Evacuation triage

Action Provide federal medical response assets and individual public health and medical personnel to assist in providing care for ill or injured victims at the location of a disaster or emergency. DMATs and Federal Medical Shelters can provide triage, medical or surgical stabilization, and continued monitoring and care of patients until they can be evacuated to locations where they will... 

Some disaster events are of such magnitude and duration that rapid evacuation of the victims is not possible. Occasionally an event occurs that requires that victims be evaluated immediately, but because of the inability to evacuate the patient to a higher source of care, the triage process must be extended. 

The Medical Disaster Response (MDR) project was developed to specifically address an event where specially trained, local health care providers evaluate patients immediately after the event but cannot evacuate patients to definitive care (Benson, Koenig, Schultz, 1996). In this type of scenario, a dynamic triage methodology was developed that permits the triage process to evolve over hours or even days, thereby maximizing patient survival and resulting in a more efficient use... 

The response phase should use the American Medical Association s DISASTER algorithm. This stands for Detect, Incident Command, Scene Safety and Security, Assess Hazards, Support Required, Triage and TLeatment, Evacuation, and Recovery. An explosion is... 

The basic concept of operations envisages that contaminated casualties who are rescued or self-evacuate from the heavily contaminated hot zone should be rapidly undressed, triaged (Fisher et al, 1999), given basic life support treatment and decontaminated in the warm zone before being passed to the cold zone for fuller assessment, treatment and, if necessary, subsequent transfer to hospital. 

Figure 6. Interaction of the red and white plans for the evacuation of casualties following a disaster. The fire service are responsible for rescue and primary evacuation of casualties as far as the advanced medical post. Here, casualties are triaged and receive primary treatment. The hospital white plan for the management of mass casualties is extended to this point using medically manned mobile intensive care units which can carry out extensive early care before transporting the patient to the most appropriate hospital facility. In the case of a toxic release, this will be to a special reference hospital, manned and equipped to deal with casualties from a chemical-biological release...

The AMP is under the overall control of the director of medical rescue (DSM) who is usually a fire service medical officer (these are a feature of the French system). Running of the AMP is the responsibility of aphysician, chosen by the DSM, whose responsibilities include triage, immediate casualty care and evacuation of the patients to designated hospitals (le grand noria). 

A. General. Medical Treatment Facilities (MTFs) will establish decontamination areas. When casualties arrive at the MTF, they must be seen at a triage point and evacuated to the proper area. The triage officer must determine if the patients have a surgical or medical condition that requires priority over decontamination. Ninety to ninety-five percent of all decontamination can be accomplished by removing the outer clothing and shoes. This can usually be accomplished before admission without interfering with medical treatment. Several unique aspects must be considered. 

B. Instruct field evacuation teams to transport casualties to an uncontaminated area. Resistant or disoriented individuals should be restrained in the triage area after they have been given the necessary first aid. 

Casualties with severe effects, those who require on-the-spot assistance from the unit lifesaver or medic, will generally be sent back to the aid post or BAS for further care. The decision by the unit life-saver or medic to call for the litter team or ambulance team to evacuate that casualty is the first of many levels at which triage decisions are made on each casualty. 

Casualties with severe but stable injuries or others who must be evacuated without treatment will be sent directly from the triage area to the ambulance area to be evacuated dirty. At a higher-echelon MTF, such as a hospital, where more-complete care can be provided, all casualties will be decontaminated for entry into the clean treatment area. 

As discussed in greater detail in Chapter 14, Triage of Chemical Casualties, the triage officer must know the natural history of the injuries he faces, including chemical injuries. He must also have knowledge of evacuation capabilities and the facilities at higher echelons of care as well as his own decontamination capabilities and assets for medical care. 

The triage officer will send casualties (a) back to duty, (b) to the emergency treatment station, (c) to the decontamination area, or (d) to the dirty evacuation area. 

In addition to knowing the natural course of the disease or injury, the triage officer also should be aware of the current medical assets, the current casualty population, the anticipated number and types of incoming casualties, the current status of the evacuation process, and the assets and casualty population at the evacuation site. Committing assets to the stabilization of a seriously injured casualty in anticipation of early evacuation and more definitive care would be pointless if evacuation could not be accomplished within the time needed... 

Triage categories are based on the need for medical care, and they should not be confused with categories for evacuation to a higher-echelon medical treatment facility (MTF) for definitive care. The need for evacuation and, more importantly, the... 

Triage is a matter of judgment by the triage officer. This judgment should be based on knowledge of medical assets, the casualty load, and, at least at unit-level MTFs, the evacuation process. Most importantly, the triage officer must have full knowledge of the natural course of an injury and its potential complications. 

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