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START Triage System - Do you use this?
START Triage System and the new WMD Triage Tags...
1. Do you use it?
2. Have you heard of it?
3. Do you have it memorized?
4. When do you initiate it?
1. My department and as far as I know, all fire departments in California use this system for managing mass casualty incidents.
2. It was developed here in California years ago, so it's an proven and valuable tool here.
3. 32 CAN DO is the term that makes it easy to remember coupled with RPM
4. 3 or more patients is the determination when to declare that you have a MCI
5. The new Triage tags have been modified by a company (attached info) that enables use for WMD incidents. Key point about the new tags is that they are water proof. Patients going through the decon process get wet, which means that if you are using the old tags, anything you write down will be destroyed by soap and water...
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triage2_042199ap.jpg, 19 KB
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Replies to This Discussion
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Permalink Reply by Tony P on
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Ye Gods Mike! Another acronym?
I can see how it works, but I'm glad that we stick with simple 1st Aid. CPR if needed, stop obvious bleeding and keep patient safe.. The ambos can take over as soon as they arrive.
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Permalink Reply by Mike Schlags (Captain Busy) Retd on
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So you are telling me Tony that the fire department in Australia does not assume command as the incident commander, using the ICS system where you have a medical branch to deal with the MCI issues? or that the first unit on scene does not do any medical care or triage? If this is the case, then what looks like a complicated system is actually very easy to learn. If this is a new concept for you, cool. Standby to get educated brother because the system totally works. A company officer needs to manage the incident and not get caught up in actually providing medical care. The firefighters on scene as the first responders use this system to get folks ready for medical personnel as they arrive... and it's the fire department who coordinates helicopters used for medivac transport and it's the 1st paramedic on scene who assumes the role of Medcom which is the dedicated person who alerts the hospital that they have a major incident. By doing this, where patients are transported is done in a very organizied and coordinated fashion. ms
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No medical branch with our fire services, 1st Aid only. Ambulance, all Paramedics, is another service. We will start 1st aid at an incident, but the ambulances are never far behind (sometimes they get there first) and so take over. With an MVA for instance, the Police are in overall control, if there's fire then we do what needs to be done, if there's entrapment then the rescue people (either Fire or another volunteer organisation, the State Emergency Service) do their bit, patient care is the role of the Ambulance Service and that includes air transport.
Our system is different to yours, but it works and works well. The biggest difference is probablythe the separation of ambulance and fire. Both are State-wide State run organisations, with each sticking to its own field of expertise. We also only have one Police organisation in each state so never any jurisdiction issues.
I'm a Firefighter with 1st Aid qualification; do a three year university degree to become a paramedic? I don't think so! Education? Not needed mate, I see and understand what you do, but don't need to learn the nitty-gritty of it all, it won't happen here.
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Permalink Reply by Ben on
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Yep, we use it. With a minor change though. We check the carotid before checking respirations. I could be wrong, though. I will check. Other than that it works fine for us. Pretty easy to remember, easy to use, and effective.
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Permalink Reply by Ben Waller on
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We use it as a department standard.
We implement it any time the number of initial patients exceeds the number of crew members available, or when there is a high proportion of priority 1 patients...in other words, not very often.
We carry 50 tags on each ambulance, a 200 tag kit on the battalion rig, a 200 tag kit on the hazmat/COBRA rig, and a 200 tag backup system for training.
We memorize the decon and RPM parts of it, but it's really easy to just read the tag if you forget.
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Providing time efficient EMS delivery is the number one goal here as I am sure it is for you in Australia. One key point here is that in situations such as the LAFD Amtrak commuter train MCI incident, the area where people were trapped required firefighters to perform the rescues and initiate emergency ACLS on scene. This type of environment requires PPE and training, neither are provided typically by private ambulance company paramedics. Additionally, it is not uncommon to have the private ambulance provider not able to clear an ambulance because they are busy with interhospital transports, bread and butter for private EMS. The fire department on the other hand has minimum response times and the ability to deliver ACLS immediately. On a selfish note, if one of our own goes down, we have immediate onsite emergency pre-hospital care, and we have the right equipment to pull it off.
We have a couple of ambulances, only because the areas were not considered profitable enough for the privates, even though they have a pretty sweet and fat contract to provide the services. As a result, most of our medics, even though not being assigned to a dedicated paramedic engine company, have the ability to provide immediate ACLS with a small paramedic backpack that has some basic drugs, IV's and supplies.
When a medic is not on duty at a non-medic station, the EMS pack is safely locked up due to obvious security and accountability issues. When a medic works an overtime shift at a non-EMS station, the pack comes out and the engine designation is changed from Engine 18 for example to Medic Engine 18, which enables folks to know that a paramedic is staffing the engine.
Yup, we both work in totally different worlds and it sounds like you don't have the problem of running out of ambulances with paramedics like we do. But isn't it cool to discover how we are different? One thing remains the same though Tony, we still have in common putting the wet stuff on the red stuff... : )
TCSS,
Mike
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