# Doing Triage -- Segment One -- Time 6:42

John:

If you pay attention to airway, bleeding and shock problems you'll make
a big impact in survivability rates post disaster and if we can get our
students our community emergency response team members to be orientated
to airway bleeding and shock problems they can make a big impact on the
people that surround them. I do remember several success stories one of
which being a gal telling us that her husband had collapsed inside the
kitchen and he was turning blue. The only thing that she could remember
was the repetition of airway, bleeding and shock. Cause we get people
over and over to pay attention to those things, airway, bleeding and
shock. Just like we get them to pay attention to me and my buddy will
always do a good size-up and we will enhance our safety by wear the
right kind of protective clothing, things like gloves, goggles, helmet,
mask, boots. And boots that's right we will be part of the solution not
part of the problem.

All right, well lets take another step forward in our training. The long
road of training awaits us. And what we're going to do is we're going to
move into the realm of, we've been taking care of the single patient,
we've only had one patient, but now what we want to do is we want to
take care of a number of patients. We want to do triage. What does
triage mean? It actually is it's a French verb that literally translates
"to sort". The origin of the word dates back to a French and British
term that was used to describe a wooling process. It separated a fine
grade wool from a lesser quality wool. Although people have argued about
where the word came from the definition that they have not argued bout
is what the goal of triage is, the goal of triage is to do the greatest
good for the greatest number. The goal of triage is to do the greatest
good for the greatest number. We find that the origins of triage
literally date back to Napoleon's era, now Napoleon had a brilliant
battlefield surgeon, who was very upset at how the medical care was
given to Napoleon's troops after one of these battles. So what he did
was he went and got a wagon, which ended up being the first battle field
ambulance, and then he would go out into the battle fields and he would
start sorting through some of the patients. And he knew that if he ended
up going over and he saw a solider who had a lance wound to the leg or a
musket ball to the leg or to the arm, that he could take that solider,
put him in the ambulance, take him back to the hospital or the aids
station, whatever they called them, and within a relatively short period
of time he would have a veteran replacement that he could put back out
on the line. Was that important to them at the time? When you think
about the type of warfare they did, yes it was. But god help you if you
end up being the one who has a musket ball to the abdomen or a lance
wound to the chest because the doctor knew and the soldiers knew what
your outcome was going to be. What was their surgical capability at the
time? Not very good at all. And that was the first sorting process. We
changed things a little bit but the goal of triage has never changed.
The goal of triage is to do the greatest good for the greatest number.
How triage works is we put categories or classifications as it pertains
for patients need for medical care. There are three categories we can
put patients into. We can put patients into immediate, into a delayed
and into a dead category. There are a lot of different triage systems.
When you go home to your jurisdiction you will find different wording,
you will find a variety of triage systems. The ultimate concept is that
whatever kind of system you use your community education process should
include your own system. One of the things that we did is that our
approach was, there was a place in Huntington Beach California that
produces a video, it was very good about it called START , Simple,
Triage and Rapid Transport video. It's a very good video. But we changed
a few things for ourselves we tried to make it even more simplistic. It
is very difficult to teach civilians how to use expectant and minor
categories. We don't do that very well how do you expect other people to
do that. But the system works well for us when we break people down into
three different categories the immediate, the delayed and the dead. The
immediate category is reserved for those who have a life threatening
problems such as airway, breathing or shock. The second category
delayed, is for those who don't. They don't have an airway, breathing or
shock problem. Can they be hurt? Yes, but they just don't have one of
those life threatening problems. Last category is reserved for those who
we can't help anymore, the dead. All right, well how do you figure out
which category to put somebody into, well, by doing the triage
evaluation. When you do the triage evaluation it's a quick assessment to
check airway, bleeding and mental status. But John, what is mental
status? One of the things that you'll find out very quickly is that
shock will manifest itself by a change in mental status. For example,
someone who's normally quite, not very talkative doesn't yell doesn't do
anything like that, when there sitting their after they've been shot and
suddenly they become very aggressive, they become very agitated. That
change in mental status is a good indicator that something is wrong and
what is wrong is that the patient is going into shock. That is a change
that we need to pay attention to. Airway, bleeding and mental status or
shock that's what were going to check for and were going to do a rapid
evaluation of the patient. Cory come on back up.