Triage & Transport

Nur Rachmat Lubis

Divisi Orthopaedi, Departemen Bedah
FK UNSRI/ RS dr M. Hoesin
Palembang

Triage
[French, from trier, to sort, from Old French.]

A method of quickly identifying victims

who have immediately life-threatening
injuries AND who have the best chance
of surviving.

What is Trauma Triage?

A method of matching the needs of the trauma
patient to the resources of the hospital.

Trauma patients are assessed and transported to

the most appropriate hospital for that patients
injuries.

Clinical practice
Normal clinical practice

Multiple-casualty
incident

Mass casualties

Triage = Process

by which priorities are set for the management

of mass casualties.

Trauma Triage
Appropriate: Right Patient to the Right Hospital at
the Right Time

OVER Triage:
Minimally injured pts are transported to Trauma Centers
Result: Overburdens the system, no ill effect on pt care

UNDER Triage:
Severely injured pts are transported to Non-Trauma

Centers
Result: Hospitals may not be equipped to treat the pt
and pt care may suffer

How do we perform
Trauma Triage?
Triage & Transport Pathways Card
Standardized Injury Severity Indicators
GCS
RTS

Provider experience/judgment

Steps to Increase Likelihood of

Appropriate Trauma Triage
Know the Trauma Triage and Transport
Pathways

Be familiar with severity indicators (GCS &

RTS)

Know your local resources

On Scene: Mutual Aid, ALS Intercept, Air

Transport
Hospital: Local Hospital capabilities & distance
to Regional Trauma Center

Triage & Transportation Guidelines

All ambulance services must
develop trauma triage and
transport guidelines meeting
minimum standard
Trauma triage and transport
guidelines direct trauma
patients to appropriate
facility
Criteria based on CDC
guidelines

Tagging
Complements Triage
Rapid Identification
of patient

Color Coded / Bar

Coded system

Plastic bands can

substitute tags

Noji
Nojiet
etal,
al,NEJM
NEJM

Spee
d
Accurac
y
Organization

3
Assessments
Ventilation
Perfusion
Cognition

2 Treatments
Airway Maintenance
Hemorrhage Control

START SYSTEM
Created in the 1980s by Hoag Hospital and the
Newport Beach CA Fire Dept

Allows rapid assessment of victims

It should not take more than 15 sec/ Pt
Once victim is in treatment area more detailed
assessment should be made

START SYSTEM
Clasification is based on three items

Respiratory
Perfusion
Mental status evaluation

START First Step

Can the Patient Walk?
YES

Green
(Minor)

NO

Evaluate Ventilation
(Step-2)

START Step-2
Ventilation Present?
NO

YES

Open Airway
Ventilation Present?

NO

Black

> 30/Min
YES

< 30/min

Red/ Immediate

Red/ Immediate

Evaluate Circulation
(Step-3)

START Step-3
Circulation

Absent Radial Pulse

Control Hemorrhage
Red/ Immediate

Present Radial Pulse

Evaluate Level of
Consciousness

START Step-4
Level of Consciousness
Cant Follow Simple
Commands

Red/ Immediate

Can Follow Simple

Commands

Yellow/ Delayed

Transport Decision
Injury Severity
Hospital capability, location, driving
time
Area Level III Trauma Hospital is 10 minutes
Regional Level I Hospital is 20 minutes

ALS intercept is unavailable

Transport/Transfer Guidelines
The referring physician should contact physicians at the
receiving hospital directly and provide the following
information:
1. Brief history of the injury.
2. Current status of the patient including vital

signs,

physical exam and pertinent

history, and any treatment rendered.
3. Mode of transport, destination, and estimated time of
arrival.

Triage, Transport
and Destination

Triage and Transport

To achieve best possible outcomes, system must be

designed so that the right patient is transported to the
right facility at the right time
Primary or Field Triage Criteria
Aid providers in identifying which patients have the
greatest likelihood of adverse outcomes and might
benefit from the resources of a designated trauma
center
ACS Field triage scheme should be utilized
Not one single set of criteria that can define the
appropriate trauma center for each area of the state

Summary of triage theory &

philosophy:
sorting by priority

A simple emergency plan: personnel, space,

infrastructure, equipment, supplies =
system

"Best for most" policy

Priority patients are those with a good chance

of good survival.

JUST DO IT

Thank you