Physiological:
-Systolic BP less then 90
-Respiratory Distress--Rate < 10 or > 29
-Altered mental status, or Glasgow score 20 minutes using heavy tools
-Death of any occupant in the patient's vehicle
-Ejection of patient from an enclosed vehicle
-Falls greater then 15 feet
Comorbid Factors:
(Any combination of high-energy transfer in comorbid factor should increase the index of suspicion for severe trauma injury.)
-AGE <12 or >60
-Pregnancy
-Significant preexisting medical problems
-Extremes of HOT and COLD
-Presence of intoxicants
Index of Suspicion:
-You may enter any patient into the Trauma System suspected of having experienced trauma regardless of physical findings. The reasons for system entry must be documented completely.
Rapid Trauma
Priority, Color, Condition, Notes:
1 Red Immediate Life Threatening
2 Yellow Urgent Can Delay up to 1 hour
3 Green Delayed Up to 3 Hours
4 Black Deceased No Care Needed
Priorty one:
Unconscious, disoriented, very confused, rapid respirations, weak irreguler pulse, severe uncontrolled bleeding, other signs of shock (cold, clammy skin, low blood pressure, ect.)
Priorty two:
Urgent, can delay Transport up to 1 hour: Conscious, oriented, with an significant fracture or other signigicant injury, but without signs of shock.
Priorty three:
Delayed Transport up to 3 hours, Walking wounded, CAOx3, minor injuries.
Priorty four:
Deceased no care needed: no pulse, no respirations (open Airway first), obvious mortal wounds (e.g. decapitation.)
Notes:
-Assessment of Patients should be <1 minute each.
(Have someone else control bleeding during your survey.)
-All unconscious patients are Priorty 1 - Immediate.
-"Walking wounded" are usually GREEN - Priority 3
-All pulseless patients are BLACK - Priorty 4
Mentation/LOC Assessment:
A- Alert able to answer questions
V- Verbal responds to verbal stimuli
P- Pain responds only to pain stimuli, protect airway
U- unconscious Protect airway, consider intubation
Multiple Patients:
-Strategically park vehicle and stay in one place
-Establish Command, and identify yourself as Command to dispatch (use calm clear voice)
-Size up the scene and advise dispatch of:
a. Exact location and type of incident
b. Any hazerdous conditions
c. The location of the command post
d. The best routes of access to the scene
e. Estimated number and severity of patients
-Designate an EMT to perform rapid triage (see rapid triage), tag and number mulitiple patients (Immediate, Delayed, Ambulatory)
-Order Resources (fire, police, ambulances, HazMat, extrication, Air Units, tow vehicles, buses, ect.)
-Set up staging areas (clearly state the location of staging/assembly areas, and thing of access and egress)
-Coordinate access of incoming units to the scene
-Assign patients to incoming medical units
-Maintain communications with On Line Medical Control (OLMC)
-Keep Patient log indicating patient number, severity, treating and transporting units, medical interventions, and destination hospitals.
Mass Casualty Incident:
(use multiple patient guidelines above and the following ICS groups.)
Medical Branch Director:
-Responsible for overall medical direction/coordination
-Orders additional medical resources
-Serves as a resource for group supervisors
Triage Group Supervisor:
-Estimates number and severity of patients
-Establishes tagging and extrication teams
-Establishes triage areas, if necessary
-Maintains rapid and orderly flow of patients to treatment areas
Treatment Area Group Supervisors:
-Secures treatment areas, idnetifies equipment needs
-Clearly marks, Treatment Areas for Immediate, Delayed, Ambulatory
-Established treatment teams when resources allow, Identifies order of patient transport
Transportation Group Supervisors:
-Establishes Patient Landing Zone (near treatment area)
-Assigns Patients to ambulences, supervises actual loading.
-Relays Unit number, severty and number of patients to Communications Group Supervisor.
Communications Group Supervisor:
-Communicates with Medical Resources Hospital (MRH) to identify receiving hospitals
-Maintains patient log
-Recieves information from Transportation Group. Radios or phones this information to MRH, and is given the destination hospital for each ambulence. Confirms destination with ambulence, and moves another unit from EMS Staging Area into Loading Zone.
