Advanced Trauma Life Support ATLS Student Course Manual 2018

YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.

BUKU PEDOMAN PELAKSANAAN KEPANITERAAN KLINIK DI RSAU

permenkes-11-2017

PMK No. 2052 ttg Izin Praktik Kedokteran

UU No. 44 Th 2009 ttg Rumah Sakit

Panduan 20 peny l primer

UU0202013

SKDI-disahkan

Kode-Etik-Kedokteran-Indonesia-2012

103713-06. PP_Nomor_93_Tahun_2015 tentang Rumah Sakit Pendidikan (1)

ppk pelayanan primer

THT

NEURO

OBSGYN

MATA

Appendix F TRIAGE SCENARIOS OBJECTIVES 1. Define triage. 3. Apply the principles of triage to actual scenarios. 2. Explain the general principles of triage and the factors that must be considered during the triage process. This is a self-assessment exercise, to be completed before you arrive for the course. Please read through the introductory information on the following pages before reading the individual scenarios and answering the related questions. This content is presented in a group discussion format during the course, and your active participation is expected. At the end of this session, your instructor will review the correct answers. The goal of this exercise is to understand how to apply trauma triage principles in multiple-patient scenarios. Definition of Triage Triage is the process of prioritizing patient treatment during mass-casualty events. Principles of Triage The general principles of triage include: •• Recognize that rescuer safety is the first priority. •• Do the most good for the most patients using available resources. •• Make timely decisions. •• Prepare for triage to occur at multiple levels. •• Know and understand the resources available. •• Plan and rehearse responses with practice drills. •• Determine triage category types in advance. •• Triage is continuous at each level. Safety Comes First By rushing into a scene that is hazardous, responders can risk creating even more casualties—themselves. The goal of rescue is to rapidly extricate individuals from the scene, and generating more injured persons is certainly counterproductive. Triage should only begin when providers will not be injured. Responders must be aware of the possibility of a “second hit” (e.g., further structural collapse, perpetrators, fires, earthquake aftershocks, additional explosions, and additional vehicle collisions). Some scenes may need to be made safe by firemen, search and rescue teams, or law enforcement before medical personnel can enter. Do the Most Good for the Most Patients Using Available Resources The central, guiding principle underlying all other triage principles, rules, and strategies is to do the most good for the most patients, using available resources. Multiple-casualty incidents, by definition, do not exceed the resources available. Mass-casualty events, however, do exceed available medical resources and require triage; the care provider, site, system, and/or facility is unable to manage the number of casualties using standard methods. Standard of care n BACK TO TABLE OF CONTENTS 317

318 APPENDIX F n Triage Scenarios interventions, evacuations, and procedures cannot be completed for each injury for every patient within the usual time frame. Responders apply the principles of triage when the number of casualties exceeds the medical capabilities that are immediately available to provide usual and customary care. Make Timely Decisions Time is of the essence during triage. The most difficult aspect of this process is making medical decisions without complete data. The triage decision maker (or triage officer) must be able to rapidly assess the scene and the numbers of casualties, focus on individual patients for short periods of time, and make immediate triage determinations for each patient. Triage decisions are typically made by deciding which injuries constitute the greatest immediate threat to life. Thus the airway, breathing, circulation, and disability priorities of ATLS are the same priorities used in making triage decisions. In general, airway problems are more rapidly lethal than breathing problems, which are more rapidly lethal than circulation problems, which are more rapidly lethal than neurologic injuries. Trauma team members use all available information, including vital signs when available, to make each triage decision. Triage Occurs at Multiple Levels Triage is not a one-time, one-place event or decision. Triage first occurs at the scene or site of the event as decisions are made regarding which patients to treat first and the sequence in which patients will be evacuated. Triage also typically occurs just outside the hospital to determine where patients will be seen in the facility (e.g., emergency department, operating room, intensive care unit, ward, or clinic). Triage occurs again in the preoperative area as decisions are made regarding the sequence in which patients are taken for operation. Because patients’ conditions may improve or worsen with interventions and time, they may be triaged several times. Know and Understand the Resources Available Optimal triage decisions are made with knowledge and understanding of the available resources at each level or stage of patient care. The triage officer must be knowledgeable and kept abreast of changes in resources. A surgeon with sound knowledge of the local health system may be the ideal triage officer for in-hospital triage positions because he or she understands all components of hospital function, including the operating rooms. This arrangement will not work in situations with limited numbers of surgeons and does not apply to the incident site. As responders arrive at the scene, they will be directed by the incident commander at the scene. For mass-casualty events, a hospital incident commander is responsible for directing the response at the hospital. Planning and Rehearsal Triage must be planned and rehearsed, to the extent possible. Events likely to occur in the local area are a good starting point for mass-casualty planning and rehearsal. For example, simulate a mass-casualty event from an airplane crash if the facility is near a major airport, a chemical spill if near a busy railroad, or an earthquake if in an earthquake zone. Specific rehearsal for each type of disaster is not possible, but broad planning and fine-tuning of facility responses based on practice drills are possible and necessary. Determine Triage Category Types The title and color markings for each triage category should be determined at a system-wide level as part of planning and rehearsal. Many options are used around the world. One common, simple method is to use tags with the colors of a stoplight: red, yellow, and green. Red implies life-threatening injury that requires immediate intervention and/or operation. Yellow implies injuries that may become life- or limb-threatening if care is delayed beyond several hours. Green patients are the walking wounded who have suffered only minor injuries. These patients can sometimes be used to assist with their own care and the care of others. Black is frequently used to mark deceased patients. Many systems add another color, such as blue or gray, for “expectant” patients—those who are so severely injured that, given the current number of casualties requiring care, the decision is made to simply give palliative treatment while first caring for red (and perhaps some yellow) patients. Patients who are classified as expectant due to the severity of their injuries would typically be the first priority in situations in which only two or three casualties require immediate care. However, the rules, protocols, and standards of care change in the face of a mass-casualty event in which providers must “do the most good for the most patients using available resources.” (Also see triage information in Appendix C: Trauma Care in Mass-Casualty, Austere, and Operational Environments and Appendix D: Disaster Preparedness and Response.) n BACK TO TABLE OF CONTENTS