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64-443: CTAS may refer to: Medicine [ edit ] Canadian Triage and Acuity Scale Compulsive Tool Acquisition Syndrome, also known as Gear Acquisition Syndrome Military [ edit ] Case Telescoped Armament System Business [ edit ] Cintas Computers [ edit ] Data Definition Language: Create Table as Select Topics referred to by

128-519: A crucial role in the mass casualty incident timeline. A hospital can receive trauma center status by meeting specific criteria established by the American College of Surgeons (ACS) and passing a site review. Trauma centers have levels ranging from level 1 to level 4, with each level varying in different responsibilities and resources provided: This is not an exhaustive list of agencies, and many other agencies and groups of people could be involved in

192-484: A disaster uses a multi-tier scale: This triage is performed by a physician called médecin trieur (sorting medic). The German triage system uses four color codes: In Hong Kong , triage in Accident & Emergency Departments is performed by experienced registered nurses , patients are divided into five triage categories: Critical , Emergency , Urgent , Semi-urgent and Non-urgent . In mass casualty incidents,

256-434: A disaster. Generally, in the healthcare field, the term "mass casualty event" (MCE) is used when hospital resources are overwhelmed by the number or severity of casualties. During these incidents, hospitals can discharge all fit patients, dedicate more resources to the emergency department, and expand their intensive care unit to accommodate anticipated long-term care needs. While up to 80% of victims will be transported from

320-573: A form of secondary triage, where the evaluation occurs at a secondary location like a hospital, or after the arrival of more qualified care providers. There are a three primary concepts referred to as Reverse Triage. The first is concerned with the discharge of patients from hospital often to prepare for an incoming mass casualty. The second concept of Reverse Triage is utilized for certain conditions such as lightning injuries, where those appearing to be dead may be treated ahead of other patients, as they can typically be resuscitated successfully. The third

384-403: A mass casualty incident. Ideally, once an MCI has been declared, a well-coordinated flow of events will occur, using three separate phases: triage, treatment, and transportation. The first-arriving crew will conduct triage . Pre-hospital emergency triage generally consists of a check for immediate life-threatening concerns, usually lasting no more than one minute per patient. In North America,

448-512: A neighborhood. Without proper personal protective equipment, more than 253 residents were evacuated and 50 were hospitalized. 20 vehicles were called to the scene, and a mobile operating center was setup nearby, likely within the zone of contamination. Unaware of the presence of Sarin, triage was performed following the standard system of the time, which ultimately resulted in eight care givers experiencing mild sarin poisoning, and an unknown amount of additional staff experiencing general malaise. At

512-426: A permanent hospital, more advanced care was provided at each stage, and the mindset of treating only what was absolutely necessary fell away. Although triage almost certainly occurred in the days after the atomic bombings of Hiroshima and Nagasaki , the pandemonium caused by the attack left records of such action non-existent until after the fifth day, at which point they are largely without historical use. In 1947,

576-719: A secondary or tertiary care facility to survive, those who require low-intensity care to survive, those who are uninjured, and those who are deceased or will be so imminently. In the United States, this most commonly takes the form of the START triage model, in Canada, the CTAS model, and in Australia the ATS model. Assessment often begins with asking anyone who can walk to walk to a designated area, labeling them

640-503: A significant amount of time to deploy (in relation to the length of most incidents), emergency personnel can set up temporary interim-care centers fairly quickly if needed using the personnel and resources they have on-hand. These centers are usually staffed by a combination of doctors, nurses, paramedics/emergency medical technicians, first responders, and social workers (for example, from the Red Cross ), who work to get families reunited after

704-454: A two-person crew is responding to a motor vehicle collision with three severely injured people could be considered a mass casualty incident. The general public more commonly recognizes events such as building collapses, train and bus collisions , plane crashes , earthquakes and other large-scale emergencies as mass casualty incidents. Events such as the Oklahoma City bombing in 1995,

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768-588: A wider applicability, as some conditions which may be survivable outside of extreme circumstances become unsurvivable due to the nature of a mass casualty incident. For these patients, as well as those who are deemed to be unsavable, palliative care can mean the difference of a painful death, and a relatively peaceful one. During the COVID-19 pandemic issues of palliative care in triage became more obvious as some countries were forced to deny care to large groups of individuals due to lack of supplies and ventilators . In

832-569: Is a temporary treatment center which allows for the assessment and treatment of patients until they can either be discharged or transported to a hospital. These are often placed in gymnasiums, schools, arenas, community centers, hotels, and or other locations that can support a field hospital setup. Permanent buildings are preferred to tents as they provide shelter, power, and running water, but many governments maintain complete field hospital setups that can be deployed anywhere within their jurisdiction within 12–24 hours. While full field hospitals require

896-414: Is also possible that lightly injured casualties will be transported first when access to those who are more severely injured will be delayed due to heavy or difficult rescue efforts. The care that is rendered at the scene of an MCI is usually only temporary and is designed to stabilize the casualties until they can receive more definitive care at a hospital or an interim-care center. An interim-care center

960-482: Is determined based on the severity of the patient's injuries. Usually, the most seriously injured are transported first, with the least serious transported only after all the critical patients have been transported. In an effort to remove as many lightly injured civilians as possible, an incident commander may choose to have those least seriously injured transported to local hospitals or interim-care centers in order to provide more room for emergency personnel to work. It

1024-409: Is different from Wikidata All article disambiguation pages All disambiguation pages Canadian Triage and Acuity Scale The methodologies of triage vary by institution, locality, and country but have the same universal underlying concepts. In most cases, the triage process places the most injured and most able to be helped as the first priority, with the most terminally injured

1088-410: Is less likely to occur when triaging is performed by hospital medical teams, rather than paramedics or EMTs. In telephone triage, care providers like nurses assess symptoms and medical history, and make a care recommendation over the phone . A review of available literature found that these services provide accurate and safe information about 90% of the time. In triage, palliative care takes on

1152-571: Is not immediately obvious, it is used in any patient who appears to be a child (patients who appear to be young adults are triaged using START). In hospital settings, Australia and New Zealand rely on the Australasian Triage Scale (abbreviated ATS and formally known as the National Triage Scale ). The scale has been in use since 1994. The scale consists of 5 levels, with 1 being the most critical (resuscitation), and 5 being

1216-472: Is rapid patient assessment designed to check bodily function in order of importance. A triage tag is a premade label placed on each patient that serves to accomplish several objectives: Triage tags take a variety of forms. Some countries use a nationally standardized triage tag, while in other countries commercially available triage tags are used, which vary by jurisdictional choice. In some cases, international organizations also have standardized tags, as

1280-757: Is the case with NATO . The most commonly used commercial systems include the METTAG, the SMARTTAG, E/T LIGHT and the CRUCIFORM systems. More advanced tagging systems incorporate special markers to indicate whether or not patients have been contaminated by hazardous materials, and also tear off strips for tracking the movement of patients through the process. In advanced triage, those with advanced training, such as doctors, nurses and paramedics make further care determinations based on more in-depth assessments, and may make use of advanced diagnostics like CT scans . This can also be

1344-476: Is the concept of treating the least injured, often to return them to functional capability. This approach originated in the military, where returning combatants to the theatre of war may lead to overall victory (and survivability). Undertriage is underestimating the severity of an illness or injury. An example of this would be categorizing a Priority 1 (Immediate) patient as a Priority 2 (Delayed) or Priority 3 (Minimal). The rate of undertriage generally varies by

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1408-533: The German forces . Once at a casualty clearing station, wounds were dressed, and anyone requiring immediate surgical intervention was placed in a cart and brought immediately to an ambulance pickup area. If the wounded could wait, they would be evacuated by ambulance during the night. Ambulances, driven by YMCA and American Red Cross trained drivers then removed the casualties to mobile surgical centers , called postes avances des hospitaux du front or outposts of

1472-409: The START system (simple triage and rapid treatment) is the most common and is considered the easiest to use. Using START, the medical responder assigns each patient to one of four color-coded triage levels, based on their breathing, circulation, and mental status. The triage levels are: Triage personnel do not conduct treatment, with the exception of: Generally, a small group of responders, usually

1536-838: The START triage system is used. In Japan , the triage system is mainly used by health professionals. The categories of triage, in corresponding color codes, are: All public hospitals in Singapore use the Patient Acuity Category Scale (PACS) to triage patient in Emergency Departement. PACS is a symptom-based differential diagnosis approach that triages patients according to their presenting complaints and objective assessments such as vital signs and Glasgow Coma Scale, allowing acute patients to be identified quickly for treatment. PACS classifies patients into four main categories: P1, P2, P3, and P4. In mass casualty incidents,

1600-418: The START triage system is used. In Spain , there are 2 models which are the most common found in hospitals around the country: Mass-casualty incident A mass casualty incident (often shortened to MCI ) describes an incident in which emergency medical services resources, such as personnel and equipment, are overwhelmed by the number and severity of casualties . For example, an incident where

1664-531: The September 11 attacks in 2001, and the Boston Marathon bombing in 2013 are well-publicized examples of mass casualty incidents. The most common types of MCIs are generally caused by terrorism, mass-transportation accidents, fires or natural disasters. A multiple casualty incident is one in which there are multiple casualties. The key difference from a mass casualty incident is that in a multiple casualty incident

1728-587: The Surgeon in Chief of Napoleon's Imperial Guard laid the groundwork for what would eventually become modern triage introducing the concept of "treat[ing] the wounded according to the observed gravity of their injuries and the urgency for medical care, regardless of their rank or nationality". Simple triage is usually used in a scene of an accident or " mass-casualty incident " (MCI), in order to sort patients into those who need critical attention and immediate transport to

1792-855: The Texas City Disaster occurred when the SS Grandcamp exploded in Texas City, Texas , killing 600 people and injuring thousands more. The entire fire department was killed in the blast, and what followed was a massive informal triage of the victims. Drug stores, clinics, and homes were opened as makeshift triage stations. As the city has no hospital, they had to evacuate casualties to area facilities, including those in Galveston and Houston , with at least one doctor relying on skills he had learned in World War II to inform care decisions. The Korean War saw

1856-570: The Canadian Triage and Acuity Scale (CTAS), which is used across the country to sort incoming patients. The system categorizes patients by both injury and physiological findings, and ranks them by severity from 1–5 (1 being highest). The model is not currently used for mass casualty triage, and instead the START protocol and METTAG triage tags is used. In France , the Prehospital triage in case of

1920-527: The Edwin Smith Papyrus contains descriptions of the assessment and treatment of a multitude of medical conditions, and divides injuries into three categories: During the reign of Emperor Maximilian I , during wartime, a policy was implemented where soldiers were prioritized over all others in hospitals, and the sickest soldiers received treatment first. Modern triage grew out of the work of Baron Dominique-Jean Larrey and Barron Francois Percy during

1984-507: The Trauma and Injury Severity Score, the latter of which has been shown to be most effective at determining outcome. S.T.A.R.T. (Simple Triage and Rapid Treatment) is a simple triage system that can be performed by lightly trained lay and emergency personnel in emergencies. It was developed at Hoag Hospital in Newport Beach, California for use by emergency services in 1983. Triage separates

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2048-479: The United States directly. The fact that the U.S. was no longer seen as untouchable, along with the later Oklahoma City bombing in 1995, and the September 11th attack lead to long term changes in triage practices to be more focused on operational safety and the risk of secondary attacks designed to kill care providers. In June 1994, emergency crews began responding to calls related to symptoms of toxic gas exposure in

2112-500: The advent of the tiered triage, wherein care providers sorted people into categories defined ahead of time. These categories, immediate, delayed, minimal and expectant are still the basis for most triage systems today. The time period was also marked by improvements in medical understanding, including shock, which allowed effective interventions to be administered earlier in the Triage process, which in turn significantly improved outcomes. At

2176-448: The care of large numbers of patients, or are places that could be so set up. Examples include schools, sports stadiums, and large camps that can be prepared and used for the care, feeding, and holding of large numbers of victims of a mass casualty or other type of event. Such improvised facilities are generally developed in cooperation with the local hospital, which sees them as a strategy for creating surge capacity. While hospitals remain

2240-462: The concepts created during the Korean War. Advances in helicopters allowed the introduction of the first helicopter medics, who were able to provide fluid resuscitation , and other interventions mid-flight. This made it so that the average time from injury to definitive care was less than two hours. This evolution also flowed into the everyday life, with air ambulances emerging in the civilian world by

2304-556: The entire process. The demobilization process has to be in place from the beginning, once an area has been mobilized. This is critical, as a mass casualty incident can get out of hand quickly. Having everything planned out step-by-step can alleviate these concerns and help cover for the unexpected. The demobilization process also gives the local community and the corresponding agencies an idea for how long their city and specific areas will be consumed with emergency personnel and essentially blocked off. In many events, such as Hurricane Katrina ,

2368-407: The field, evacuation of all casualties is the ultimate goal, so that the site of the incident can ultimately be cleared, if necessary investigated, and eventually rendered safe. Additional considerations must be made to avoid overwhelming local resources, and in some extreme cases, this can mean evacuating some patients to other countries. Alternative care facilities are places that are set up for

2432-496: The field. Moreover, the recent development of new machine learning methods offers the possibility to learn optimal triage policies from data and in time could replace or improve upon expert-crafted models. Most simply, the general purpose of triage is to sort patients by level of acuity to inform care decisions; so that the most people possible can be saved. Although a multitude of systems, color codes, codewords, and categories exist to help direct it, in all cases, triage follows

2496-401: The first two or three crews on scene, can complete triage. When responding to a chemical, biological, or radiological incident, the first-arriving crew must establish safety zones prior to entering the scene. Safety zones include: These zones should be clearly identified and with engineer tapes, lights, or cones. All responders and patients must leave the hot zone in designated pathways into

2560-402: The frontline hospitals. At the mobile surgical hospitals, the most severe cases were treated, specifically those who were likely to die before reaching a permanent, more equipped hospital. Anyone who could survive the trip was transported to a farther away, often costal, hospital. Upon reaching a permanent hospital, casualties received appropriate care to treat all of their injuries. By

2624-742: The incident scene to safer treatment areas located nearby. These treatment areas must always be within walking distance, and will be staffed by appropriate numbers of properly certified medical personnel and support people. The litter bearers do not have to be advanced medical personnel; their role is to simply place casualties onto carrying devices and transport them to the appropriate treatment area. Casualties should be transported in order of treatment priority: red-tagged patients first, followed by yellow-tagged, then green-tagged, and finally black-tagged. Each colored triage category will have its own treatment area. Treatment areas are often defined by colored tarpaulins , flagging tape, signs, or tents. Upon arrival in

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2688-423: The incident, in an existing building or pitched tent. The final stage in the pre-hospital management of a mass casualty incident is the transport of casualties to hospitals for more definitive care. If the number of ambulances available is inadequate, other vehicles may transport patients, such as police cars , firetrucks , air ambulances , transit buses, or personal vehicles. As with treatment, transport priority

2752-966: The incident. In the United States , the Incident Command System is known as the National Incident Management System (NIMS). According to the Federal Emergency Management Agency , "NIMS provides the template for the management of incidents." After the proper agencies have arrived, a more detailed assessment of the scene will be performed using the M.E.T.H.A.N.E method , which summarizes information necessary for responders: There are multiple agencies involved in most mass casualty incidents, which means there are many individuals that require training for these specific situations. The most common types of agencies and responders are listed below. Trauma centers play

2816-411: The information that is provided by emergency units. A formal declaration of an MCI is usually made by an officer or chief of the agency in charge. Initially, the senior paramedic at the scene will be in charge of the incident, but as additional resources arrive, a senior officer or chief will take command, usually using an incident command system structure to form a unified command to run all aspects of

2880-456: The injured into four groups: Triage also sets priorities for evacuation and transport as follows: The JumpSTART pediatric triage MCI triage tool is a variation of the S.T.A.R.T. model. Both systems are used to sort patients into categories at mass casualty incidents (MCIs). However, JumpSTART was designed specifically for triaging children in disaster settings. Though JumpSTART was developed for use in children from infancy to age 8, where age

2944-685: The last priority (except in the case of reverse triage). Triage systems vary dramatically based on a variety of factors, and can follow specific, measurable metrics, like trauma scoring systems , or can be based on the medical opinion of the provider. Triage is an imperfect practice, and can be largely subjective, especially when based on general opinion rather than a score. This is because triage needs to balance multiple and sometimes contradictory objectives simultaneously, most of them being fundamental to personhood: likelihood of death, efficacy of treatment, patients' remaining lifespan, ethics, and religion. The term triage comes directly from French , where

3008-534: The least critical (nonurgent). In field settings, various standardized triage systems are used, and there is no area wide standard. In 1995, the CAEP Triage and Acuity scale was launched in Canada relying on a simplified version of the Australian National Triage Scale. This scale used three categories, emergent, urgent, and non-urgent. This scale was deprecated in 1999 with the introduction of

3072-579: The location of the triage, with a 2014 review of triage practices in emergency rooms finding that in-hospital undertriaging occurred 34% of the time in the United States, while reviews of pre-hospital triage finding undertriage rates of 14%. Overtriage is the overestimating of the severity of an illness or injury. An example of this would be categorizing a Priority 3 (Minimal) patient as a Priority 2 (Delayed) or Priority 1 (Immediate). Acceptable overtriage rates have been typically up to 50% in an effort to avoid undertriage. Some studies suggest that overtriage

3136-524: The lowest priority, and assessing other patients from there. Upon completion of the initial assessment by the care provider, which is based on the so-called ABCDE approach , patients are generally labelled with their available information, including "patient’s name, gender, injuries, interventions, care-provider IDs, casualty triage score, and an easily visible overall triage category". An ABCDE assessment (other variations include ABC, ABCD, ABCDEF, and many others, including those localized to non-English)

3200-470: The mid-1960's. The use of triage in emergency departments and ambulance services also quickly followed. In 1993, the north tower of the World Trade Center was bombed , in a plot with a similar intended outcome as the later September 11th attacks . While search, rescue and triage operations immediately following were ordinary, the attack itself represented one of the first terrorist attacks affecting

3264-510: The onset of World War II, American and British forces had adopted and adapted triage, with other global powers doing the same. The increased availability of airplanes allowed rapid evacuation to a hospital outside of the warzone to become a part of the triage process. Although the basic practices remained the same as in World War I, with initial evacuation to an aid station, followed by transitions to higher levels of care, and eventual admission to

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3328-462: The preferred destination for all patients, during a mass casualty event such improvised facilities may be required in order to divert low-acuity patients away from hospitals in order to prevent the hospitals becoming overwhelmed. The general concept was first described in a 17th-century BCE Egyptian document, the Edwin Smith Papyrus . Discovered in 1862, outside of modern-day Luxor, Egypt ,

3392-421: The reign of Napoleon . Larrey in particular introduced the concept of a "flying ambulance " (flying in this case meaning rapidly moving) or in its native French, Ambulance Volante . In 1914, Antoine Depage developed the five-tiered Ordre de Triage , a triage system which set specific benchmarks on evacuation, described staged evacuation. French and Belgian doctors began using these concepts to inform

3456-467: The resources available are sufficient to manage the needs of the victims. The issue of resource availability is therefore critical to the understanding of these concepts. One crosses over from a multiple to a mass casualty incident when resources are exceeded and the systems are overwhelmed. A mass casualty incident will usually be declared by the first arriving unit at the scene of the incident, and less usually by an emergency call dispatcher, depending on

3520-545: The same basic process. In all systems, patients are first assessed for injuries, then, they are categorized based on the severity of those injuries. Although the number of categories differs from system to system, all have at least three in common; high severity, low severity, and deceased. Some systems involve features like scoring systems, such as the Revised Trauma Score , the Injury Severity Score , and

3584-405: The same term [REDACTED] This disambiguation page lists articles associated with the title CTAS . If an internal link led you here, you may wish to change the link to point directly to the intended article. Retrieved from " https://en.wikipedia.org/w/index.php?title=CTAS&oldid=1194666277 " Category : Disambiguation pages Hidden categories: Short description

3648-480: The same time, Mobile Army Surgical Hospitals (MASH) were introduced along with helicopters for evacuation. These helicopters, however were used for evacuation only, and care was not provided in the air during the evacuation. These advances reduced fatalities for injured soldiers by up to 30%, and changed the nature of battlefield medicine significantly. The conditions of the Vietnam War drove further development on

3712-404: The scene to hospitals, others who are less injured might walk themselves to these facilities and increase the load at the closest facility to the incident. MCEs can include epidemics , chemical emergencies, mass shootings , and natural disasters like weather. The final product of an MCI that happens to link up with the M.E.T.H.A.N.E. method is the act of demobilization which is crucial to

3776-549: The term means to pick or to sort, it itself coming from the Old French verb trier , meaning to separate, sort, shift, or select; with trier in turn came from late Latin tritare, to grind. Although the concept existed much earlier, at least as far back as the reign of Maximillian I , it was not until the 1800s that the Old French trier was used to describe the practice of triage. That year, Baron Dominique-Jean Larrey ,

3840-565: The time, no decontamination procedures or gas masks were available for incidents involving contaminants. In response, the Japan Self-Defense Forces created a decontamination team, which was then instrumental to the response of the Tokyo subway sarin attack which occurred only seven months later. As medical technology has advanced, so have modern approaches to triage, which are increasingly based on scientific models. The categorizations of

3904-484: The treatment area, the casualties are re-assessed and they are treated with the goal of stabilizing them until they can be transported to hospitals; transported to the morgue or medical examiner's office; or released. Some mass casualty incidents require an onsite morgue to await transfer of bodies to a permanent morgue, when they must be removed to access injured victims or to keep them out of public sight and prevent heightening emotions further. They are usually far aside

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3968-472: The treatment of casualties at aid stations behind the front. Those responsible for the removal of the wounded from a battlefield or their care afterwards would divide the victims into three categories: From that delineation, aid workers would follow the Ordre de Triage : In the first order of triage, the injured would be evacuated to clearing stations in the night, when darkness offered maximum protection from

4032-460: The victims are frequently the result of triage scores based on specific physiological assessment findings. Some models, such as the START model may be algorithm -based. As triage concepts become more sophisticated, and to improve patient safety and quality of care, several human-in-the-loop decision-support tools have been designed on top of triage systems to standardize and automate the triage process (e.g., eCTAS, NHS 111 ) in both hospitals and

4096-407: The warm zone where they will be decontaminated. A designated officer should be posted at the hot zone and warm zone to make sure all contaminated personal are treated and decontaminated before entering the cold zone. Once casualties have been triaged, they can be moved to appropriate treatment areas. Unless a patient is green-tagged and ambulatory, litter bearers will have to transport patients from

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