Mom was surprisingly calm focused more on diaper changing at the moment. I will review START as I've obviously forgotten some. Thanks. This case mom had an abrasion on arm denied LOC or hitting head baby no other signs of injury except bruising at neck from car seat straps. I felt possible neck injury outweighed definite arm injury so I focused on baby who was definitely scared of all te noise.
 
Sassafras said:
I'll have to review START again, we just skimmed it, but I remember more that black is as stable as they're getting so move on to reds yellows and greens LOL. But that's mass casualty and is 3 patients really considered mass casualty?
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Are you really pulling tags on a two car MVA?

MCI in my area is a situation that is going to commit a majority of the available units.
 
CAOX3 said:
Are you really pulling tags on a two car MVA?

MCI in my area is a situation that is going to commit a majority of the available units.
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Goodness no. That would be overkill. I was saying that's about all I remember about MCIs from class so I need to review it. Nothing more. I didn't consider it an MCI just felt outnumbered with two patients to my one person. Thankfully both were stable though.
 
Sassafras said:
Goodness no. That would be overkill. I was saying that's about all I remember about MCIs from class so I need to review it. Nothing more. I didn't consider it an MCI just felt outnumbered with two patients to my one person. Thankfully both were stable though.
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Ok I understand.
 
Sassafras said:
he asked us to begin triage. Mom and baby were found sitting on the curb, driver of other car down the road a bit. All parties out of car before help arrived. Partner went with driver down the road and sent me to mom and baby.
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That's not triage, unless, of course, something (like every other GD'd thing!) has changed.

Triage is you stick with your partner and TOGETHER go to each patient involved and evaluate the severity of each's injuries WITHOUT intervening. Okay, I say open an airway or maybe quick slap a tourniquet on, but the purpose is to come out with a clear, prioritized plan; if not for yourselves to follow through on, then for those who come as your back up.

It's one of the most difficult things to do. Had your partner gone with you to the Mom & kid, you both would have known Mom could have supported Baby adequately; "Hold the baby like this; don't move until we get back." is all you needed to say and then move on.

Seeing the condition (non-emergent, let alone critical) of the Mom and Baby (you cite no evidence to justify immediate intervention; I heard nothing about a head-to-toe evaluation which, it sounded like would have been your next logical step since you assigned yourself to the baby!) you could easily continue on to the driver, just in case.

(Although, now the numbers drop from three potential disasters to one possible serious injury. Continue in Squad 51 but cancel backup!)

Now both of your attention goes to the driver who -- c'mon face it, he walked FROM the car to another place! -- is presumably on his feet. At that point the lack of need for triage is somewhat obvious, but if you decide to triage, you commit to it, pure and simple.

You were not outnumbered. Outnumbered means critical patients to handle. You were overwhelmed, and only by three patients at that!

It'll take a while for you to understand better what high stakes means, but you'll get there!
 
For car accidents I do a mini triage (assuming it's not a true MCI like a school bus)

1: I do my START (look at breathing, asses mental status while talking to them)
2: Ask what car they were in.
3: Ask what hurts
4: If they were wearing a seat belt
5: If they got knocked out
6: Ask who else was in the car (very important when people are milling around the accident so you don't miss any patients)

The truth is that if they are walking around the accident they are all greens so START doesn't really apply. I think it's worth asking these few extra questions because it'll help figuring out who needs to be transported first, how many additional units you need etc. Most car accidents you have the time to do this, most are fender bender maybe with some neck pain, not rolled school busses.
 
I did start toe to head on baby. It was definitely more than a fender bender and honestly we were surprised anyone was able to get out of the one car but mom thought she saw smoke and so she pulled her and baby out of car (honestly I think it was airbag powder but it scared her enough to move).

Yes I was a bit overwhelmed but being it's the closest I've gotten to an MVI I would have been slightly overwhelmed anyway. You don't tend to get these types of calls with IFT. And I find the more I learn the more I have to learn. Thanks for the input and for helping me process things.
 
firetender said:
That's not triage, unless, of course, something (like every other GD'd thing!) has changed.
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We don't have to call it 'triage'. The key thing is you have an organized approach to a multiple patient scenario, whatever the scenario.
 
I thought Black was dead.
 
phideux said:
I thought Black was dead.
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thats_the_joke.jpg
 
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