Triage

dr. Wirawan Anggorotomo, Sp.An.

SMF Anestesiologi dan Terapi Intensif

FK Univ.Malahayati/ RS Pertamina Bintang Amin
Bandar Lampung
Triage
The sorting of and allocation of treatment to patients and especially battle
and disaster victims according to a system of priorities designed to
maximize the number of survivors
(from the French trier, to sort)
(Merriam-Webster)
TRIAGE
Tindakan untuk mengelompokkan korban
berdasarkan beratnya cedera, kemungkinan untuk
hidup, dan keberhasilan tindakan berdasarkan
sumber daya (SDM atau peralatan) yang tersedia.
Triage:metode cepat untuk menentukan
prioritas penanganan pasien/korban
Casualty
Incident Site Collection Triage Unit Leader
Point

Simple Triage And Rapid Treatment

JumpSTART
Triage
• Triage harus dilakukan
SECEPATNYA

• Gunakan START/
JumpSTART untuk
menentukan prioritas

• 30–60 detik per pasien

• Pasang pita di bagian kiri atas

lengan atau kaki
 START – JumpSTART Triage
• Pisahkan pasien “walking wounded” dengan
perintah:
Jika anda dapat mendengar saya dan bisa bergerak,
pindah ke…..
• Arahkan korban ke titik kumpul atau area tindakan
untuk pemeriksaan dan penanganan lebih lanjut
• Tunjuk seseorang untuk mengawasi pasien dan
mengamankan area hijau
• Pita dipasang di titik kumpul
• Pasien/korban termasuk kategori MINOR
START/JumpSTART
Gunakan
START/JumpSTART untuk
menilai dan memilah pasien
yang tersisa

USE COLORED
RIBBONS ONLY
START/JumpSTART
Pengelompokan pasien dengan menilai RPM

Respirations

Pulse/perfusion

Mental Status
START First Step
Can the Patient Walk?

YES NO

Evaluate
Green Ventilation
(Minor) (Step-2)
START Step-2
Ventilation Present?
NO YES

Open Airway

Ventilation Present? > 30/Min < 30/min

NO YES Red/ Immediate

Black Red/ Immediate Evaluate Circulation

(Step-3)
 START Step-3
Circulation

Absent Radial Pulse Present Radial Pulse

Control Hemorrhage
Evaluate Level of
Consciousness
Red/ Immediate
START Step-4
Level of Consciousness

Can’t Follow Simple Can Follow Simple

Commands Commands

Red/ Immediate Yellow/ Delayed

 Combined START/JumpSTART Triage
CAN YOU YES ** Using the JS algorithm
MINOR SECONDARY TRIAGE ** evaluate all children first
WALK ? who did not walk under
their own power.
NO
Evaluate infants first in
BREATHING secondary triage using
NO Position Upper Airway IMMEDIATE
Breathing ? entire JS algorithm !

APNEIC
PEDIATRIC ADULT
HAS A NO PULSE
PULSE
APNEIC PEDI Neurological Assessment
YES 5 Rescue Breaths Expected /
Deceased A Alert
BREATHING
V Responds to
IMMEDIATE Verbal Stimuli
Responds to
Respiratory > 30 ADULT P
IMMEDIATE Painful Stimuli
Rate? PEDI Unresponsive
45 > OR < 15
< 30 ADULT U To Noxious
15 - 45 PEDI ADULT Stimuli
CR >2 Sec or NO PALPABLE PULSE
Perfusion ? IMMEDIATE
PEDI - NO PALPABLE PULSE
YES “P” INAPPROPRIATE POSTURING OR “U”
( PEDIATRIC )
Mental DOESN’T OBEY COMMANDS IMMEDIATE
Status ? ADULT
OBEY COMMANDS - ADULT
DELAYED
“A”, “V”, OR “P” ( APPROPRIATE ) - PEDIATRIC

Http ://www . starttriage . com Http :// www . jumpstarttriage . com

Triage Category (Immediate)
Adult Pediatric
Respirations > 30 BPM Respirations < 15 or > 45
CR > 2 seconds or CR > 2 seconds or no palpable
no palpable radial pulse radial or brachial pulse
Cannot follow simple Inappropriate “Pain”
commands (e.g., posturing) or
“Unresponsive”
Pneumothorax
Hemorrhagic Shock
Closed Head Injury
 Triage Category (Delayed)
Adult: respirations, capillary refill, and mentation are normal
• Isolated burns

• Extremity fractures

• Stable other trauma

• Most patients with

medical complaints

Pediatric: “A,” “V,” or appropriate “P”

(e.g., withdrawal from pain stimulus)
 Triage Category (Minor)

• “Walking
wounded”
• Psychological
casualties
• Always look for
children being
carried and assess
them
 BLACK Triage Category (Deceased)

• Obvious mortality or death

(pulseless and apneic)
• Decapitation
• Blunt trauma arrest
• Injuries incompatible with life
• Brain matter visible
Noji et al, NEJM
Simpulan
• Triage memberikan penanganan yang efektif
dan efisien, membantu meningkatkan
kemampuan survival pasien sebanyak
mungkin
• Pengaturan sumber daya akan
meningkatkan efisiensi
• Pasien dengan cedera berat akan segera
ditangani dan ditransfer sesuai prosedur
• Menjamin akuntabilitas pasien
 START/JumpSTART—RPM
RESPIRATIONS
Is the patient breathing?
Yes
Adult – respirations > 30 = Red/Immediate
Pediatric – respirations < 15 or > 45 = Red/Immediate
Adult – respirations < 30 = check perfusion
Pediatric – respirations > 15 and < 45 = check perfusion
START/JumpSTART—RPM
RESPIRATIONS
Is the patient breathing?

No
Reposition the airway…
Respirations begin = IMMEDIATE/RED
If patient is APNEIC
 Adult – deceased = BLACK
 Pediatric: Pulse Present – give
5 rescue breaths
 respirations begin =
IMMEDIATE/RED
 absent respirations –
deceased = BLACK
 START/JumpSTART—RPM
PULSE/PERFUSION
Is the RADIAL pulse present?

Is capillary refill (CR) LESS than < 2

seconds?
Yes
Check mental status

No
Adult: Pulse absent or
CR > 2 seconds patient
= IMMEDIATE/RED
Pediatric: No palpable
pulse patient =
IMMEDIATE/RED
 START/JumpSTART—RPM
MENTAL STATUS…
Can the patient follow simple commands?
Yes
Adult =
Pediatric: alert, verbal, or pain response is
appropriate
=

No
Adult = IMMEDIATE / RED
Pediatric – “P” pain causes inappropriate
posturing or “U” unresponsive to noxious
stimuli = IMMEDIATE/ RED
 START/JumpSTART
If the patient is IMMEDIATE/RED upon initial
assessment…then, before moving the patient to the
treatment area, attempt only life-saving interventions:

Airway, Needle Decompression, Tourniquet,

Antidote

DO NOT ATTEMPT ANY OTHER

TREATMENT AT THIS TIME