Triage tags

[fireboyny 61]

I was wondering what departments here in Westchester have a Triage tag system set in place for mass casualty situations. I know FDNY has a pretty easy, and effective color coded system in place.

[Pedro911 22]

we have a kit that has the following: colored staging tarps corellating to the triage colors. As well as a tagging kit. (black, red, yellow, green)

[grumpyff 1,159]

These tags? http://www.mettag.com/mt137.html

I think it is pretty much standardized

[x4093k 654]

we have a kit that has the following: colored staging tarps corellating to the triage colors. As well as a tagging kit. (black, red, yellow, green)

Whose "we"?

[PFDRes47cue 653]

I am not positive, but feel safe to assume that every EMS agency has triage equipment (i.e.: tags, tarps, etc). This might be a requirement but don't quote me.

[Sailr322 88]

The major difference between EMS agencies in Westchester and NYC, and it may be the same in northern counties, but I cannot speak for sure since I don't know how they works, is that NYC uses an orange tag. Everything else is pretty much the same.

Black: Dead or injuries that are not survivable, no airway

Red: Life threatening injuries requiring immediate transportation, need to reposition an airway, respiration rate is less than 30, no radial pulse, fails to follow commands, and is non-ambulatory

Yellow: Non-life threatening injuries, have an airway, respiration rate is greater than 30, has a radial pulse, follows commands, and is non-ambulatory

Green: Minor injuries, ambulatory

Orange (NYC only): Chest pain, respiratory distress, stridor, increased work of breathing, head/chest trauma

This is just what I have come to understand. Again I am not sure if this applies to areas outside of NYC. Anyone that has more information about the Westchester system or any corrections to what I know feel free to add.

[PEMO3 523]

The other issue is you rarely see triage (aside from drills) done properly e.g assess, tag and move on. You see many units arrive at incidents that are technically MCIs and getting tunnel vision. Stopping at the first patient and treating, working up the traumatic arrest on the MVA with 5 plus patients and only one unit on scene, etc. Tags are great but they need to be used with the philosophy behind their use: assess, identify, classify, prioritize then treat.Stopping mid stream at the first black tag to start CPR defeats the triage system unless you have multiple units on scene and the red and yellow tags will not suffer for it.

[helicopper 1,050]

Black: Dead or injuries that are not survivable, no airway

Red: Life threatening injuries requiring immediate transportation, need to reposition an airway, respiration rate is less than 30, no radial pulse, fails to follow commands, and is non-ambulatory

I think the respiratory rate is misquoted. Less than 30 (and more than 6-8 ) is generally a good thing.

[ny10570 745]

Triage tags are a state requirement and I believe one of the few items carried on every DOH certified vehicle.

I stand corrected. There is no requirement to carry triage tags.

FDNYs new modified start triage is state approved for ise by any agency. I know we've given our training materials to a few outside agencies but don't know if any have followed through.

Edited July 4, 2012 by ny10570

[Rescue97 6]

FDNY has an ORANGE tag which is someone with a high suspect of a medical issue that is not trauma related like cardiac or asthma, its more of a clinical judgement.

Using this system i personally think its a waste of time, alot of people might disagree with me but i think we are making it more complicated then it should be.

so we have 5 tag colors: BLACK, RED, ORANGE, YELLOW, GREEN

[Ga-Lin 86]

Hard to belive but triage tags are not required equipment as listed in part 800. Executive order #26 signed by then Gov. G Pataki designated the "ICS as the state standard command & control system during emergency operations." Later (1998) Kits were distributed by NYS DOH EMS to VAC's, REMSCO's, Course sponser's etc. and many still have those original brown MCI kits in the bottom of the outside compartments,you know, along with the other never touched or used equipment such as vests, flares, etc. I wonder how many actually have looked in the kits, much less had a drill in their use.

I just had a discussion with my EMT class on MCIs, here's what I came up with. The average capacity of a metro north car is 100, the eve commute runs about 8-10 cars. Thats 800-1000 people thats more than a plane crash. Lets just say that by the time the train reachs say Katonah in Westchester or Harriman in Orange county they have half of that capacity 400-500. Train derails. Lets say that just a third of that number are injured. The rest were lucky (real lucky) that still 125-150, lets say half of them need ambulance transport, the others are walking wounded and can be transported by bus (if your community has thought that far ahead & can mobilize) that's 62-75 bodies. Two streacher patients in each ambulance....30-40 ambulances!!! Certainly commercial services will have to be used but lets think about command & control. I've seen many VACs hold MCI drills (which I admit is less than most VACs do) and they always seem to have enough resources to deal with their pt. load, amazing. Sorry for the rant, but I think many VAC & county leadership just don't think past the day to day problem of just staffing one ambulance, and we should...thats our business & our community depends on us for it.

[helicopper 1,050]

FDNY has an ORANGE tag which is someone with a high suspect of a medical issue that is not trauma related like cardiac or asthma, its more of a clinical judgement.

Using this system i personally think its a waste of time, alot of people might disagree with me but i think we are making it more complicated then it should be.

so we have 5 tag colors: BLACK, RED, ORANGE, YELLOW, GREEN

If the existing system is a waste of time - regardless of its success in both studies and real incidents - what do you propose?

The waste of time is that EMS providers still don't know how to properly triage someone, the overwhelming majority are inadequately trained for "MCI or disaster operations", and command and control is still going to be a black tag on the EMS side.

It's already been pointed out that throughout much of Westchester (and the other 'burbs) there are rolling MCI's just waiting to happen ever 20 or so minutes peak and every hour off-peak but we don't drill or exercise for that contingency. Most EMS providers still focus on a single patient instead of properly triaging all of them and managing the entire scene. Even in areas that drill regularly, with pre-staged resources, the EMS operation is long and disorganized.

So, off the rant and back to my question, what MCI management do you advocate if the existing ones are all a waste of time????

[INIT915 1,119]

Using this system i personally think its a waste of time, alot of people might disagree with me but i think we are making it more complicated then it should be.

Is this from your personal experiance?

[Sailr322 88]

I think the respiratory rate is misquoted. Less than 30 (and more than 6-8 ) is generally a good thing.

Yes, I am sorry I should have made it a little bit clearer lol. The grater than 30 is when the tag changes, and I accidentally put it as less than 30. I should have explained a bit more. Less than 30, but greater than 8 thanks for pointing this out so I can make it a bit more clear what I meant.

If the existing system is a waste of time - regardless of its success in both studies and real incidents - what do you propose?

The waste of time is that EMS providers still don't know how to properly triage someone, the overwhelming majority are inadequately trained for "MCI or disaster operations", and command and control is still going to be a black tag on the EMS side.

It's already been pointed out that throughout much of Westchester (and the other 'burbs) there are rolling MCI's just waiting to happen ever 20 or so minutes peak and every hour off-peak but we don't drill or exercise for that contingency. Most EMS providers still focus on a single patient instead of properly triaging all of them and managing the entire scene. Even in areas that drill regularly, with pre-staged resources, the EMS operation is long and disorganized.

So, off the rant and back to my question, what MCI management do you advocate if the existing ones are all a waste of time????

Thank you helicopper. I think today also is a very clear example of the effectiveness of the management system we have in place. Several different agencies were able to work together, along with commercial agencies as well as FDNY. Case and point, the existing one is NOT a waste of time. Units were on location, deemed what they needed, were able to call in additional support, and prioritized the patients quickly and effectively as well as determining the appropriate facilities to transport them to in a very timely manner. If the existing MCI management we have in place was not effective and indeed a waste of time why was today so successful?

[ny10570 745]

Is this from your personal experiance?

If the existing system is a waste of time - regardless of its success in both studies and real incidents - what do you propose?

The waste of time is that EMS providers still don't know how to properly triage someone, the overwhelming majority are inadequately trained for "MCI or disaster operations", and command and control is still going to be a black tag on the EMS side.

It's already been pointed out that throughout much of Westchester (and the other 'burbs) there are rolling MCI's just waiting to happen ever 20 or so minutes peak and every hour off-peak but we don't drill or exercise for that contingency. Most EMS providers still focus on a single patient instead of properly triaging all of them and managing the entire scene. Even in areas that drill regularly, with pre-staged resources, the EMS operation is long and disorganized.

So, off the rant and back to my question, what MCI management do you advocate if the existing ones are all a waste of time????

I believe he is talking about the FDNY's new modified start triage. The orange tag makes sense administratively, but in application it is unnecessary and redundant.