Triage officers

Note. Depending on the size and nature of the disaster, and available staff, several triage teams may be assembled or different levels of staff may be used to perform these functional roles. In some facilities, a senior level emergency department registered nurse may be designated as the Triage Officer. ... 

Effective triage requires the presence of a triage officer who is trained to identify the type of casualties that will be sorted. For instance, a person contaminated with a liquid nerve agent who arrives as an ambulatory casualty may deteriorate rapidly once the agent is absorbed. Triage officers are in a key position, and the individual must be capable of making quick and frequently difficult decisions. Also, triage officers must be very familiar with the medical staff and the hospital s capabilities and limitations. 

There was One Triage Officer (Expert in Mass Casualties Management) at the entry point of EMT for primary triage of casualties... 

There was a Triage officer at the entry point of Field hospital (Expert in Mass Casualties Management) who was responsible to re-triage the patient as well as two other medical doctors one of them expert in Intensive care to supervise the treatment of patients with severe exposure or traumatic injuries in the ICU and another one to supervise the treatment of casualties in other wards of... 

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. 

The triage officer sorts each casualty into one of the four triage categories immediate, minimal, delayed, or expectant (Exhibit 13-1). At lower echelons of care, the triage officer may be a senior medic (who may also be the staff at the emergency treatment station) at higher echelons, he may be a physician s assistant, dentist, or physician. 

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 the most forward MTF, the emergency treatment station will likely be staffed by the same senior medic who functions as the triage officer. At higher echelons of care, a physician s assistant or physician might staff this station. 

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... 

At the first echelon of medical care, the chemical casualty is contaminated and both he and the triage officer are in protective clothing. Furthermore, the first medical care given to the casualty is in a contaminated area, on the hot or dirty side of the hotline at the emergency treatment station (see Figure 13-1 in Chapter 13, Field Management of Chemical Casualties). This is unlike the clean side of the hotline at any echelon of care where casualties are decontaminated before they enter, or un-... 

The process of patient decontamination must be a factor in the judgment of the triage officer during... 

Cyanide casualties present the triage officer with few problems. In general, a person exposed to a lethal amount of cyanide will die within 5 to 10 minutes and will not reach the MTF. Conversely, a person who does reach the MTF will not require therapy and will probably be in the minimal group, able to return to duty soon. If the exposure occurs near the treatment area, a severely exposed casualty might appear for treatment. He will be unconscious, convulsing or postictal, and apneic. If the circulation is still intact, the antidotes will restore the casualty to a reasonably functional status within a short period of time. The triage officer, however, must keep in mind that it takes 5 to 10 minutes to... 

Casualties who have liquid mustard burns over 50% or more of body surface area or burns of lesser extent but with more than minimal pulmonary involvement pose a problem for the triage officer. An estimated LD50 (ie, the dose that is lethal to 50% of the exposed population) of liquid mustard, 100 mg/ kg, will cover 20% to 25% of body surface area. It is unlikely that a casualty will survive 2 LD50 because of the tissue damage from the radiomimetic effects of mustard. Two LD50 of liquid will cover about 50% of body surface area, and casualties with a burn this size or greater from liquid mustard should be considered expectant. They will require intensive care (which may include care in an aseptic environment because of leukopenia) for weeks to months, which can be provided only at the far-rear echelons or in the continental United States. Chances of survival... 

Knowledge about the following physical manifestations of phosgene intoxication2 may be helpful to the triage officer if a reliable history of the time of exposure is available ... 

Thus, if the triage officer sees a casualty with crackles or rhonchi 3 hours after exposure, the officer can assume that the casualty will be severely ill in 3 hours within that time, the casualty must reach a medical facility where care can be provided. Even with optimal care, the chances of survival are not good. It should be emphasized that these guidelines apply only to objective signs, not the casualty s symptoms (such as dyspnea). In a contaminated area, it will not be easy and may not be possible to elicit these signs. 

Triage of casualties of chemical agents is based on the same principles as the triage of conventional casualties. The triage officer tries to provide immediate care to those who need it to survive he sets aside temporarily or delays treatment of those who... 

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. 

At this time, emergency responders will be given a precise role, e.g. medical commander, hazard advisor or triage officer. It is important to keep to this allocated role so that dupUcation and confusion are minimised. As with the... 

Before treatment can begin, it is necessary to decide treatment priorities in order to ensure that the most severely iU or injured are treated first. This is triage. A triage officer wiU be appointed by the ambulance service to carry out this task. Triage is covered in detail... 

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