Understanding Mass Casualty Incidents and Triage Principles

Mass casualty incidents (MCIs) overwhelm normal medical resources, requiring different approaches to save the most lives possible.

What Defines a Mass Casualty Incident:

Key Characteristics:

- More patients than resources - Overwhelmed local response - Need for triage decisions - Extended response times - Resource scarcity - Multiple agencies involved

Types of MCIs:

- Natural disasters (earthquakes, hurricanes, floods) - Transportation accidents - Building collapses - Active shooter events - Terrorist attacks - Pandemic situations - Industrial accidents

START Triage System (Simple Triage and Rapid Treatment):

Purpose: Sort patients in 60 seconds or less per person

Categories:

1. RED (Immediate) - Life-threatening but saveable 2. YELLOW (Delayed) - Urgent but can wait 3. GREEN (Minor) - Walking wounded 4. BLACK (Deceased/Expectant) - Dead or unsaveable

The START Algorithm:

Step 1: Can They Walk?

- If YES → GREEN (minor) - Direct to collection point - If NO → Continue assessment

Step 2: Are They Breathing?

- If NO → Open airway - If still NO → BLACK (deceased) - If YES → Check rate - Rate >30 → RED (immediate) - Rate <30 → Continue

Step 3: Check Circulation

- Radial pulse present? - Or capillary refill <2 seconds? - If NO → RED (immediate) - If YES → Continue

Step 4: Mental Status

- Can follow simple commands? - If NO → RED (immediate) - If YES → YELLOW (delayed)

> Quick Reference Box: > Triage Memorization: 30-2-Can Do > - Respirations over 30 = RED > - Capillary refill over 2 seconds = RED > - Can't follow commands = RED > - Otherwise = YELLOW or GREEN

JumpSTART (Pediatric Triage):

Key Differences for Children:

- Check breathing differently - Give 5 rescue breaths if not breathing - Use AVPU scale for mental status - Different respiratory rates - Consider developmental stage

Pediatric Modifications:

- Respiratory rate >45 (infant) or >35 (child) = RED - No palpable pulse = Give 5 breaths then recheck - AVPU less than "A" (Alert) = RED

Triage Tagging Systems:

Physical Tags:

- Commercial triage tags - Tear-off sections - Color-coded - Patient information - Time stamps

Improvised Marking:

- Lipstick/marker on forehead - Colored tape/fabric - Survey tape - Anything visible - Must be consistent