1.

Mengetahui peran dan praktek

triage

2. Mengerti proses triage

Tujuan dari triage

: adalah untuk menghasilkan penanganan

terbaik bagi korban terutama bila
berhadapan dengan korban dalam jumlah
yang banyak
DASAR MELAKUKAN TRIAGE :

1. Berat ringannya luka

2. Jumlah yang terluka
3. Sumber daya yang tersedia,
4. Kesempatan untuk
menyelamatkan korban
 FUNGSI TRIAGE

1. Menilai tanda-tanda dan kondisi vital dari korban

2. Menentukan kebutuhan medis
3. Menilai kemungkinan keselamatan thd korban
4. Menilai dan penanganan
5. Menentukan prioritas penanganan korban
6. Memberikan pasien label warna sesuai dengan
skala prioritas
 Triage

SKALA PRIORITAS DAPAT

MENURUNKAN MORBIDITAS
DAN MORTALITAS SELAMA
BENCANA
Procedures of Triage

 TRAGE DILAKUKAN SEBELUM MELAKUKAN

PENANGANAN
 < 60 DETIK
 Menentukan prioritas penanganan pasien
dan prioritas evakuasi korban ke Emergency
Departement yang mempunyai fasilitas yang
lebih baik untuk penanganan difinitif
 Single Patient Triage

 Single patient triage – penting di ruang emergency

terutama pada keadaan dimana ruang emrgency
sangat sibuk dan fasilitas kamar operasi yang
keseluruhan terpakai.
 Single patient triage – dengan mengadakan skala
prioritas di ruang emergency, maka kita dapat
menurunkan morbiditas dan mortalitas.
 Katagori Triage, termasuk.
a) Emergent
b) Urgent
c) Non-urgent
 KATAGORI EMERGENT

 Major trauma
 Airway obstruction
 Tension pneumothorax
 Flail Chest
 Hypovolemic shock (Class III and IV)
 Burns with inhalation injury
management should begin upon arrival
 Urgent
 Vertebral and Spine Injury
 Femoral shaft fracture
 Closed head injury
 Burns

They all are at risk if not treated in a few hours

 Non-urgent

 Skinlacerations
 Contusions
 Abrasions
 Upper extremity fractures
 Fever
 Associated medical conditions
 THE GOLDEN HOUR
 Amount of time from injury to the
definitive care.
 Care given within the first hour, mortality
and morbidity is favorably reduced
 Mass casualty triage
 Mass casualty triage – pada musibah massal
yang mengakibatkan jumlah korban yang
banyak seperti keadaan bencana.
 Pada level tersebut tidak dapat dilakukan
penanganan secara bersamaan maka diperlukan
suatu prioritas.
 Katagori Triage an.
a) Immediate
b) Delayed
c) Walking wounded
d) Dead and dying
 START Triage
Simple Triage And Rapid Treatment
Dengan menilai :
1. Respiration
2. Circulation
3. Mental Status
 START
Tujuan dari triage memakai
START untuk mengatasi
1.Sumbatan Jalan nafas
2.Pernafasan
3.Perdarahan
 KATAGORI
1. Meningga(l BLACK)
No ventilations present after
clearing airway
2. Berat/kritis (RED)
RR >30/min
delayed capillary refill(>2 secs)
unable to follow simple
commands
3. Sedang (YELLOW)
4. Ringan(GREEN)
“Walking wounded”
Prosedur Dari START
(time <60 seconds / patient)

 Frekwensi Pernafasan
 assess for RR and adequacy
 not breathing – check for foreign body
obstruction; remove loose dentures; reposition
head with C-spine precautions
 Tidak bernafas – HITAM
 Frekwensi Nafas > 30/min – MERAH
 Frekwensi Nafas < 30/min – Jangan diberi
label, tapi
 Nilai Perfusi
Prosedure dari START

 Perfusi
 assess capillary refill (> atau < 2 detik)
 >2 detik – MERAH
 <2 detik – jangan diberi label tapi nilai status
mental
 Kontrol Perdarahan.
 Prosedure dari START

 Status Mental
 Perintah sederhana
 “open and close your eyes”
 “squeeze my hands”
 Tidak bisa dilakukan – MERAH
 Bisa dilakukan -- KUNING
 TEAM
BANTUAN MEDIS BALI
PADA GEMPABUMI
TGL 27 MEI 2006
YOGYAKARTA

Team Bedah Bali I Membentuk

System Disaster RS bersama semua
SDM yang Ada Di RS Panti Rapih
pada hari pertama
Kunjungan Gubernur Bali,di RS Panti Rapih
pada Hari ke V
 PELEPASAN RELAWAN MASYARAKAT BALI KE PROPINSI ACEH
OLEH
GUBERNUR PROPINSI BALI

Prof. Dr. A A Gde Muningjaya, MPH/ Dr. IN Kuning Atmadjaya, SpB, FInaCS/ Dr. Putu Sandhi Kumara/ Dr. Putu Kurniyantha/Yullius Sukristanto/
Edy Suprayitno/Wayan Widiyasa, SpP/Putu Rakadana/Gde Arya Gunawan/Ketut Ramiyantha
Secondary Assessment of Victim
Endpoint ( SAVE )
 KATAGORI TRIAGE SAVE:
 Korban yang akan mati tanpa melihat jumlah
perawatan yang diterimanya
 Korban yang akan selamat tanpa melihat
langkah perawatan
 Korban yang akan sangat beruntung dari
intervensi di lapangan yang sangat terbatas.
 KESIMPULAN

 LATIHAN MELAKUKAN TRIAGE HARUS

SERING DILAKUKAN
 SISTEM DISASTER DIMASUKKAN DALAM
AKREDITASI RUMAH SAKIT.
 Case

 A 10 passenger bus crashes on a busy road

hitting a family of 5 in another vehicle head
on. The following are some of the victims
from the scene that you are now the triage
officer for. Triage these patients RED,
GREEN, YELLOW and BLACK according to
START criteria.
 Remember you have less then 60 seconds to
assess each victim.
 VICTIM 1
 17 yo female with
large bleeding
laceration to leg
 Respirations: 20
 Pulse: 65
 Mental Status:
Screaming
 Victim 2
 51yo driver of the family
vehicle, entrapped in
wreckage with obvious
head injury and brain
matter protruding
 Respirations: NONE
 Pulse: NOT PALPABLE
 Mental status:
UNRESPONSIVE
 Victim 3
 65 yo male with
complaint of painful
breathing and bloody
bruised left chest
 Respiration: 35
 Pulse: 120
 Mental Status: Intact
 Victim 4
 6 yo unconscious
male in back seat of
car
 Respirations: Absent
 Pulse: Weak and
thready
 Mental Status:
Diminished
 Victim 5
 26 yo female with
mild bruising of
abdomen, walking at
the scene
 Respirations: 24
 Pulse: 120
 Mental Status: Intact
 Victim 6
 3 yo male crying no
apparent injuries
 Respirations: 35
 Pulse: 110
 Mental Status: Intact
 Victim 7
 45 yo female complaining
for left hand pain with
obvious deformity of wrist
with bone exposed
 Respiration: 30
 Pulse: Absent in wrist
 Mental Status: Intact
 Victim 8
 19 yo female
unresponsive with
bleeding from ears
 Respirations: None
 Pulse: No peripheral
pulse
 Mental Status:
Unresponsive
 Victim 9
 30 yo male
complaining of neck
pain walking at the
scene
 Respirations: 25
 Pulse: 95
 Mental Status: Intact
 Victim 10
 60 yo male with
complaining for chest
pain
 Respirations: 40
 Pulse: 110
 Mental Status: Intact
 VICTIM 1
 17 yo female with large bleeding laceration to
leg
 Respirations: 20
 Pulse: 65
 Mental Status: Screaming

 YELLOW
 APPLY PRESSURE DRESSING AND MOVE ON TO NEXT
PERSON
 Victim 2

 51yo driver of the family vehicle,

entrapped in wreckage with obvious
head injury and brain matter protruding
 Respirations:NONE
 Pulse: NOT PALPABLE
 Mental status: UNRESPONSIVE

 BLACK
 Move to next victim
 Victim 3

 65 yo male with complaint of painful

breathing and bloody bruised left chest
 Respiration: 35
 Pulse: 120
 Mental Status: Intact

 RED
 Quick exam reveals decreased breath sounds on
left, needle decompression relieves the
pneumothorax and respiration and pulse improve
 Victim 4

 6 yo unconscious male in back seat of car

 Respirations: Absent
 Pulse: Weak and thready
 Mental Status: Diminished

 RED
 As soon as a jaw thrust maneuver is performed
respiration is restored and patient mental status
improves
 Victim 5

 26 yo female with mild bruising of

abdomen, walking at the scene
 Respirations: 24
 Pulse:120
 Mental Status: Intact

 YELLOW
 Mild bruising of the abdomen with elevated
pulse could signify a serious injury
 Victim 6

 3 yo male crying no apparent injuries

 Respirations: 35
 Pulse: 110
 Mental Status: Intact

 GREEN
 Respiratory rate for children in JUMPSTART is
above 45 and below 15
 Pulse is present and intact as is the mental status
of the child
 Victim 7
 45 yo female complaining for left hand pain
with obvious deformity of wrist with bone
exposed
 Respiration: 30
 Pulse: Absent in wrist
 Mental Status: Intact

 YELLOW
 Even though this is a limb threatening injury., it is
not life threatening. If the patient is placed in a
splint, they can wait to be fully evaluated
 Victim 8
 19 yo female unresponsive with bleeding
from ears
 Respirations:None
 Pulse: No peripheral pulse
 Mental Status: Unresponsive

 BLACK
 Victim 9
 30 yo male complaining of neck pain
walking at the scene
 Respirations: 25
 Pulse: 95
 Mental Status: Intact

 YELLOW
 He is walking and neurologically intact
 Victim 10

 60 yo male with complaining for chest pain

 Respirations: 40
 Pulse: 190
 Mental Status: Intact

 RED
 His respirations are above 35, he has a rapid pulse
and is complaining of chest pain, so there is a high
degree of suspicion for injury
 Questions
 In START triage an adult with
respirations at a rate of 36 per minute is
tagged as:
1. Red
2. Yellow
3. Green
4. Black
 Questions
 In START triage, an adult with a
fractured tibia, respirations of 20, and a
palpable radial pulses and no mental
impairment is tagged
1. Red
2. Yellow
3. Green
4. Black
 Questions
 The Goal when triaging a patient is to
spend less than _____ per patient
1. 10 seconds
2. 60 seconds
3. 120 seconds
4. 5 minutes
 Conclusion
 Learn triage classifications
 Apply the classifications in a timely
manner
 Remember that children are different from
adults