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Triage bencana

2 DaRRaN
TRIAGE
• PRIORITAS I (MERAH)
1. Sumbatan jalan nafas / distress pernafasan.
2. Luka tusuk dada
3. Hipotensi / syok
4. Perdarahan pembuluh nadi
5. Problem kejiwaan serius
6. Tangan dan kaki terpotong dengan perdarahan
7. Combustio TK II > 25 %
8. Combustio TK III > 25 %
• PRIORITAS II (KUNING)
1. Combustio TK II / TK III > 25%
2. Patah tulang besar
3. Trauma thorak /abdoment
4. Laserasi luas
5. Trauma bola mata
• PRIORITAS III (HIJAU)
1. Contusio dan laserai otot ringan
2. Combustio TK II < 20 %(kecuali daerah muka dan tangan)
• PRIORITAS 0 (HITAM)
1. Henti jantung kritis
2. Trauma kepala kritis
3. Radiasi tinggi
TRIAGE PADA BENCANA / MUSIBAH
MASAL

19 September 2019
START TRIAGE
• Simple
• Triage
• And
• Rapid
• Treatment
Dasar : - respirasi
- sirkulasi
- status mental
START

• Tindakan penyelamatan
- sumbatan jalan nafas
- perdarahan hebat
• Tidak lebih dari 60 detik
RAPID ASSESSMENT TRIAGE

METODE START
( SIMPLE TRIAGE AND RAPID TREATMENT )
0. Awal
1. Airway
2. Breathing
3. Circulation
4. Kesadaran

19 September 2019
0. AWAL

• Panggil semua korban yang dapat berjalan, dan


perintahkan pergi kesuatu tempat.

• Semua korban ditempat ini dapat kartu hijau.

19 September 2019
Penderita terdekat Masih bernafas ??
Tidak bernafas buka airway
Tetap tidak bernafas : Hitam
Bila kembali bernafas : Merah
Bernafas spontan Tahap berikutnya

19 September 2019
Napas spontan
> 30 x / menit : Merah
< 30 x / menit : Tahap Berikut

19 September 2019
Capillary refill
Gelap capillary refill sulit dinilai, periksa nadi pergelangan tangan

> 2 detik / > 100x /mnt: Merah


< 2 detik / < 100x /mnt: Tahap berikut

19 September 2019
Tidak dapat mengikuti perintah : Merah
Dapat mengikuti perintah : Kuning

19 September 2019
BAGAN ALIR “START”
Bisa jalan ?
Ya Cedera Ringan Hijau

Tidak Ya
Pasien
Bernafas 30 lebih 30 kurang
Buka Airway 30 x/ menit

Tidak Pasien nafas Ya


setelah buka
Airway

Meninggal Urgen
HITAM MERAH PERFUSI
Periksa Kesadaran

Tidak Ada
Nadi Radialis/
Kapilari refile
Kontrol Periksa
Pendarahan Kesadaran
Tidak Ya
Urgen Mengikuti Tertunda
MERAH Perintah KUNING
Kategori HIJAU
merah
Kuning
Hitam
Pemilahan Korban Masal dalam Kategori Disaster (Triage in Overwhelming
Multiple Casualty Incident)

SAVE START
Korban
massal
kategori
disaster
Secondary Assesment of Victim Endpoint

imediate

unsavegeable Delayed

save
Pemilahan Korban Masal dalam Kategori Disaster (Triage in
Overwhelming Multiple Casualty Incident)

• SAVE (Secondary Assessment of Victim Endpoint) merupakan sistem


triage sekunder yang mencoba membantu memberikan solusi
tarhadap dilema beberapa pilihan yang sulit untuk menangani para
korban dilapangan.
• Sistem ini dirancang untuk digunakan dalam zona disaster.
• Konsep dari SAVE ini adalah memprioritaskan para korban yang
dianggap paling dapat terselamatkan dan memiliki kondisi medis yang
memerlukan penanganan segera.
Katagori Triase Lapangan
MERAH Gawat , mengancam jiwa
KUNING Darurat , tdk mengancam jiwa

HIJAU tidak gawat, cedera ringan


HITAM mati/sangat parah & tdk ada
harapan hidup
Gawat darurat MERAH
Gawat tidak darurat PUTIH
Tidak gawat, darurat KUNING
Tidak gawat, tidak darurat HIJAU
Meninggal HITAM

24
Forensik/
Hitam
Km Jenazah

Ambulan Terminal Care


Triase Standard
Pra-RS Gadar HCU

R. Resus.
Merah ICU
Orange
ICCU

PICU/ Perina

Admini- ReTriase / R. OK
Pasien UGD

R. Tindak / Monitor
strasi Triase RS
IW

Kuning Kebidanan

Ambulan lain/ R.Rawat


Datang sendiri/ Dewasa
diantar
R. Rawat
anak

Hijau Pulang

R. Tunggu 25
Triage cannot be organised ad hoc.
It requires planning:

• Preparation before the crisis


• Organisation of the personnel
• Organisation of the space
• Organisation of the infrastructure
• Organisation of the equipment
• Organisation of supplies
• Training
• Communication

• Security
• Convergence reaction = relatives, friends &
the curious (especially the armed ones)
Triage involves a dynamic equilibrium between needs
and resources.

Needs = number of wounded and types of wounds

Resources = infrastructure and equipment at hand &


competent personnel present
The Triage Team

• Triage team leader: co-ordinator

• Clinical triage officer

• Head nurse, matron: chief organiser

• Nursing groups

• Follow-up medical groups


Clinical Triage Officer

No task in the medical services requires


greater understanding,
skill,
and judgement
than the sorting of casualties
and the establishment of priorities for
treatment.
Triage decisions must be respected.

Discuss afterwards.
Triage is a dynamic process:

 begins at the point of wounding,

 occurs all along the chain of casualty care,

 occurs at the hospital reception,

 and continues inside the hospital wards:

 continuous reassessment of patients.


Triage Documentation

• Include basic
information
• Short-form
• Clear
• Concise
• Complete
Triage Documentation

Reality check
What really happens!

During post-triage
evaluation:
decided to use plastic
sleeve to hold the
documentation.
The triage process:

• Sift

• Place patients in main categories: priority

• Sort

• Priority amongst the priorities


Sift
1) Select those most severely injured and

2) identify and remove:

• the dead

• the slightly injured

• the uninjured
Sort
Categorise the most severely injured based on:

• life-threatening conditions (ABC)

• anatomic site of injury

• Red Cross Wound Score

• treatment available in terms of personnel and


supplies
ICRC TRIAGE CATEGORIES

I. Serious wounds: resuscitation and immediate


surgery

II. Second priority: need surgery but can wait

III. Superficial wounds: ambulatory management

IV. Severe wounds: supportive treatment


Category I: Resuscitation and immediate surgery

Patients who need urgent surgery – life-saving – and have


a good chance of recovery.

(E.g. Airway, Breathing, Circulation: tracheostomy, haemothorax,


haemorrhaging abdominal injuries, peripheral blood vessels)
Distal pulse absent
Category II: Need surgery but can wait

Patients who require surgery but not on an urgent


basis.

A large number of patients will fall into this group.

(E.g. non-haemorrhaging abdominal injuries, wounds of limbs


with fractures and/or major soft tissue wounds, penetrating head
wounds GCS > 8.)
Category I for Airway; Category II for debridement
Femoral vessels intact
Category III: Superficial wounds
(no surgery, ambulatory treatment)

Patients with wounds requiring little or no surgery.

In practice, this is a large group, including superficial wounds managed


under local anaesthesia in the emergency room or with simple first aid
measures.
Multiple superficial fragments
Category IV: Very severe wounds
(no surgery, supportive treatment)

Patients with such severe injuries that they are unlikely to


survive or would have a poor quality of survival.

The moribund or those with multiple major injuries whose


management could be considered wasteful of scarce resources in a
mass casualty situation.
War Wounded in the Field

WW in the field
(GSW, mine, blast)
100 wounded

30 - 40 % 60 - 70 %
No surgery Hospital care

First Aid 90% Surgery 10% NO Surgery


Dressing

12-15% Head Small wounds


10% Chest Paraplegia
10% Abdomen Quadriplegia
60-65% Limbs Observation
Epidemiology of Triage:
short evacuation time

• Category I 5 - 10%

• Category II 25 – 30%

• Category III 50 - 60%

• Category IV 5 - 7%
Triage in Monrovia 2003
3 June – 22 August
• Total patients triaged = 2588

• Total admitted = 1015 (40% of triaged)

• War wounded = 88.5% of admissions

• Operations = 1433

• Admitted but not operated = 296

• All category 1 patients triaged, admitted and operated within


24 hours
Number Patients
100
120
140
160
180
200

0
20
40
60
80
3.06
7.06
11.06
15.06
19.06
23.06
27.06
1 July
5.07
three peaks

9.07
13.07
Date

17.07
Patients triaged by date:

21.07
25.07
29.07
2.08
6.08
10.08
14.08
18.08
22.08
Summary of triage theory & philosophy:
sorting by priority

A simple emergency plan: personnel, space, infrastructure,


equipment, supplies = system

"Best for most" policy

Priority patients are those with a good chance of good


survival.

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