LEBANESE RED CROSS

Emergency Medical Services

Sieve Triage

Refresher

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Objectives

• By the end of this session participants will be able to:
• Define mass casualty incident
• Explain the 4 triage categories
• Explain and apply sieve triage algorithm and the three management steps during triage according to the Lebanese Red Cross protocols

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• Patient assessment technique is not effective in mass casualty incidents.

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�MCI definition�

• MCI is defined as any emergency that involve more victim than can safely be cared for by the first responding unit.
• Examples of common causes of MCls are vehicle collisions that involve multiple vehicles, earthquakes, floods, large explosions and building collapses.

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�WHAT?�

• The first priority in an MCI, after safety, is patient triage. Triage simply means "to sort" your patients based on the severity of their injuries.
• Triage aims to get the right patient to the right place at the right time with the right care provider

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��WHEN?��

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• Triage should be applied when the demand exceeds the availability of the resources

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WHERE?

• At first glance
• On the scene
• At evacuation
• At the hospital

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Triage is a dynamic process and patients’ categories may change between the initial assessment and subsequent assessments.

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Conducting Sieve Triage:

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1. The first step is to ask who is able to walk – The people that are able to are classified “Green”

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Conducting Sieve Triage:

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2. Starting with patients closest to you, assess all non-walking patients for the following:

• Assess breathing
• If patient is not breathing open airways by manual maneuver
• If the patient is still not breathing then he is classified “Black”
• If the patient starts to breathe then tag him as immediate “Red”, place him in recovery position and move on to the next patient.

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Conducting Sieve Triage:

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Conducting Sieve Triage:

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3. If the patient is breathing, we take respiratory rate. If RR faster than 30 or slower than 10, he is tagged as immediate “Red”

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Conducting Sieve Triage:

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4. If the patient is breathing between 10 and 29 breaths/min, assess pulse and CRT. If pulse > 120 bpm OR CRT >2 sec he is tagged as “Red”

5. And if pulse <120 bpm AND CRT<2 secs is tagged “Yellow”

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�Transport Decision: �

Taking action based on triage results:

• Green: no immediate transport to hospital. Just send to gathering area. Time for resources to work on priorities
• Each red coded patient needs an ambulance
• Each yellow coded patient needs an ambulance
• Black: no immediate transport

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�Management in Triage:�

While triaging patients, very minimal interventions are allowed, these are:

• Opening airways: using HTCL or jaw thrust maneuvers
• Putting patients in recovery position
• Controlling bleeding using compressive bandages and tourniquet

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Case Studies

• Divide into groups of 3-4
• In 10 minutes, apply sieve triage to each case and note the needed management

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�Case study 1:�

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• When responding to an explosion at Coral gas station, you are approached by a woman with her child who is crying. They are both anxious and breathing very quickly.
• Triage decision: Green
• Management: None

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�Case study 2:�

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• When responding to a fire in a building in Naame, you find a man come up to you calling for help. He has severe burns on his face, chest and abdomen, he is breathing rapidly at 34 bpm.
• Triage decision: Green
• Management: None

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�Case study 3:�

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• When responding to a gun fight in Haret el Naame, you find a patient that was shot in the chest. He is breathing, RR 28, pulse 124 bpm.
• Triage decision: Red
• Management: Control bleeding

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�Case study 4:�

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• In the same gun fight, there is another patient that was shot in the leg. He is breathing at 24 bpm, CRT 2 seconds, pulse 115 bpm.
• Triage decision: Yellow
• Management: Control bleeding

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�Case study 5:�

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• When responding to an MVC, you find a patient lying in supine position on the side of the road. You assess breathing, there is none, you open airways, he starts breathing at 15 bpm.
• Triage decision: Red
• Management: Open airways, recovery position

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�Case study 6:�

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• When responding to a collapsed building in Debbiyeh, you find a patient stuck under the rubble. She is unable to breathe. You open her airways using HTCL, she is still not breathing.
• Triage decision: Black
• Management: None

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�Case study 7:�

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• When responding to a MVC in Chhim, you find an unconscious patient in the backseat of a car, she is bleeding from her forehead, RR 26 bpm, CRT 1 second and PR 105 bpm.
• Triage decision: Yellow
• Management: Control bleeding

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�Case study 8:�

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• When responding to an explosion at the oxygen factory in Barja, you find a patient in supine position. He is not breathing, you open his airways, he still is not breathing.
• Triage decision: Black
• Management: None

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Questions

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