Triage Study Guide

📖 Core Concepts Triage – Process to rank injured patients by treatment priority and to ration limited supplies. Priority principle – Treat the most injured and most treatable first; the most terminally injured are lowest (except reverse‑triage). Simple (field) triage – Rapid on‑scene sorting into Immediate, Delayed, Minor, and Expectant categories (e.g., START). ABCDE assessment – Quick physiological check: Airway → Breathing → Circulation → Disability (neurologic) → Exposure. Undertriage vs. Overtriage – Undertriage = severity underestimated (dangerous); Overtriage = severity overestimated (resource‑heavy). Acceptable overtriage can be as high as 50 % to protect against undertriage. Reverse triage – (1) Discharge/transfer patients to free capacity before a new mass‑casualty event; (2) Treat least‑injured first to return them to function quickly. 📌 Must Remember START categories: Red (Immediate, Priority 1) – life‑threatening, needs evacuation ≤ 1 hr. Yellow (Delayed, Priority 2) – serious but can wait. Green (Minor, Priority 3) – low‑acuity, self‑care possible. Black (Expectant) – injuries beyond help; may be left on scene. Key rule: “Most injured and most treatable” → highest priority. Overtriage tolerance: up to 50 % is considered acceptable to avoid lethal undertriage. Ethical pillars: fidelity, veracity, justice, autonomy, beneficence. Utilitarian triage goal: maximize overall survival, even if some individuals die. 🔄 Key Processes Initial scene safety & resource check – ensure responder safety before any assessment. Rapid ABCDE scan – identify airway obstruction, breathing problems, circulatory shock, neurologic deficits, and dangerous exposures. START triage decision tree (simplified): Can the patient walk? → Green. Not walking → assess breathing > 30 rpm? → Red if yes, otherwise check perfusion (capillary refill > 2 s) → Yellow if normal, Red if abnormal, then check mental status → Red if unable to follow commands. Tag assignment – attach color tag with patient ID, vital findings, and any hazard warnings. Evacuation planning – prioritize Immediate patients for transport within 1 hour; move Expectant patients only if safe/necessary. Advanced secondary triage – at hospitals, use imaging, Revised Trauma Score, ISS, etc., to refine priority and direct definitive care. 🔍 Key Comparisons START vs. JumpSTART – START = adult‑focused; JumpSTART adds pediatric respiratory‑rate and capillary‑refill cut‑offs for children ≤ 8 yr. Immediate (Red) vs. Delayed (Yellow) – Red = life‑threatening, needs rapid evacuation; Yellow = serious but can wait longer for transport. Undertriage vs. Overtriage – Undertriage = missed critical injuries (dangerous); Overtriage = unnecessary resource use (acceptable up to 50 %). Simple field triage vs. Advanced secondary triage – Simple = visual/vital quick checks, color tags; Advanced = full diagnostics, scores, definitive treatment decisions. ⚠️ Common Misunderstandings “Deceased patients are always tagged Black.” – In START, deceased are left where they fall; Black tags are for patients deemed unsalvageable but still alive. “Overtriage is always bad.” – Some overtriage is deliberately tolerated to protect against the far more serious consequences of undertriage. “Triage is purely objective.” – Many decisions rely on provider judgment; scoring systems help but cannot eliminate subjectivity. “VIPs always receive priority.” – Ethical guidelines state VIP care is only permissible if it does not compromise fairness to the broader patient population. 🧠 Mental Models / Intuition “Golden Rule of Triage” – Treat the patient who will gain the most life‑years from treatment now. Color‑code hierarchy – Imagine a traffic light: Red = stop (must act now), Yellow = caution (can wait), Green = go (can self‑manage). “Rescue bandwidth” – Visualize limited ambulance slots as a bandwidth pipe; fill it first with the highest‑value (most treatable) data packets. 🚩 Exceptions & Edge Cases Reverse triage – When capacity is needed for an incoming surge, discharge or transfer stable patients (reverse of usual priority). Pediatric patients – Use JumpSTART criteria; normal adult respiratory thresholds can misclassify children. Mass‑casualty with chemical/biological hazard – Tags must also flag contamination; evacuation may prioritize decontamination over injury severity. Pandemic (e.g., COVID‑19) – Triage may shift to prioritize short‑ and long‑term survivability to preserve ventilators and ICU beds. 📍 When to Use Which START – Default for U.S. mass‑casualty scenes; when rapid visual/vital assessment is possible and resources are limited. JumpSTART – Any incident with a significant pediatric population (< 8 yr). CTAS / ATS / Manchester / MITT – Routine emergency‑department triage or when a country’s national system mandates it; not for immediate field mass‑casualty sorting. Advanced secondary triage – At hospitals once patients have been evacuated; apply scoring systems (RTS, ISS) to allocate operating rooms, ICU beds, etc. Reverse triage – Prior to a predicted surge (e.g., impending disaster) or when hospital capacity is critically low. 👀 Patterns to Recognize “Walking = Green” – Any casualty able to ambulate independently is likely Minor. Breathing > 30 rpm = Red – Hyperventilation in adults often signals severe thoracic injury or shock. Capillary refill > 2 s + altered mental status = Red – Classic START trigger for Immediate. Consistent overtriage in a unit – May indicate overly cautious protocol or lack of training on physiologic thresholds. 🗂️ Exam Traps Choosing “Black” for a patient who is simply unconscious – Black is reserved for those beyond help; an unconscious but potentially salvageable patient should be Red or Yellow based on vitals. Assuming all countries use START – Only the U.S. widely uses START; Canada uses CTAS for ED, Australia uses ATS, etc. Confusing “Reverse triage” with “Reverse triage (military) = treat least injured first” – Both meanings exist; exam may ask for specific context. Selecting “Overtriage is always unacceptable” – Remember the accepted 50 % overtriage ceiling to protect against undertriage. Ignoring ethical principle of justice when discussing VIP care – Correct answer will note that VIP priority is only ethical if it does not compromise overall fairness.