Every day that passes is a missed opportunity to create positive change in one's organization. There are many ways to involve crews in training that can offer hidden benefits. In this article, I will share one department's method for involving crews to prepare them for triaging patients in a mass casualty incident (MCI). First, we need to discuss the basics.
Mass casualty incidents are a rare occurrence for any organization. When they do occur, even the simple tasks of locating triage tags and correctly triaging patients can prove to be daunting. Although training can be provided yearly, when such an incident occurs it may be difficult to recall proper use of triage tags and the START (Simple Triage and Rapid Transport) triage protocol.
Triage tags are a simple tool, and this concept often leads one to underestimate the value and importance of the tags. Additionally, one needs to examine their own system to determine if one type of tag is being used or if there are multiple styles of tags. In my system, we had five uniquely different styles of triage tags. Different tags can lead to confusion on the scene. If there are different types of tags, additional training will be required to ensure minimum competency levels on all tags.
There are a wide variety of triage tags on the market. The decision on the type your agency implements should include input from all those involved in your EMS system. Some key considerations for tags should include whether the tags have prompts to help responders conduct START and whether there is a visual queue to determine if a patient is contaminated.
When considering any type of event involving hazardous materials or bioterrorism, it is critical that all providers are keenly aware of key patient signs and symptoms that would indicate such an event. The acronym to remember is SLUDGEM, which reminds us of those classic presentations of Salivation, Lacrimation, Urination, Defecation, GI Distress, Emesis, and Miosis. It is rather easy to recall these while in a training class; however it may be difficult to recall at 2 a.m. with thirty screaming patients. Having the SLUDGEM criteria printed on the triage tag with check boxes ensures the information is recorded and not overlooked.
Another consideration will depend on whether your system is set up for a bioterrorism event. If Mark 1 auto injectors are part of your EMS/Fire system, one may want to have a location on the tag to note the number of injectors that have been administered to a patient. This information is vital because these medications need to be re-administered in a timely manner. This information needs to be part of the patient's immediate record as well as their permanent medical record at the receiving facility. That critical information could be quickly retrieved from a tag.
It is important that both prehospital and hospital personnel understand the importance of the tags. By introducing this information to the hospital based providers, the fire service takes a proactive approach in their EMS system. This also creates a seamlessly integrated system for triaging patients.
Surprisingly, many physicians and nurses may be unaware of the START criteria and its importance in a MCI. This provides an excellent forum to offer your training and services to hospital based providers. Explaining why a one-minute triage is a vital task in a prehospital setting may shed new light on your unique role as a healthcare provider.
Involving hospital staff will also open discussions to determine how the tags should be used when patients are admitted into their facility. The tags have critical information regarding patient care, such as vital signs and the possible administration of auto injectors. The time to determine how hospitals will use the tags is before a MCI occurs. One MCI that I was personally involved in had one hospital putting the triage tags in the patient's chart while another threw them away. Their staff was unaware of the importance of the tags and this event created the need for system-wide dialogue.