What Field Triage Products Do You Need For Effective Mass Casualty Management?

Field triage is a critical aspect of a mass casualty event to determine the level of care each patient needs. Both medical directors and local leaders need to have a plan and a trauma system for these situations. Let’s take a look at the guidelines for field triage of injured patients and what field triage products are needed most.

What Is a Mass Casualty Event?

A mass casualty event (MCE) is an incident in which emergency medicine (emerg med) resources, such as personnel and equipment, are overwhelmed by the number of patients. These events can result from natural disasters or accidents. They can also be caused by terrorist attacks or other criminal acts.

In these situations, health care providers need to prioritize who gets treated first to save as many lives as possible. The protocol for doing so is called “field triage.”

A mass casualty event, for example, would be when a crash occurs and 30 people are injured, but the nearest hospital only has ten beds and medical supplies for 20 patients.

The most common types of MCEs are vehicle collisions, industrial accidents, acts of terrorism or violence, weather-related events such as hurricanes and floods, or natural disasters like earthquakes, tornadoes and wildfires. Immediate response is critical – not only for saving lives but also for preventing further casualties.

How is a Mass Fatality Event Different?

A mass casualty is considered a mass fatality if the morbidity rate overwhelms local resources for collecting antemortem data, victim identification, and other recovery operations. However, tending to the survivors should be first in mind until triage is complete. Additional equipment that helps prepare for mass fatalities includes the use of portable morgues. 

What is Field Triage?

Field triage is the initial assessment and disposition of casualties based on a total assessment of the situation. It is conducted by emergency medical services (EMS) providers in the prehospital environment, but it can also be done in an emergency department (in-hospital triage).

The goal of field triage is to:

  • Identify trauma victims who require immediate lifesaving treatments or procedures, and then identify those who do not and can be transported to non-trauma centers
  • Apply treatment measures that are practical in a limited resource environment
  • Maximize resources for optimal patient outcomes

Triage is the process of evaluating, prioritizing and determining the treatment type for each patient. It is a very important part of emergency care. During this process, medical professionals determine the high-risk patients that need trauma center care and those that can wait to be treated.

This process decides which trauma patients can be safely treated outside of a hospital and which ones need to go to a level I trauma center. The decision is based on the patient’s condition and the resources available. The goal is to ensure that all patients get the care they need in time.

Field triage decisions are generally made by EMTs or paramedics in the field, but often EMS personnel are assisted by other resources. For example, some areas have systems in place where doctors provide advice during the field triage process. Some states have protocols that EMS personnel must follow when making field triage decisions. These factors vary widely from one location to another, so it’s best to familiarize yourself with the specifics of your area.

Types of Triage

During trauma triage, the injured are grouped in similar categories based on their condition. This field triage decision scheme is often classifying trauma patients into one of three priorities. The first priority is life-threatening – severe injuries requiring immediate intervention. The second priority is non-life-threatening injuries and the less seriously injured. The third priority is the walking wounded.

The principles of field triage are to stabilize the patient, stop further injury and get the patient to definitive care as quickly as possible.

The most common types of triage performed include the following:

Mass Casualty Triage – This type of triage takes place in disaster situations where there are many casualties including car accidents, combat situations, natural disasters and plane crashes.

Urgent Care Triage – This type of triage takes place in urgent care centers or ERs where there are not a large number of casualties but the number exceeds the number of beds or treatment areas available.

Rapid Triage (Secondary Triage) – It is a method that can be used to rapidly determine the number of patients and injury severity; it is performed by a single person.

Slow Triage (Primary Triage) – It is a method that can be used to assess all patients at the scene; it is performed by two or more people with training in triage.

This process should be taken seriously for accurate patient identification. Overtriage occurs when the healthcare professional overestimates the severity of a patient’s condition, leading to the undertriage of a patient with more urgent needs.

How Do You Stay Prepared?

To prepare for any kind of situation that could cause a mass casualty event, you must develop a disaster plan with your community. Not only does this plan need to identify how people will perform their jobs during an emergency, but it also needs to find ways for everyone to work together to help others stay safe, secure and cared for. In other words, you must address both primary and secondary disasters in your plan.

The essential supplies for effective field triage are the following:

  • A patient transport vehicle (i.e., ambulance) to safely transport patients from the scene of a mass casualty incident (MCI) to a treatment facility.
  • Sufficient numbers of trained personnel to establish and maintain an effective triage system.
  • An MCI triage tag system to accurately identify and prioritize patients by expected outcome.
  • Essential first aid supplies and equipment to care for patients until they can be transported or receive definitive care.

There are special considerations that should be made when handling a mass casualty situation involving a contagious disease. The Centers for Disease Control and Prevention (www.cdc.gov) has guidelines to protect first-responders and prevent public health issues.

The American College of Surgeons Committee on Trauma (ACS COT) aims to develop and implement programs specifically designed to support injury prevention and ensure optimal patient outcomes.

What Field Triage Products Do You Need?

Triage assessment uses both physical exam findings and subjective descriptions. Some of the essential supplies used in field triage include the following:

    • Oximeter monitors: Oximeters measure oxygen saturation levels in the blood. They are placed on a patient’s finger or toe and measure blood flow to the appendage.
    • Sphygmomanometer: An instrument that measures blood pressure using a cuff placed around a person’s wrist or arm.
    • Stethoscopes: Used to listen to internal sounds like a heartbeat or lungs during deep breathing.
    • Glucometer: Measures sugar levels in the blood for diabetics. It is usually used to check for any changes in blood sugar levels.
    • Pen and paper: To complete your initial assessment of the patient and record their vitals, you will need a way to write them down.
    • A flashlight: To assess the patient’s injuries or look for any other signs of distress, you may need to shine some light on them.
    • Gauze bandages: Gauze pads can be used to stop bleeding or tend to wounds that don’t require stitches.
    • Antiseptic wipes: Wipes can be used to cleanse wounds before tending to them or applying bandages.
    • Adhesive bandages: If a wound is small enough that it doesn’t require stitches, adhesive bandages can help stop bleeding and protect the wounded area from further damage.
    • A face shield: Face shields protect you from dangerous exposure while tending to a patient, especially if the mechanism of injury is unknown.
    • Scissors: Sharp scissors can be used to cut open clothing if needed. They can also cut bandages or gauze into smaller pieces if necessary.
    • Extra personal protective equipment (PPE)
    • Triage tags

Why are Triage Tags Important?

Triage tags are used to communicate patient status and guide treatment decisions. Ideally, they also identify patients and provide information on the triage process. The simplest triage tags are color-coded green, yellow and red to indicate the urgency of treatment. The more complex can contain space for collecting information on a patient’s injuries, vital signs, treatments given and disposition.​ It is important to use a standardized system because it facilitates communication between EMS providers and hospital staff. 

The Emergency Severity Index (ESI) is widely used by EMS agencies in the United States.​ Another common system is START (Simple Triage and Rapid Treatment), which uses a more simple color-coded system. Some hospitals have their own preferred tag systems, so EMS personnel must be familiar with several different types of tags. Some tags also are used to identify minors and pediatric patients.

Another common process used is the Glasgow Coma Scale (GCS), which communicates the consciousness of acute medical and trauma patients. It evaluates the patient’s eye-opening, motor, and verbal responses.

Find These Products at Penn Care

There are many field triage products available that can make your process more efficient and save more lives. When you’re building up your triage supplies, call the professionals at Penn Care to meet all your disaster preparation needs. We’re your complete healthcare solution for medical supplies, personal protective equipment and disaster response.