Sort It Out

It’s a beautiful day outside as you drive down a rural road with your windows down, completing some errands and enjoying the scenery. You’re a couple of car lengths behind a blue van and you can see the silhouettes of at least three pairs of little hands and 3 little heads and you say to yourself, “Man, they have their hands full!” as you head into a curve.

Suddenly a car ‘cheating the curve’ comes around the bend , pulls into the van and the van lurches off the side of the road and rolls end-over-end several times in a deafening crash of breaking glass and twisting metal as the car flies into a stand of trees. You immediately get close to the edge of the road, turn your emergency flashers on, call 9-1-1 and give them your location and let them know what happened and that you’re going to try to help. You grab your first-aid bag with your D.A.R.K. and head down the steep embankment.

The first thing you notice is that the van is right-side up but severely damaged. You hear high-pitched cries and voices calling for “mama”. As a parent, this is a nightmarish scene, but you press forward.

The car ‘cheating the curve’ has hit the trees on the edge of the road and you get to it first and notice an adult-sized figure resting on the hood of the car face down. As you get closer, you notice a large pool of blood on the hood and that half of the driver’s face is gone. The eyes are locked open and there are no signs of life. You move on to the sounds of voices.

There are two small children, a boy and girl, 8-10 years old, walking around in a daze with small cuts to their arms, crying. You ask them what happened and they tell you that they got out of their seat belts and got out of the van. As you’re asking them this you notice an adult and a child lying close together. The child appears to be about 4 years old and has frothy, pink bubbles coming from an area on her left upper chest and is whimpering and crying for her ‘mama’. The adult is a female, with an open fracture of the left femur with bright-red pulsatile bleeding calling for help for her baby. As you’re getting out your TQ, you ask her what her name is, what day it is, what happened and she tells you everything correctly.

You wrap the TQ high around the upper thigh, near the inguinal crease and tighten it down until no bleeding is present. You then grab your HALO seals and expose the little girl’s injury and wipe away any blood, affix a seal to the front and check the back for any exit wound. Finding none, you utilize the 4” Emergency Bandage and secure it to her chest, applying pressure over the wound and place her on her affected side in the recovery position. While you’re doing this you ask her what her name is and she says, “Daisy…like the flower.” You grab a couple of space blankets out of your bag and wrap both the small child and her mother in them.

You check on the boy and girl, grab your gauze and shears and begin to dress their small, superficial cuts and thankfully hear the wail of approaching sirens.

You’ve just completed triage and treatment of multiple motor-vehicle accident victims to the best of your ability.
Remember, triage means “to sort” and by doing that, we are simply doing the most good for those whom we can actually help. This means in a mass casualty situation such as this, we have to adhere to some basic triage principals and categorize them with colors according to their injuries.

Our Minimally Injured/walking wounded are our “Green” patients and can either treat themselves or be left to attend to until later.

Our Delayed patients are those with sprains, fractures that can wait to be stabilized after more urgent patients are attended to and are “Yellow”.

The most Immediate patients, “Red”, are those who are in danger of bleeding out or have airway or breathing injuries and can be corrected rapidly with LSI. (LSI-Lifesaving Intervention) You’ll notice we had two of these. The mom was in greatest danger due to life-threatening hemorrhage while the little girl’s open pneumothorax could wait, even though still a Red. You may have to triage within categories just like this.

Once stabilized, an immediate could be downgraded just as a lower category can be upgraded if they degrade. Just remember to constantly reassess the victims frequently, gauging mental status changes or other signs and symptoms, checking TQ’s and bandages, respiratory effort, etc.

The final category is Expectant or “Black” in which we can’t do anything at the POI (Point of Injury) to assist them. These are patients who have no obvious signs of life or who have sustained such grievous injuries (exposed brain tissue, near decapitation) that our limited capabilities would be ineffectual and would be time spent on them that we could be spending assisting others who both need and would benefit from our aid. Move on to those you can help.
Triage is not about selecting who lives and who dies but is about helping those whom you know you can help in the quickest, most effective manner possible and our skills in triage may be called upon in something as ‘simple’ as a motor vehicle accident. If there’s more than one patient, triage principles apply.

Triage-Sort them out-Do the greatest good for those you can help.

-Pocket Doc