Triage. An introduction to combat medicine

 

Triage. An introduction to combat medicine

Welcome to the next level of preparedness. Trauma. Trauma can come from many sources. A slip with an knife in the kitchen. A smashed thumb in the workshop. A terrible cut from a chainsaw. Being at the wrong place at the wrong time and caught up in a riot. Now add in those same injuries, but multiply times 10. You now have a MCE. Pick the scenario. It can happen. Learning how to prioritize, delegate, investigate, assess and treat are skills anyone can learn.

Applying them with out emotion is a different beast altogether. It is doable. One of the hardest things to master in triage is seeing the injuries, and not getting personal with them. Another is being able to itemize the injuries, almost coldly and place them in the order of severity, and the order of treatment.

This is a HUGE deviation from the basic first aid that we talk about. With the fast moving changes sweeping the country and the world, Freya and I decided that we need to change up some of our topics and delve into more advanced lifesaving.

A word of warning and disclaimer. We are not doctors. We can not diagnose, prescribe or treat injury nor illness outside of a SHTF situations. This blog post is for informational use only. Pagan Preparedness, nor the owners, operators, instructors or author’s claim any responsibility for people using this information in any manner.

Glossary of terms

MOI= Method Of Injury

LOC=Level Of Consciousness

LOR = Loss of Resistance

MCE Mass Casualty Event

Triage= The process of sorting people based on their need for immediate medical treatment as compared to their chance of benefiting from such care.

 

The military triage flow sheet.

 

 

This is the method I used as a combat medic. There are terms here that people may be uncomfortable with. Items like balancing resources that you have now, to what you may have to what benefit it will give the patient, AND what loss/benefit of the expending those supplies will have on the group

Triage Decision Flowchart

Triage Decision Flowchart, showing the five steps in the triage process.

Step 1: Remove GREEN patients. Get help, you can’t do it all yourself

ASSESS:

 2: MOI

 3: LOC

         4: Breathing.

 

Always remember. There are many more patients than rescuers.

Triage is designed to separate patients into categories according to their injuries, level of consciousness , and yes even if they are alive. It is important to do the examination quickly but be very complete with it. Lives depend on it. This is one the things that gives us medics bad dreams. At the triage station you may have to make a decision on if someone lives or dies.

 

The triage that we’ll go over here, is slightly different than what one will see in the local emergency room. The basics are the same, but the application of a hostile or dangerous environment adds a new level of difficulty,

An example of the difference between combat and civilian triage is the Boston Marathon bombing. The civilian medics on site risked their lives and rushed to the aid of the victims. And treated them where they fell. There also was a detachment of Army Medics to support the Army team running. They risked their lives and rushed to the aid of the victims AND SNATCHED THEM UP AND BROUGHT THEM TO SAFETY BEFORE TREATING THEM. The civilian medics triage and treated on site. Military medics, train to if at all possible get the victim to a safe or at least safer area before triage or treating.

 

Triage and Head to Toe assessments

Evaluate each patient and tag them RED (immediate),

YELLOW (delayed), BLACK (dead/dying).

Field Triage Algorithm

 

The colors we use are to make it easy( It isn’t easy, but needs to be done)

 

Green Green is for those that are stable, with minor injuries. IE Walking wounded

Yellow Yellow is for those that are more seriously injured. IE Wounds, burns, that require treatment ASAP but they are still stable and can wait.

RED Red is for those that need to be treated NOW or they WILL DIE. Most head injuries, penetrating wounds to the chest, missing or severely mangled limbs

BLACK Black is for those victims that are dead, or sad to say are dying. Black level patients need to be carefully screened according to the resources you have on hand.

 

What does “Resources on hand mean?” In a SHTF, or a disaster , IE Katrina, Sandy, or Moore Oklahoma Civil war as the one in Bosnia. Sometimes we don’t know when we will get replacement supplies, The injuries of a black level patient can use as much resources as 10 yellow level, or even 4-5 red level patients. Now in the semi normal times we have now, EVERY PATIENT WILL RECEIVE what ever they need to be comfortable and keep the alive until transfer to higher level care.

There are limited resources. Time is critical.

Glasgow Coma Scale

Eye Opening Response

  • Spontaneous–open with blinking at baseline 4 points
  • To verbal stimuli, command, speech 3 points
  • To pain only (not applied to face) 2 points
  • No response 1 point

Verbal Response

  • Oriented 5 points
  • Confused conversation, but able to answer questions 4 points
  • Inappropriate words 3 points
  • Incomprehensible speech 2 points
  • No response 1 point

Motor Response

Obeys commands for movement 6 points

Purposeful movement to painful stimulus 5 points

Withdraws in response to pain 4 points

Flexion in response to pain (decorticate posturing) 3 points

Decorticate posturing

Extension response in response to pain (decerebrate posturing) 2 points

Decerebrate posturing

No response 1 point

 

Coma: No eye opening, no ability to follow commands, no word verbalization (3-8)

Head Injury Classification:

Severe Head Injury—-GCS score of 8 or less

Moderate Head Injury—-GCS score of 9 to 12

Mild Head Injury—-GCS score of 13 to 15

Glasgow Coma Scale, is a quick, practical standardized system for assessing the degree of consciousness in the critically ill and for predicting the duration and ultimate outcome of coma, primarily in patients with head injuries. The system involves eye opening, verbal response, and motor response, all of which are evaluated independently according to a rank order that indicates the level of consciousness and degree of dysfunction.

Awake or not.

The degree of consciousness is assessed numerically by the best response. The results may be plotted on a graph to provide a visual representation of the improvement, stability, or deterioration of a patient’s level of consciousness, which is crucial to predicting the eventual outcome of coma. The sum of the numeric values for each parameter can also be used as an overall objective measurement, with 15 indicative of no impairment, 3 compatible with brain death, and 7 usually accepted as a state of coma.

The test score can also function as an indicator for certain diagnostic tests or treatments, such as the need for a computed tomography scan, intracranial pressure monitoring, and intubation. The scale has a high degree of consistency even when used by staff with varied experience.

Via Mosby’s Medical Dictionary, 8th edition. © 2009, Elsevier.

 

That is a mouthful to read, but it gives the entire story about the GCS. It is designed to quickly and accurately diagnose the severity of head injuries. What makes it so useful is EVERY on can use it, and no matter the experience level of the medic they will be the same results as a veteran EMT-P

 

Shock:

Shock is the body’s reaction to a serious injury. It is a general term that describes a weakening of the body’s systems, especially the cardiovascular system, at a time when they are needed most.

A person in shock will often appear pale, have clammy skin and possibly cold sweats. The pulse will often be shallow and rapid. Breathing may also be very shallow. A person in shock may faint or vomit (or both). If shock is not treated, it can cause death.

Treatment for shock should always come after taking care of the primary injuries.

To treat shock:

Have the victim lie down and be calm. Start with no pillow.

Cover him with a blanket.

If his face is pale, elevate his feet. If his face is flush, elevate his head. Remember the old Boy Scout First Aid Merit badge saying about shock:
If the face is pale, raise the tail. If the face is red, raise the head.

Monitor his condition and write down what you see:

Take his pulse every five minutes.

Note the breathing pattern: shallow/deep, quick/slow

Check the injury and change dressings or make adjustments as needed.

Look for additional injuries.

Ask the victim for medical information: medical history, allergies, phone numbers of people to contact, etc.

Talk to the victim and reassure him. There are MANY levels to shock. So much more an entire post will be dedicated to shock.

We have covered a LOT of a news letter. This blog is taken from my 4 day Battlefield Medic Course. I have re-written some of it to flow better in a newsletter. Reading about the how to do it is one thing. Doing it for real is another. Take classes. Practice Practice, PRACTICE! You can print this off and practice different scenarios. Mass Casualty event. Earthquake, Tornado, Hurricane. Rogue government turning on the people, (Whoops that one slipped out!!)

In closing,

Since we are starting a new series and more in depth medical coverage/training we need to start putting together equipment that will make the job easier. I’m not going to list a first aid kit. We all have that covered. (We DO don’t we?) This is more intermediate to advanced equipment that all should have.,

Tools to get.

Stethoscope. Mine for work at the hospital is a 90 dollar 3m Littmann Cardiac Stethoscope. No way I’m putting that in a field bag. If you see my with my Littmann  you know SHTF!  The MDF Sprague Rappaport Dual Head is a fine field stethoscope. It is good enough for front line cardiac use but it takes a bit more concentration to hear some heart sounds. This is the one I have in my jump bag. Also MDF will send you replacement parts as you need them.

Blood pressure cuff. Do. Not. Get. A. Battery operated. Wrist Cuff.  They SUCK!!!! A manual cuff is the best. They always work, and they can substitute for a tourniquet. This one,  is very similar to the one I have.

This Triage belt is pretty cool. But it is expensive and is really a solution looking for a problem. Get this Multipack of colored electrical tape and pick up these MOLLE Pouches.  They are 2 for 14 bucks.  In addition to the colored tape and in pencil small note book, Trauma Shears and what ever you think you may need, make TWO kits and do it for half the cost ONE fancy triage belt.

That is all for this week. Next week, we’ll first start of with the basics of using your new toys, then dive in to a new layer of more advanced first aid. Freya and I are going to try to get these as actual classes via webinar. It’s one thing to read about something. But having it laid out and you walked though the tasks is totally different

 

 

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