Maryland Triage System Tag, START, and JumpSTART

JAN 2019 Enabling Objecves

Upon compleon of this training the parcipant will be able to:

• Define TRIAGE and explain when it is appropriate for use • List three reasons a paent triage and tracking system is required for successful operaons • Categorize the Triage status of paents ulizing the START and JumpSTART Triage Systems • Explain the design and use of paper Triage Tags • Idenfy five capabilies of the paper Maryland Triage Tags Triage The sorng of and allocaon of treatment to paents and especially bale and disaster vicms according to a system of priories designed to maximize the number of survivors (from the French trier, to sort) (Merriam-Webster)

Developed by Baron Dominique-Jean Larrey, Napoleon's Chief Surgeon, for use by the first ambulance corps—the ambulances volantes—during the early 1800s

Why Triage and Tag?

• Sorng of paents to provide for the survival of the most paents • Assignment of resources in the most efficient method • Most severe survivable injuries receive rapid treatment • Accountability of paents • Family reunificaon Triage: A rapid approach to priorizing a large number of paents

Casualty Incident Site Collection Triage Unit Leader Point

Simple Triage And Rapid Treatment JumpSTART Triage • Triage should be performed RAPIDLY

• Ulize START/ JumpSTART Triage to determine priority

• 15–60 seconds per paent

• Affix a color tape on upper arm or leg

START – JumpSTART Triage

•Clear the “ walking wounded” with verbal instrucon: If you can hear me and you can move, walk to… •Direct paents to the casualty collecon point (CCP) or treatment area for detailed assessment and medical care •Assign a Green Minor Manager to the area to control paents and manage area •Tag will be issued at the CCP •These paents may be classified as MINOR START/JumpSTART

Now use START/JumpSTART to assess and categorize the remaining paents…

USE COLORED RIBBONS ONLY

START/JumpSTART

Categorize the paents by assessing each paent’s RPMs…

üR espirations

üP ulse/perfusion

üM ental Status START/JumpSTART—RPM RESPIRATIONS Is the paent breathing? Yes

Adult – respiraons > 30 = Red/Immediate

Pediatric – respiraons < 15 or > 45 = Red/Immediate

Adult – respiraons < 30 = check perfusion

Pediatric – respiraons > 15 and < 45 = check perfusion START/JumpSTART—RPM RESPIRATIONS Is the paent breathing?

No Reposion the airway…

Respiraons begin = IMMEDIATE/RED

If paent is APNEIC

§ Adult – deceased = BLACK

§ Pediatric: Pulse Present – give 5 rescue breaths § respiraons begin = IMMEDIATE/RED § absent respiraons – deceased = BLACK START/JumpSTART—RPM PULSE/PERFUSION

Is the RADIAL pulse present?

Is capillary refill (CR) LESS than < 2 seconds?

Yes Check mental status

No Adult: Pulse absent or CR > 2 seconds paent = IMMEDIATE/RED Pediatric: No palpable pulse paent = IMMEDIATE/RED

START/JumpSTART—RPM

MENTAL STATUS…

Can the paent follow simple commands? Yes

Adult =

Pediatric: alert, verbal, or pain response is appropriate =

No

Adult = IMMEDIATE / RED

Pediatric – “P” pain causes inappropriate posturing or “U” unresponsive to noxious smuli = IMMEDIATE/ RED START/JumpSTART

If the paent is IMMEDIATE/RED upon inial assessment…then, before moving the paent to the treatment area, aempt only life-saving intervenons:

Airway, Needle Decompression, Tourniquet, Andote

DO NOT ATTEMPT ANY OTHER TREATMENT AT THIS TIME Combined START/JumpSTART Triage

CAN YOU YES ** Using the JS algorithm MINOR SECONDARY TRIAGE ** evaluate all children first WALK ? who did not walk under NO their own power. Evaluate infants first in BREATHING secondary triage using NO Position Upper Airway IMMEDIATE Breathing ? entire JS algorithm ! APNEIC PEDIATRIC ADULT HAS A NO PULSE PULSE APNEIC PEDI Neurological Assessment YES 5 Rescue Breaths Expected / Deceased A Alert BREATHING V Responds to IMMEDIATE Verbal Stimuli Responds to > 30 ADULT P Respiratory IMMEDIATE Painful Stimuli Rate ? 45 > OR < 15 PEDI Unresponsive < 30 ADULT U To Noxious 15 - 45 PEDI ADULT Stimuli CR >2 Sec or NO PALPABLE PULSE Perfusion ? IMMEDIATE PEDI - NO PALPABLE PULSE YES “P” INAPPROPRIATE POSTURING OR “U” ( PEDIATRIC ) Mental DOESN’T OBEY COMMANDS IMMEDIATE Status ? ADULT OBEY COMMANDS - ADULT DELAYED “A” , “V” , OR “P”( APPROPRIATE ) - PEDIATRIC

Http ://www . starttriage . com Http :// www . jumpstarttriage . com Fast Triage – Ribbon Applied First

Apply ribbon to upper arm or upper thigh Triage Category (Immediate) Adult Pediatric

Respiraons > 30 BPM Respiraons < 15 or > 45 CR > 2 seconds or CR > 2 seconds or no palpable no palpable radial pulse radial or brachial pulse Cannot follow simple Inappropriate “Pain” commands (e.g., posturing) or “Unresponsive” Pneumothorax Hemorrhagic Shock Closed Head Injury

Triage Category (Delayed)

Adult: respiraons, capillary refill, and mentaon are normal

• Isolated burns

• Extremity fractures

• Stable other trauma

• Most paents with medical complaints

Pediatric: “A,” “V,” or appropriate “P” (e.g., withdrawal from pain smulus)

Triage Category (Minor)

• “Walking wounded” • Psychological casuales • Always look for children being carried and assess them

BLACK Triage Category (Deceased)

• Obvious mortality or death (pulseless and apneic) •Decapitaon •Blunt trauma arrest •Injuries incompable with life •Brain maer visible

Revised Paper Triage Tag

FRONT BACK

Do Not Use Gray Category Triage Tag Secons

• Paent informaon • Triage status • Chief complaint • Transporng unit • Vital signs • Peel-off bar codes • Medical history • Transport record • Treatment • Family contact * Triage tags should be used in all MCI scenarios, even when • Wrist band handheld device is employed

• PATIENT INFORMATION • Triage status • Chief complaint • Transporng unit • Peel-off bar codes • Transport record • Vital signs • Medical history • Treatment • Family contact • Wrist band The paper triage tag includes a • Paent informaon GREY category for • TRIAGE STATUS future use based • Chief complaint on ancipated • Transporng unit naonal • Peel-off bar codes acceptance. • Transport record • Vital signs IT WILL NOT BE • Medical history USED IN THE • Treatment TRIAGE OF • Family contact PATIENTS UNTIL • Wrist band APPROVED BY MIEMSS. • Paent informaon • Triage status • CHIEF COMPLAINT • Transporng unit • Peel-off bar codes • Transport record • Vital signs • Medical history • Treatment • Family contact • Wrist band • Paent informaon • Triage status • Chief complaint • TRANSPORTING UNIT • Peel-off bar codes • Transport record • Vital signs • Medical history • Treatment • Family contact • Wrist band • Paent informaon • Triage status • Chief complaint • Transporng unit • PEEL-OFF BAR CODES • Transport record • Vital signs • Medical history • Treatment • Family contact • Wrist band • Detachable as a tear- off and as a peel-off • Paent informaon scky label • Triage status • Chief complaint • Used to document paent movement • Transporng unit • Peel-off bar codes • Must be affixed to • TRANSPORT RECORD Transport Taccal Worksheet with the • Vital signs unit, priority, and • Medical history desnaon marked • Treatment and inialed. • Family contact

• Wrist band Commonly called the “Ticket”

Removable wrist

band has been

added with an area for DOB and name

• Paent informaon • Triage status • Chief complaint • Transporng unit • Peel-off bar codes • Transport record • Vital signs • Medical history • Treatment • Family contact • WRIST BAND • Paent informaon • Triage status • Chief complaint • Transporng unit • Peel-off bar codes • Transport record • VITAL SIGNS • Medical history • Treatment • Family contact • Wrist band • Paent informaon • Triage status • Chief complaint • Transporng unit • Peel-off bar codes • Transport record • Vital signs • MEDICAL HISTORY • Treatment • Family contact • Wrist band • Paent informaon • Triage status • Chief complaint • Transporng unit • Peel-off bar codes • Transport record • Vital signs • Medical history • TREATMENT • Family contact • Wrist band • Paent informaon • Triage status • Chief complaint • Transporng unit • Peel-off bar codes • Transport record • Vital signs • Medical history • Treatment • FAMILY CONTACT • Wrist band Triage Summary • Triage allows for effecve and efficient care, helping to increase the survivability for as many paents as possible • Assignment of resources will increase efficiency • Most severely injured paents will receive rapid treatment and transport in logical order • Ensures accountability of all paents • Allows for family reunificaon

Maryland Triage System MIEMSS gratefully acknowledges the following individuals for their efforts in the development of this program: Maryland Triage System

Maryland Instute for Emergency Medical Services Systems 653 West Pra Street Balmore, MD 21201 410-706-3996