Triage
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Triage, derived from a French word meaning "to sort", originated in military medicine, but is widely used in medical situations where there is more demand for resources than can immediately be met. In the general practice of emergency medicine, patients presenting at an emergency room usually receive basic triage from a nurse, who determines who is in need of immediate care, urgent care, and care when it is available; patients are not taken to physicians on a first-come-first-served basis. As opposed to general emergency care, triage takes on special significance in multiple casualty incidents and mass casualty incidents. These, of course, are common in battlefield situations, where the practice came into use. The goal of triage is to optimize several different factors: the severity of a patient's condition, the resources that are available, the probability that a given set of resources will produce a desirable outcome, and the overall demand on resources. Triage, for multiple and mass casualty incidents that are within the purview of one emergency response system, often begins in the field. Customary categorizationUntil resources start being overwhelmed and an incident changes from multiple to mass casualty, there are three main categories:
Depending on policy, including legal, ethical, and operational considerations, there may be diversion of frightened but healthy people, and those that are clearly dead. Guidelines for determining death, in the field, vary with the training of the responder and the operational environment; it takes little training to determine that decapitation is incompatible with life, and more to attempt to reestablish breathing with various fast resuscitation measures.[1] Mechanism of injury plays an important part, such as blunt trauma from blast. [2] In less critical situations, there is more variation on the authority of paramedical personnel to declare death under field conditions. Decapitation remains a criterion, but, while a pulseless and nonbreathing victim would immediately be declared dead under mass casualty condition, more evaluation might be done if there are no other victims that can clearly be helped. For example, an increasingly large number of systems recognize that a pulseless victim of blunt chest trauma has essentially no chance of survival, while a victim of penetrating chest trauma may have some survival chance if they can be transported to a facility capable of certain immediate (i.e., as in the emergency room) surgical interventions.
Specialized rating systemsEmergency and critical care medicine needs to use triage in non-disaster situations as events in which only minimal triage criteria are practical. Specialized methods have been developed for certain types of patients, differentiating, for example, between medical and trauma patients.[4] One of the controversies in trauma triage is the extent to which "mechanism of injury" should be considered: is the victim of an automobile accident believed been at some value of high speed, or a gunshot wound to a certain anatomic area, to be triaged as urgent regardless of their immediate clinical presentation? Triage for acute radiation syndrome involves both mechanism of radiation injury as well as immediate clinical presentation. Decisions may be especially difficult when the patient seems only mildly ill, but there is objective measurement data that shows a non-survivable radiation dose was received. References
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