# Triage --- **Triage** is a method of determining which patient of many should be treated first, often the role of a [[nursing|nurse]]. The goals of triage are: - rapid assessment - determination of severity - need for emergency car ## Non-Disaster Triage - Non-disaster triage - Most resources for each patient - Disaster triage - Maximize resources for the most patients - uses North Atlantic Treaty Organization (NATO) color-coding system Goals of triage Rapid assessment Determination of severity Need for emergency care Disaster Triage Triage = “to Sort”  Under usual circumstances, patients are triaged in such a way that the most critically ill – or “who’s going to die first” gets the most resources (both personnel and material/equipment).  In disasters and mass casualty incidents where there aren’t enough resources to care for everyone, our approach to triage changes.  We talked about this a couple of slides ago – in disasters with many casualties, we go  with the Utilitarian principle to **do the greatest good for the greatest number of people**.  This means that decisions surrounding where and how to use limited resources are based on the likelihood of survival AND consumption of available resources.  I think the last part of this is often overlooking – this idea that we must consider how much of the available resources will go to saving someone.  If one or two people are going to take up a large quantity of resources – let’s say one person might be able to survive with treatment, but that treatment means that 90% of the providers and equipment are needed to provide that care, it’s likely they are going to be assigned a lower triage priority, so they won’t be among the first to get treatment.  The goals of triage are to rapidly assess those who are injured, determine their injury severity and need for emergency care, and then “tag” them to indicate what level of care they will get.  Color-coded tagging systems are used in disasters and MCIs.  We’re going to look at NATO’s triage categories. Different from standard triage models Utilitarian approach Greatest good for the greatest number injured Traumatic injuries Exacerbations of pre-existing medical conditions ### NATO Color Coding This is NATO’s categories – I will mention the terminology used in your book for the categories that correspond to these.  Table 68-2 on page 2223 in H&C details these categories, with examples of typical conditions seen in each. •BLACK/EXPECTANT: This indicates that the patient is unlikely to survive and in a disaster situation; no further resources should be expended on this patient.  In case of radiation exposure-comfort measures and emotional support only. •RED/EMERGENT: Airway, breathing, and/or circulation complaints that can be addressed in a rapid manner (e.g.,. opening of an airway, suctioning); circulatory compromise •YELLOW/URGENT: These patients may have mild alterations in Airway, Breathing, or Circulation and healthcare providers should have a high index of suspicion for **possible serious injury**, although the victim is currently stable and treatment may be delayed. •GREEN/NON-URGENT: Injuries are minor and treatment can be delayed hours to days. Ambulatory. These are often the “walking wounded” and in a mass casualty event, would likely be treated at a remote site and not brought to the hospital >[!image]- NATO Triage Tag ![[NATO triage tag.png]] ### SALT This is another triage system that was specifically developed for MCIs and is currently being used in the US.  It follows the acronym SALT, for Sort, Assess, Lifesaving Interventions and Treatment/Transport.  It starts with a general assortment in the first step, based on  ability to walk, then ability to engage in purposeful movement, and lastly those who are not moving.  It then moves on to the second step that is a more in-depth assessment of the need for lifesaving interventions.  As a practicing nurse, you should be familiar with the system that your facility uses for triage – it’ll most likely be some form of this and/or combination of this a the NATO color-schemed triage categories. ![[SALT triage.png]] With MCIs there inevitably will arise some ethical dilemmas for nurses.   Your book lists several, including conflicts related to rationing care, confidentiality, futile therapy, resussitation, assisted suicide. You may find it difficult to ration care – basically not provide care for someone and allow them to die without intervening, or withdrawing care if it’s futile.  You may have to make decision about whether or not you will resuscitate a patient.  The book lists assisted suicide, and this is something that really gets me…this is the idea that in a disaster or MCI, some providers make decisions to end the lives of patients who were too critical to move or give care to (based on triage principles), but they were going to experience immense suffering before they died naturally.  On the slide I’ve included the link to an article about a Dr. and 2 RNs who were forced to make this decision during hurricane katrina During Covid, healthcare providers were faced with extraordinarily difficult decisions and experienced and witnessed unthinkable despair.  Many are dealing with the emotional impacts of working through COVID. Providers were also faced with decisions about how much care they can provide while also caring for themselves – this was a huge moral dilemma. The ANA came out with with a statement that under certain circumstances nurses could choose not to respond to the pandemic – things like safety concerns d/t lack of PPE, or being a member of a vulnerable group. CISM: team of counselors trained to treat victims and responders; discuss coping strategies, education regarding physical/emotional responses to stress, debriefing.  CISMs are usually part of Office of Emergency Management in cities, counties and states. ___