DISASTER TRIAGE AND MANAGEMENT | NCM 120 | TOPIC 2

UNIT 1 (CHAPTER 1) DISASTER NURSING 4TH ED BY TENER GOODWIN

DISASTER TRIAGE Deceased  No detectable vital signs (not breathing on
v Triage is a process which places the right patient in the right their own or after airway opening
place at the right time to receive the right level of care maneuvers)

ABILITIES OF AN EFFECTIVE TRIAGE OFFICER Expectant  Who are still alive but due to injuries are
(BURKLE, 1984) unlikely to survive given available resources
v Clinically experienced  Mass radiation exposure  vomiting &
diarrhea
v Good judgement and leadership  Exposure to organophosphates 
v Calm and cool under stress seizures
 Crush injuries, extensive penetrating
v Decisive trauma, head injury, extensive burns,
agonal respirations
v Knowledgeable of available resources
v Sense of humor
v Creative problems solve POPULATION BASED TRIAGE
v Based on mass casualty scenarios that unfold in a single
v Available
location at a single point in time
v Experienced and knowledgeable regarding anticipated
v Main goal: prevent secondary illness or injury
casualties
v E.g. SARS, bioterrorist events, natural disasters
PHILOSOPHIES OF DIFFERENT TYPES OF ACUTE
MEDICAL TRIAGE 5 POPULATION BASED TRIAGE CATEGORIES
1. DIALY TRIAGE (SEIRV CLASSIFICATIONS)
v Routine basis in the ED
Susceptible  Unexposed but susceptible
v Utilizing standard approach augmented by clinical judgment
v Priority to the most ill even if chances of survival is low Exposed  In contact, maybe infected but still not
contagious
2. INCIDENT TRIAGE
v Large number of patients Infectious  Symptomatic and contagious
v Still able to provide care to all patients utilizing existing agency
Removed  No longer contagious due to survival,
recourses immunity or death
v Disaster plans are NOT activated
Vaccinated  A critical resource for essential work force
v Priority is still to the most critically ill or on
3. DISASTER TRIAGE prophylactic
antibiotics
v Multi casualty (MCI)
v Hospitals are overwhelmed and immediate care cannot be
provided to everyone PHASES OF DISASTER TRIAGE
PRIMARY TRIAGE
v Priority to those who are likely to survive
v Sort patients into categories (Primary survey)
SECONDARY TRIAGE
DISASTER TRIAGE v Additional information (thorough physical assessment)
v Identify injuries that are treatable using available resources on
Minimal/  Physiologically well compensated and likely
Minor to remain so far for an extended period the scene
 Basic immediate care TERTIARY TRIAGE
 E.g. Minor laceration, burns or other soft
tissue or orthopedic injuries w/o significant
v Resources are overwhelmed
bleeding or Neurovascular compromise. v Personnel determine if facility can provide the care needed by
 Directed to community clinics or urgent care
centers the patient
v Referrals and transfers
Delayed  Compensated but significant potential for
deterioration if there are long delays IN HOSPITAL TRIAGE
 Maybe stabilized in the field 3 TEIR SYSTEM
 E.g. stable with possible head/spine injuries EMERGENT (CLASS 1)
w/o neuro deficits, controlled significant
bleeding or orthopedic injuries with NV v Tx immediately or within 15-30 mins
compromise that improve after splinting v E.g cardiac arrest, obstruction, respi destress, uncontrolled
acute bleeding
Immediate  Uncompensated, life-threatening but
treatable with rapid interventions URGENT (CLASS 2)
 E.g. poorly controlled external bleeding,
v Serious illness but can wait up to 2 hours
moderate burns or penetrating trauma,
altered mental status, early shock, respi v E.g. deformed long bone fractures, controlled bleeding, safe
distress
acute psychiatric problems, acute abdominal pain, complicated
 Transport first from the scene
open wounds

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Disaster triage and management NCM 120
NON-URGENT (CLASS 3)
v Can wait for more than 2 hours
PRIMARY TIRGAE TOOLS
v E.g. simple fractures, minor laceration, ear or throat pain, rash, SALT (SORT-ASSESS-LIFE SAVING
meds refill INTERVENTIONS- TREATMENT)
4 TEIR SYSTEM
EMERGENT (CLASS 1A)
v Must be treated immediately (STAT)
v E.g. cardiac arrest, respi distress or failure, airway obstruction,
shock and seizure
EMERGENT (CLASS 1B)
v Tx within a few minutes
v Moderate to severe respi distress, cardiac dysrhythmia with
adequate BP, heavy bleeding without hypotension or tachy
URGENT (CLASS 2)
v Same
NON-URGENT (CLASS 3)
v Same
5 TEIR SYSTEM v Uses and all hazard approach that is intended to be used for
EMERGENT (CLASS 1A) any age patient in any type of event
v Same v After interventions prioritize (Dead, immediate, expectant,
EMERGENT (CLASS 1B) delayed, minimal)
v Same START (SIMPLE TRIAGE AND RAPID
URGENT (CLASS 2) TREATMENT)
v Same v Commonly used

NON-URGENT ED CARE (CLASS 3) adult MCI

v Require technology of ED to diagnose or treat v 5 basic
v E.g. injuries requiring x-rays parameters: RPM,

NON-URGENT AMBULATORY CARE (CLASS 3) perfusion and

v E.g. medication refills, suture or staple removals, chronic ability to walk
conditions that are stable

TRIAGE TEAM

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Disaster triage and management NCM 120

JUMP START (PEDIA MCI TOOL)

DISASTER MANAGEMENT
v Strategic planning
 Done to prepare health organizations for any type of
emergency or disaster (management, training &
protection)
v Contingency panning
 Provide actions that are consistent with the overall plan,
to minimize the challenge to staff when a specific
emergency or disaster require specialized activity
v Forward planning
 When org has been alerted to an impending disaster or
event
 Activation of existing strategic contingency plans
v JumpSTART  Used for all victims who appear to be children
v START used for all victims who appear to be young adults or
CLASSIFICATIONS OF DIASASTER
older INTERNAL
v Cardiac arrest more often follow hypoxia/apnea in children v Within an organization of facility
v Apnea follows cardiac arrest in adults v E.g. loss of utilities, fire, labor strike
v Low respi rate is a critical threshold EXTERNAL
v AVPU used as an indicator of mental status rather than simply v Services demands exceeds the usual
the ability to obey commands v Sudden unanticipated surge

TRIAGE TAGS COMBINED EXTERNAL/INTERNAL

v External event triggers internal impact
DISASTER MAGNITUDE
LEVEL 1
v Able to contain the event and respond effectively using its own
resources
LEVEL 2
v Requires assistance of external source but can be obtained
from nearby agencies or adjacent communities
LEVEL 3
v Requires assistance from state level resources
ROLE OF LEADERSHIP
1. Describe the mission of the hospital during response to
emergencies of all kinds, including the disaster response chain
of command and emergency management system.
2. Demonstrate the ability to review, write, and revise as
needed those portions of the hospital emergency plan
applicable to your management responsibilities and participate
in the hospital’s hazard vulnerability analysis on a regular basis.
3. Manage and implement the hospital’s emergency
response plan during drills or actual emergencies within your
assigned functional role and chain of command.
4. Describe the collaborative relationship of your hospital to
other facilities or agencies in the local emergency response
system and follow the planned system during drills and
emergencies.
5. Describe the key elements of your hospital’s emergency
preparedness and response roles and polices to other agencies
and community partners.

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Disaster triage and management NCM 120
6. Initiate and maintain communication with other SAFETY AND SECURITY OFFICER
emergency response activities as appropriate to your v Ensure safety of staff, facility and environment
management responsibilities. v Final authority on safety and security

7. Describe your responsibilities for communicating with v

other employees, patients and families, media, general public, LIASON OFFICER
or your own family and demonstrate them during drills or v Function as a contact for external agencies, protecting the IC
actual emergencies. from requests from outside the organization

8. Demonstrate the use of any equipment (e.g., personal PUBLIC INFORMATION OFFICER
v Responsible for providing information to the news media
protective equipment or special communication equipment)
required by your agency response. MEDICAL/TECHNICAL SPECIALISTS
v Guidance in the facilities EOC in a variety of special situations
9. Demonstrate flexible thinking and use of resources in
responding to problems that arise carrying out your functional
SECTIONS STAFF CHEIF
PLANNING SECTION CHEIF
role during emergency situations or drills.
v Collect and distribute any information available within the
10. Evaluate the effectiveness of the response within your organization required for planning and development of an IAP
area of management responsibility in drills or actual v Planning activities to ensure adequate staffing
emergencies and identify improvements needed.
OPERATIONS SECTION CHEIF
DISASTER MANAGEMENT PROCESS v Direct all patient care activities during disaster response
PREPAREDNESS/RISK ASSESSMENT
LOGISTICS SECTION CHEIF
v Evaluation of the likelihood of emergencies or disasters for the
v Ensure that all resources and support required by the other
specific institution
sections are readily available
v Issues: weather patterns, geographical location, expectations,
FINANCE/ADMINISTRATIVE SECTION CHEIF
age, condition, and location related to other facilities (e.g
v Monitor utilization of assets and authorize the acquisition of
nuclear plants)
resources essential for the emergency response
MITIGATION
v All steps that are taken to lessen the impact of a disaster
should one occur and considered as prevention measures
RESPONSE
v Actual implementation
a) Infrastructure  capacity to respond to a disaster
b) Staff competency
c) Relationship and partnerships  local assistance or mutual
v HICS (Hospital Incident Command System) is used to organize
a disaster plan and response
1. Predictable, responsibility oriented chain of command
(one ICS commander)
2. Use of common nomenclature
3. Modular, flexible organization
4. Unified command structure incident action plan (IAP)
5. Facility action plan (FAP)
6. Unity of command manageable span of control
7. Use of job action sheets (JAS)  specific functional role
of staff
RECOVERY
v Disaster is over and attempt to return to normal operations
EVALUATION AND FOLLOW-THROUGH

HICS FUNCTIONAL ROLES

COMMAND POSITIONS
INCIDENT COMMANDER (IC)
v Organize and direct the operations of the incident.
v Appoints command staff and activates sections
v Establishes EOC (emergency operations center)
v Manages on macro level

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