Triage
When there are more casualties than first aiders, a system of determining priority of treatment is required. This is known as TRIAGE. Triage is the process of determining the priority of casualties based on the severity of their condition. Appropriate use of triage prevents the likelihood of a casualty dying from an injury that could have been managed if treated promptly. Generally, an unconscious casualty takes priority over other victims.
The goal of triage is to do the most amount of good for the greatest number of people. During the initial stages of a multiple casualty incident, first aiders may be overwhelmed by the scope of the casualties and injuries. It is important for the team leader to show leadership, remain calm and reassure the team. Never assume that every team member is okay and knows what they need to do. Give clear and precise directions to minimise confusion and anxiety. Effective leadership will instil confidence that the incident is effectively managed.
Australian Triage Scale (ATS)
The Australasian Triage Scale (ATS) is a clinical tool used to establish the maximum waiting time for medical assessment and treatment of a patient. The ATS aims to ensure that patients are treated in the order of their clinical urgency.
The ATS utilises five categories from Category 1 – an immediately life-threatening condition that requires immediate simultaneous assessment and treatment – to Category 5 – a chronic or minor condition which can be assessed and treated within two hours.
Triage assessment generally takes no more than two to five minutes when carried out by appropriately trained and experienced professionals.
SIMPLE TRIAGE AND RAPID TREATMENT SYSTEM (START)
In an emergency, first aid trained people can use a simple triage system known as ‘Simple Triage and Rapid Treatment’ (START) as per the following chart.
CONDUCTING TRIAGE
- Before commencing triage, you may encounter people who are self-evacuating the incident as you arrive. Direct these people to a suitable and safe area so they can be monitored and evaluated later.
- Clear out remaining walking wounded.
- Start assessing the first casualty that you encounter.
- Always follow infection control principles.
- Check for DRSABCD (response, airways & breathing).
- Check vital signs and conduct visual survey. If appropriate, leave casualty in recovery position.
- Make decision of what priority level they are.
- Move on to the next casualty and repeat triage assessments for all casualties.
- Assign first aiders to begin more intensive treatment in order of triage category.
What if on your first assessment the casualty falls into the RED or immediate category?
Before moving on to the next casualty, only attempt to rectify airway problems or uncontrolled bleeding. Assign one of your first aiders or a capable walking wounded casualty to assist those in the RED category to maintain the casualty’s head position to keep an open airway or keeping direct pressure on a large bleeding wound. Once all casualties have been triaged, more intensive treatment can begin.