Advanced Trauma Life Support ATLS Student Course Manual 2018

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APPENDIX D n Disaster Preparedness and Response
and other environments and generally include the
following personnel:
••
Acute care medical specialists
••
Technical specialists knowledgeable in
hazardous materials, structural engineering,
heavy equipment operation, and technical
search and rescue methodology
••
Trained canines and their handlers
Triage of Disaster Victims
Triage is one of the most important and psychologically
challenging aspects of the disaster medical response,
both during the prehospital and hospital phases of
disaster response. This is especially true for disasters
occurring in austere environments where resources
and evacuation assets are limited.
Disaster triage is significantly different from
conventional triage. The objective of conventional
trauma triage is to do the greatest good for the
individual patient. Severity of injury/disease is the
major determinant of triage category when adequate
resources are available for the care of the patient. In
contrast, the objective of disaster triage is to do the
“greatest good for the greatest number of patients.” In
a mass-casualty event, critical patients who have the
greatest chance of survival with the least expenditure
of time and resources (i.e., equipment, supplies, and
personnel) are treated first. ATLS principles, although
modified in disasters, still guide trauma teams in
triaging victims with the blunt and penetrating injuries
seen in disasters.
Levels of Disaster Triage
Triage is a dynamic and redundant decision-making
process of matching patients’ needs with available
resources. Triage occurs at many different levels as
patients move from the disaster scene to definitive
medical care.
Field Medical Triage—Level 1
Field medical triage involves rapidly categorizing
disaster victims who potentially need immediate
medical care “where they are lying” or at a casualty
collection center. Patients are designated as acute
(non-ambulatory) or non-acute (ambulatory). Color
coding may be used.
Medical Triage—Level 2
Medical triage is the rapid categorization of patients by
experienced medical providers at a casualty collection
site or at the hospital (fixed or mobile medical facility).
Medical personnel who perform triage must have
knowledge of various disaster injuries/illnesses.
Many hospitals use disaster triage in their emergency
departments to better familiarize medical providers
with the triage categories.
••
Red (urgent)—Lifesaving interventions
(airway, breathing, circulation) are required.
••
Yellow (delayed)—Immediate lifesaving
interventions are not required.
••
Green (minor)—Minimal or no medical care
is needed, or the patient has psychogenic
casualties.
••
Black—Patient is deceased.
Evacuation Triage—Level 3
Evacuation triage assigns priorities to disaster victims
for transfer to medical facilities. The goal is
appropriate evacuation (by land or air) of victims
according to severity of injury, likelihood of survival,
and available resources.
A category of triage, the expectant or palliative
category, is unique to mass-casualty events. Patients
are classified as “expectant” if they are not expected
to survive due to the severity of injuries (massive
crush injuries or extensive body-surface burns) or
underlying diseases and/or limited resources. The
expectant category of triage was first developed
given the threat of chemical warfare during military
conflicts.
Traditionally this category of disaster casualties
has been classified as yellow, or delayed. Currently
most EMS and hospital systems classify expectant
patients as a separate triage category with a different
color designation and administer palliative care.
Classification of the expectant category of disaster
victims remains controversial and must be decided at
the time of the disaster.
Triage Errors
Triage errors, in the form of over-triage and undertriage,
are always present in the chaos of disasters.
Over-triage occurs when non-critical patients with no
life-threatening injuries are assigned to immediate
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