https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148628/
https://www.frontiersin.org/articles/10.3389/fpubh.2015.00198/full
START Triage Practice – Who Wants to be an EMT?
When first responders arrive on the scene of a large-scale incident, the situation will most likely be chaotic. Injured people, panic, destruction, and potentially, an ongoing threat are likely. To provide service to the victims, the first responder’s primary concern must be to address the threat, by eliminating or containing it.
Next, first responders must organize the scene and create a manageable plan for treating all victims. The process of creating this plan is called triage. Triage maximizes the available resources.
Incidents involving weapons of mass destruction are referred to as CBRN events (which stands for chemical, biological, radiological, nuclear). In these events, responders must separate the scene into three distinct zones; cold, warm, and hot. This allows medical responders controlled access to the scene and minimizes the possibility of additional victims being exposed or infected while containing victims who are already exposed. Finally, controlled access creates a safe working area for responding personnel.
Cold Zone: This area will serve as the clean treatment area and is the outmost area of a CBRN incident. Patients who have already been contaminated will be treated here before they are transported to any other location. This area should be at least 300 yards upwind from the contaminated area.
Warm Zone: This area is considered the decontamination area and should be located at least several hundred yards away from the contaminated area, and at least 50 yards from the cold zone.
Hot Zone: This is the contaminated area, where the threat is present.
While zones are being created and separated, additional personnel may already be starting to triage the victims. First responders must recognize a potential CBRN threat and not endanger themselves when trying to reach the victims.
Triaging Victims
As stated above, triage is all about making the most of the resources at hand. Inevitably, emergency personnel must make decisions about how to allocate available resources. Not every victim will receive the same level of care. Those with critical injuries will require more attention than the less severely injured.
Mass casualty scenes divide patients by level of injury and are designated by colored flags or tarps. This provides first responders with a quick visual reference and eliminates double work. The levels of injury are separated as follows:
IMMEDIATE (CRITICALLY INJURED):
These patients are in need of immediate care or transport to save life or limb. They are designated by a red flag or tarp.
DELAYED (URGENT):
These patients are still seriously injured but it may not be life threatening. They are designated by a yellow flag or tarp.
MINOR (AMBULATORY):
These patients have only minor injuries and/or are mobile and can walk themselves to safe zone or additional medical care. They are designated by a green flag or tarp.
EXPIRED (DECEASED):
These patients are deceased. There is no longer any medical care that can help them. They are designated by a black flag or tarp.
Having a preset method of scene management helps first responders calm a chaotic scene.
