How to Properly Triage Pt's during an MCI

[DaRock98 76]

I don't mean to take this off topic but I do not know much about MCI's and tagging this is probably a stupid question and I should probably know the answer already but could someone give me the colors and and what they mean of each tag? Thank you.

Edited May 28, 2008 by ems-buff
Split topic from Comment on recent EMS response to MVA

[ems-buff 81]

I don't mean to take this off topic but I do not know much about MCI's and tagging this is probably a stupid question and I should probably know the answer already but could someone give me the colors and and what they mean of each tag? Thank you.

Black= Dead

Red= Immediately (up to 1 hour wait)

Yellow = 2 hour delay

Green = Walking Wounded (When ever possible, but with in reason)

[Bnechis 3,961]

Black= Dead

Red= Immediately (up to 1 hour wait)

Yellow = 2 hour delay

Green = Walking Wounded (When ever possible, but with in reason)

I have never heard or seen a time frame associated with triage, care to inform as to where you got that from?

[ems-buff 81]

I have never heard or seen a time frame associated with triage, care to inform as to where you got that from?

Sure,

I remember when I was 16, and was going thru the ambulance I saw those tags. I guess it is based on where you buy them. To know whats on them:

dead or (Priority 0) in black

immediately ( Priority 1) in red underneath it said delay up to one 1hr.

Delay ( Priority 2) in yellow underneath it said delay up to two hrs.

green (Priority 3) was walking wounded.

Here's a link to a website to explain Triage better

LINK TO TRIAGE

Evacuation

Simple triage identifies which people need advanced medical care. In the field, triage also sets priorities for evacuation to hospitals. In S.T.A.R.T., casualties should be evacuated as follows:

Deceased are left where they fell, covered if necessary; note that in S.T.A.R.T. a person is not triaged "deceased" unless they are not breathing and an effort to reposition their airway has been unsuccessful.

Immediate or Priority 1 (red) evacuation by MEDEVAC if available or ambulance as they need advanced medical care at once or within 1 hour. These people are in critical condition and would die without immediate assistance.

Delayed or Priority 2 (yellow) can have their medical evacuation delayed until all immediate persons have been transported. These people are in stable condition but require medical assistance.

Minor or Priority 3 (green) are not evacuated until all immediate and delayed persons have been evacuated. These will not need advanced medical care for at least several hours. Continue to re-triage in case their condition worsens. These people are able to walk, and may only require bandages and antiseptic.

[DaRock98 76]

Basically sounds like an MCI... the traumatic arrest should get black tagged, and move onto the next most serious patient....

Yes, I should have mentioned that Pt.#1, according to what I was told, had a pulse upon arrival of first units. As far as breathing, I don't know.

Ok again I don't know much about this and I am not second guessing you at all but if the pt. had a pulse in the beginning as per the post above and from what I get out of ems buff's post about the color tags why would you black tag this pt. and move on to the next? This pt. is not dead yet why wouldn't you load and go to the nearest hospital immediately? Again not saying you are wrong I am just trying to understand the situation.

[ems-buff 81]

Ok again I don't know much about this and I am not second guessing you at all but if the pt. had a pulse in the beginning as per the post above and from what I get out of ems buff's post about the color tags why would you black tag this pt. and move on to the next? This pt. is not dead yet why wouldn't you load and go to the nearest hospital immediately? Again not saying you are wrong I am just trying to understand the situation.

Maybe this chart will help you Rock:

[Guest alsfirefighter]

Ok again I don't know much about this and I am not second guessing you at all but if the pt. had a pulse in the beginning as per the post above and from what I get out of ems buff's post about the color tags why would you black tag this pt. and move on to the next? This pt. is not dead yet why wouldn't you load and go to the nearest hospital immediately? Again not saying you are wrong I am just trying to understand the situation.

Rock excellent question...and the best answer is...it depends. If you have the resources to be able to load and go then that certainly would be a option. However in cases where you have multiple patients and limited resources (persons) on scene you still have to do what is best for all the patients there until further providers arrive. What most of us are referring to, is once the patient was out of the car and went into arrest the other critical patient involved may have been better off receiving the intervention of the single ALS provider there. That is at least what I am going through when putting myself through the paces of what has been described. It is not uncommon to "black" tag a patient even though they initially may have been red. Keep in mind also that just because someone has a "pulse" doesn't mean that they aren't deserving of a black tag. Triage is to maximize the survivability of all and is designed to assist in the greater good. The person could have had agonal respirations, massive head trauma or massive multiple traumatic injuries that a single ALS provider depsite attempting to manage could cause another critical patient to succomb to injuries that were more easily manageable. In this case though, and as with all traumatic arrests the odds of reversal are very very small and transport by BLS would have been an option.

I'm also going to add, which I wanted to in my earlier post, upset or not, if you make a decision in which you honestly feel is for the good of another patient or patients and it is within sound judgement and reason, you should not be afraid to make it. If you perform a chest decompression appropriately and you have multiple patients and the patient improves, you're going to tell me you should be handcuffed to that patient and not move on to another critical patient? Once again I have to point out that we are medical providers, not chefs...I don't operate from a cookbook. If I felt that the best option being the only medic was to have BLS continue CPR, with BLS airway and with a needle hanging out of a patients chest to get to another critical patient....I will document it solidly as to why I did and had to make that decision and sit in front of anyone who would like to sit on that board and tell me how a solid decision that potentially saved or improved the outcome of a second, third or 10th patient wasn't a good decision to made at that time. I for one do not put myself out there for liability or to lose my priviledges, but I also do not limit my abilities or critical decision making based on grey areas. I would ensure an intercept is at least in place or requested, ensure the crew is ok with what is going on, give them any additional directions that need be and make a notification by phone to the on-line medical control physician of the facility they are going to and explain to him what I did and why.

That is a good way to back up your info on triage. I generally do not get into timeframes for transport except red's go first, then you get into yellows and then green, which bringing some licensed medical persons to the scene to treat and release them is a good option for large MCI's. There are times where when dealing with your facilities that give you a number of critical and delayed patients they can handle to mix the 2 in a single bus.

It is also not uncommon to hear some lecturers even talk about how some providers when presented with an issue of knowing someone should be black tagged and have a conscious dilemma about doing it, yellow tagging them instead is an option and either someone will black tag them on the 2nd triage round or they will just do what leads them to unfortunately being deemed a black tag and releases the mental burden.

[DaRock98 76]

Thank you ems for the chart!

And thank you als for the explanation I couldn't have asked for a better one!

[Bnechis 3,961]

DOH took CUPS out of the EMT program about 2 years ago. To bad, it was a good triage tool that everyone knew and used regularly.

C = Red or Black (in MCI)

U = Red or High Yellow

P = Yellow

S = Green

While not as objective as Start or other systems, everyone used it on every call.