西门子LR400雷达物位计操作手册[4]

Military vs. Civilian Triage
Military model Those with the least serious wounds may be the first treatment priority Civilian model Those with the most serious but realistically salvageable injuries are treated first
Ethical Justification
This is one of the few places where a "utilitarian rule" governs medicine: the greater good of the greater number rather than the particular good of the patient at hand. This rule is justified only because of the clear necessity of general public welfare in a crisis.
“The needs of
the many outweigh the needs of the few or the one."
Star Trek
Why are Resources Important in Triage?
Disaster is commonly defined as an incident in which patient care needs overwhelm local response resources. Daily emergency care is not usually constrained by resource availability.
Triage Tools
Simple Triage and Rapid Treatment (START)
JumpSTART Pediatric MCI Triage Tool
The Smart Triage
® Tape
Developed in Great Britain Proprietary, TSG Associates Length-based pediatric MCI triage tape Age-adjusted physiologic parameters In use in Europe, Africa and some states in the US
A. Jonsen and K. Edwards, “Resource Allocation” in Ethics in Medicine, Univ. of Washington School of Medicine, http://eduserv.hscer.washington.edu/bioethics/topics/resall.html
SALT Triage
SALT Triage
Mass Casualty Triage: An Evaluation of the Data and Development of a Proposed National Guideline
“Continuous Integrated Triage”
Primary Triage
Secondary Triage Tertiary Triage
Triage Categories
Triage Categories
Red: Life-threatening but treatable injuries requiring rapid medical attention Yellow: Potentially serious injuries, but are stable enough to wait a short while for medical treatment
Primary Disaster Triage
Goal: to sort patients based on probable needs for immediate care. Also to recognize futility. Assumptions:
Medical needs outstrip immediately available resources Additional resources will become available with time
Triage Categories
Green: Minor injuries that can wait for longer periods of time for treatment Black: Dead or still with life signs but injuries are incompatible with survival in austere conditions
Pediatric Multicasualty Incident Triage
雷达物位计 http://www.wuweiji.cn
Lou E. Romig MD, FAAP, FACEP Miami Children’s Hospital Miami-Dade Fire Rescue FL-5 DMAT
SALT Triage
Sort, Assess, Life-saving Interventions, Treatment/Transport CDC grant project to standardize MCI triage in the US Early in development Derived from existing tools Includes pediatric considerations
Primary Disaster Triage
Triage based on physiology
How well the patient is able to utilize their own resources to deal with their injuries
Which conditions will benefit the most from the expenditure of limited resources
www.tsgassociates.co.uk/English/Civilian/ products/smart_tape.htm
Triage Sieve
Care Flight Triage
Basic Disaster Life Support
National Disaster Life Support Education Consortium, via Medical College of Georgia’s Center of Operational Medicine
Topics
What is Triage?
Triage CategHale Waihona Puke Baiduries
Triage Tools
What is Triage?
“Triage” means “to sort”
Looks at medical needs and urgency of each individual patient Sorting based on limited data acquisition Also must consider resource availability
Secondary Triage Tools
There is no widely recognized tool in the US that addresses secondary MCI triage and also transport strategies. California “Medical Disaster Response” course’s SAVE tool (Secondary Assessment of Victim Endpoint)
Daily Emergencies Do the best for each individual.
Disaster Settings Do the greatest good for the greatest number. Maximize survival.
Triage is a dynamic process and is usually done more than once.
Military vs. Civilian Triage In both models, victims with clearly lethal injuries or those who are unlikely to survive even with extensive resource application are treated as the lowest priority.
Secondary Disaster Triage
Goal: to best match patients’ current and anticipated needs with available resources. Incorporates: A reassessment of physiology An assessment of physical injuries Initial treatment and assessment of patient response Further knowledge of resource availability
Endorsed by the American Medical Association www.ndlsf.org
Basic Disaster Life Support
MASS Triage Move Assess Sort Send ? Assessment guidelines ? Pediatric considerations
Military vs. Civilian Triage
Priority is to get as many soldiers back into action as possible.
Priority is to maximize survival of the greatest number of victims.
Many EMS systems use local trauma triage criteria.
Tertiary Disaster Triage
Goal: to optimize individual outcome Incorporates: Sophisticated assessment and treatment Further assessment of available medical resources Determination of best venue for definitive care
Secondary Triage Tools
Goal is to distinguish between:
Victims needing life-saving treatment that can only be provided in a hospital setting.
Victims needing life-saving treatment initially available on scene. Victims with moderate non-lifethreatening injuries, at risk for delayed complications. Victims with minor injuries.