Triage

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 at a high rate of speed and sideswipes the van. Out of control, 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. There are no other people present in this vehicle, so you move on to the sounds of voices.

You first see two small children, a boy and girl, around 8-10 years old, crying and sitting just outside the van. You ask them what happened and they tell you that they got out of their seat belts and got out of the van, so you direct them to go sit down at the base of a couple of trees away from the van and the other vehicle. As you’re continuing to move to the van, you hear an adult female voice scream, “Help my babies!!!” and you hear a small child crying, coughing and calling out, “Mama!!!” As you reach the van, you see the child strapped into the booster seat in the left rear passenger seat behind the female driver. The child appears to be about 4 years old and has frothy, pink bubbles coming from an area on her left upper chest and it looks as if it came from a jagged piece of metal. You look up front and see a bright-red spray of blood cover the windshield and see that the female’s left arm is severely injured. It’s hanging at a severe angle below the forearm and spraying blood in a pulsatile manner from a large wound in her forearm.

You deploy your TQ, wrap it above the elbow and tighten it down until no bleeding is present. As you’re doing this you tell her that it won’t feel good but it will help. She tells you, “It’s ok, just help my babies.” 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 grab your shears and cut her seat belt and keep her in her booster seat and take her over to where her siblings are seated, all the while, talking to her and reassuring her all will be ok. You then come back and help the mom out of the driver’s seat and have her sit next to her children. You grab some mylar blankets out of your bag and wrap everyone up in them, talking with them, gauging their mental status and keeping them calm.

You check on the boy and girl, grab your gauze and shears and begin to dress their small, superficial cuts and, just as you’re done, you 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 due to the lack of severity of their injuries.

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 an immediate life-saving intervention. Basically, if they have any of the following, they’re an Immediate:

1. Life-threatening hemorrhage
2. Airway injuries
3. Trouble breathing
4. Weak or absent radial pulses
5. Inability to follow commands/Disoriented

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, while still critical, could wait a little longer than the mom. 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.

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

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. 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. If you happen to come to one of our classes, we guarantee you that you will come away with the confidence of knowing that you could make a difference in a situation like this, because If you wait until the accident happens before you seek training, then you’re already too late.

Get a kit. Get the training. Be the difference.