triage------pls explain

FlyingScot, RN · Aug 27, 2007

Disaster triage and emergency room triage are actually opposites of each other. In disaster triage you generally have 4 categories. What they are called depends on the system your facility uses. Our facility uses a color code system some use numbers. Our disaster triage is as follows;

Green-walking wounded, care can be delayed (minor fractures, lacerations, etc)

can be treated on scene or bused to a minor treatment area.

Yellow-urgent but not emergent( long bone fracctures significant lacerations,c-

spine pain), these need treated ASAP but are not life-thratening.

Red-survivable life-threatening injuries, highest priority in triage system,these are

the patients who often get flown out.

Black-dead, dying or non-survivable injuries (open head injuries, partial decaps,

etc.) No care other than comfort care is provided

In emergency room triage there are several systems people use. I think the most common are the 3 tier and 5 tier systems. I am most familiar with the 3 tier system.

Non-urgent-minor complaints that can wait for indeterminate amount of time

Urgent-serious complaints that should be seen as soon as possible

Emergent-life threatening inujry or illness including cardiac arrests that are seen

immediately.

The five tier system breaks it down a little more specifically, especially with regard to the non-urgent stuff and this system is often used in ERs that have attached urgent care beds. Is thtis waht you were looking for?

lilygood · Aug 27, 2007

yup...so basically we don't apply ABC's and maslow in ER and disaster triage?

ABC's and maslow is what we use when it comes to prioritization and delegation, but that rule doesn't apply to ER, disaster triage....am I right?

appreciate u'r feedback

FlyingScot, RN · Aug 28, 2007

I'm not sure what you are asking. ABC's (airway, breathing, circulation) are definitely a part of triaging a patient regardless of the situation. I'm not sure what you mean by Maslow. Also I think you are using the terms "emergency" and "disaster" triage interchangeably so let me clarify.

Disaster triage has the four levels (Green, Yellow, Red and Black) which are used in mass casualty events like earthquakes and buildings blowing up where there may be multiple patients with different levels of acuity,

Emergency triage is what is used in the emergency room and is the tiered system I spoke of before.

They are exact opposites of each other. Disaster triage is sometimes referred to as "reverse triage".

freedom22 · Aug 28, 2007

I was also wondering- how is disaster triage opposite than emergency triage. What does "reverse triage" mean?

I understand the systems of colors or tiers but dont understand how that is reverse triage. Dont you look at ABC's for both??

Thanks.

FlyingScot, RN · Aug 28, 2007

Guys, you can't compare emergency room triage to disaster triage. They are two entirely different things and that's what is hanging you up. Disaster triage is done in a mass casualty event where the number and/or acuity of the patients will overwhelm the available medical care in the region. This happens with major disasters like earthquakes, floods, buildings blowing up, 100 car pile-ups. These things don't happen every day. In these types of situations you need to utilize your available resources in such a manner that it benefits the greatest number of people. So if you are the triage coordinator you will look at a patient quickly including looking at the ABC's and make a rapid assessment regarding what type of category they should go in. In a disaster situation somebody with obvious lethal injuries who is not breathing will not be ventilated. Someone in cardiac arrest will not get CPR. These people will be allowed to die because they will require an enormous amount of your limited resources and your care will be futile. If resources are directed toward futile cases people with life-threatening but survivable injuries will die because of lack of care. It is a terrible position to be in to have to make the decision that someone who is alive but dying will not receive care but it is a necessary evil if it will save 20 others. This type of decision making is sometimes called "reverse triage" because in the emergency room it is done the opposite way. In the emergency room a person who has no pulse is given the highest priority of care until they have been stabilized or have died despite our efforts.

Triage patients according to priority from highest to lowest

Disaster Triage

Life-threatening but survivable injury

Serious injury but can survive short wait

Walking wounded

Dead or dying or no possibility of

survival

Emergency Room Triage

Full arrests/dying patients

Life-threatening but survivable

Serious illness/injury but can wait

Minor complaints

Do you see it now? The reversal is most notable regarding the dead or dying patient.

In disaster triage they are low priority in emergency room triage they are high priority. Is it beginning to make sense? I think this is a difficult topic to grasp especially for new nurses that sometimes we have to let people die.

freedom22 · Aug 28, 2007

Thanks for your explanation. I really get it now!

FlyingScot, RN · Aug 28, 2007

I just looked at my post and realized the little chart I made did not come out right and makes no sense whatsoever. I will try to fix it.

Also, I just figured out what the OP meant when she referred to Maslow. I honestly thought it was something new that I hadn't heard of when I realized she was talking nursing theory and Maslow's hierarchy of needs. I don't find myself applying theory to my caregiving at least not formally and haven't thought about Maslow since I passed the NCLEX 20 years ago. Props to those of you who have retained that information. And to answer the question. No, you do not apply Malsow's theory when you are triaging. It is unlikely that you ever will, at least formally, in emergency nursing. I haven't done a care plan since 1990.

lilygood · Aug 28, 2007

thanks for explaining it out so clearly....really got it now!