How do you triage these patients?

[scubanurse]

Who the hell voted #1 as a green tag?

We use the Smart Triage/IC system, anyone who cannot ambulate due to injury is automatically a Priority 2 (Yellow Tag).. and I'm gonna go out on a limb, and guess that he ain't going anywhere with an open fracture of a leg.

I agree... patient #1 should NOT be a green guys! With vital signs like that? This patient is at the least in compensatory shock HR 120, RR 22, BP 95/P Hypotension ( although it is a 20 YOM so this could be close to the norm, we do not know that on scene) and an increased RR and HR indicate early signs of shock... not green material! Also an open fx should require delayed care... if they get classified as a Green it could be hours before he is seen and if major vessels/nerves are involved, this guy lost a limb... But more importantly he's a yellow based on vital signs alone..

[Canadian Caesar]

You don't actually do a real blood pressure in START triage.

So Pt#3 would be black because a 20mmHg Systolic BP would give you an absent carotid pulse would it not?

[fiznat]

You don't actually do a real blood pressure in START triage.

So Pt#3 would be black because a 20mmHg Systolic BP would give you an absent carotid pulse would it not?

Perhaps, but the patient would still be breathing................................................... dot dot dot

[CBEMT]

Your poll is no longer worth anything. You had about half of your votes before you changed the scenario. Just FYI.

Word.

[brentoli]

Posted them both at the same time in the same post (can't help the posting system)

I would have probably left my options the same, however, knowing the amount of personel you have does change things, Having 24 EMS providers (assuming 2 to a truck) for 30 paitents, is alot more than having 2 for 30. That woman who is unresponsive, will be able to get attention she needs in the senario, and not relegated down to black status by virtue of manpower.

[RomeViking09]

I would have probably left my options the same, however, knowing the amount of personel you have does change things, Having 24 EMS providers (assuming 2 to a truck) for 30 paitents, is alot more than having 2 for 30. That woman who is unresponsive, will be able to get attention she needs in the senario, and not relegated down to black status by virtue of manpower.

Well I have all the data I needed (internet combined with medics & EMTs where I live)

Data Source: 14 Online Responses 21 Local Responses 35 Total Responses of a Mix of EMTs and Paramedics

PT #1 - 20 y/o Male A/Ox 4 HR 120, RR 22, BP 95/P Closed Fx to Left Arm, Open R Lower Leg Fx

Red 10 (29%), Yellow 22 (63%), Green 3 (9%), Black 0 (0%)

Based on START Triage this Patient is a Yellow

PT # 2 - 25 y/o Female A/Ox4 HR 92 RR 20, BP 130/P, 7 Months OB, Minor Lac on right face above the eye, soreness in the left arm

Red 1 (3%), Yellow 8 (23%), Green 26 (74%), Black 0 (0%)

Based on START Triage this Patient is a Green (OB is not an Emergency in it's self and does not change triage)

PT # 3 - 28 y/o Female Unresponsive HR (weak) 20, RR (labored) 8, BP 20/P, Injuries to the chest and abd, open right femur Fx

Red 25 (71%), Yellow 0 (0%), Green 0 (0%), Black 0 (0%)

Based on START Triage this Patient is a Red (The patient is still breathing and does still have a pulse, while it is weak and his outlook is not good there is no reason to place this patient as expected yet given your resources)

Thanks to everybody who responded and helped out

[kristo]

In my system, the third patient would be classified as green. The rationale is, as many have mentioned, that this patient is extremely unlikely to survive. If we have limited resources, we would like to use them where they count. Someone mentioned putting him in black ("expected"?). While that's one idea, we don't do that here, as black is reserved for people who are already dead (injuries incompatible with life/rigor mortis/etc. or pronounced dead by a physician).

Other than that, I agree with most. Put the first one in yellow, and the pregnant lady in green.

Green means that he won't be taking resources away from those that would more likely benefit from them, but once resources become available, the patient will be treated.

Edited April 14, 2009 by kristo

[RomeViking09]

You don't actually do a real blood pressure in START triage.

So Pt#3 would be black because a 20mmHg Systolic BP would give you an absent carotid pulse would it not?

The scenario comes from a book, I think in the field you would not find a pulse on this PT you need at least a 50/P BP (source: Wilderness First Responder 2nd Edition, Published by Morris Book Publishing 2004, Patient Assessment Page 23) to have a carotid pulse, now if you checked for heart tones with a stethoscope you could get a pulse but we use START. The book says Red, I said black the first time I read the scenario based on the BP (and additional training).

[brentoli]

In my system, the third patient would be classified as green. The rationale is, as many have mentioned, that this patient is extremely unlikely to survive. If we have limited resources, we would like to use them where they count. Someone mentioned putting him in black ("expected"?). While that's one idea, we don't do that here, as black is reserved for people who are already dead (injuries incompatible with life/rigor mortis/etc. or pronounced dead by a physician).

Other than that, I agree with most. Put the first one in yellow, and the pregnant lady in green.

Green means that he won't be taking resources away from those that would more likely benefit from them, but once resources become available, the patient will be treated.

Can you explain your triage system a little more in depth kristo?

[RomeViking09]

In my system, the third patient would be classified as green. The rationale is, as many have mentioned, that this patient is extremely unlikely to survive. If we have limited resources, we would like to use them where they count. Someone mentioned putting him in black ("expected"?). While that's one idea, we don't do that here, as black is reserved for people who are already dead (injuries incompatible with life/rigor mortis/etc. or pronounced dead by a physician).

Other than that, I agree with most. Put the first one in yellow, and the pregnant lady in green.

Green means that he won't be taking resources away from those that would more likely benefit from them, but once resources become available, the patient will be treated.

Expected or Dead Patients should be placed in the same area, you would not want to place a patient who your think is going to die (given his vitals) with a bunch of walking wounded. Review the concept of Incident Command in keeping the scene as calm as possible (to a point) if you put a dead guy (or almost dead) with a bunch of living people then you are going to most likely cause someone to freak out.