TRIAGE,

STABILIZATION &
TRANSPORT
FOR THE
MALAYSIAN TRAUMA LIFE SUPPORT COURSE
 TRIAGE
DEFINITION
- The sorting of patients according to their need for emergency
treatment and evacuation.
- A French word meaning ‘to sort’.

TYPES OF TRIAGE
1. Hospital Triage.
2. Field Triage.
 TRIAGE
1) HOSPITAL TRIAGE
- Sorting out patients according to the severity of injury and the
priority of treatment.
- Performed according to the hospital’s operation policy and
depends upon these factors :-
a) Manpower & staffing
b) Availability of facilities
c) Zoning of the area - critical, semi-critical and non-critical
 CRITICAL SEMI-CRITICAL NON-CRITICAL
- All patients with life - Hemodynamically stable - Closed # of upper limbs.

threatening injuries pts.

e.g. airway obstruction - Minor injuries with no

- Hemodynamically - Closed # of lower limbs. vascular involvement.

unstable patients.
- Acute respiratory - Open fractures. - Minor illnesses e.g colds.

distress.
- Severe crush injury. - Medical conditions

- Burns >20% BSA or requiring intravenous

involving face & chest. intervention.

- Comatose patients.
 TRIAGE
2) FIELD TRIAGE
- Performed outside the hospital usually at the incident site.
- Two factors play an important role :-
a) The number of patients.
b) The severity of injuries to the patients.
- If (a) & (b) do not exceed the capability of the facility & staff,
patients with life threatening problems are treated first.
- If (a) & (b) exceeds the capability of the facility & staff,
patients
with the greater chance of survival are managed first.
 STAGES OF TRIAGE
I. SCENE ASSESSMENT
- Check for hazards/potential hazards.
- An idea of the ‘mechanism of injury’.
II. TRIAGE
- In mass casualties - ask those who can walk to a safe area.
A) Perform Primary Survey
- Start with nearest victim.
- Identify victims requiring immediate attention.
- Should not stop to treat any one victim.
- Triage is conducted in several rounds.
 STAGES OF TRIAGE
B) Triage Tag or Card
- Usually colour coded and large enough for visualization.
- Colour codes are as follows:-
1. RED- First Priority Victims.
2. YELLOW - Second Priority Victims.
3. GREEN - Third Priority Victims.
4. WHITE - Dead Victims.
 STAGES OF TRIAGE
III. EVACUATION DECISION & CRITICAL
INTERVENTIONS
- To decide whether it is a ‘scoop & run situation’ or if any life
threatening actions must be taken first.
- The principles of evacuation are based upon:
‘Those who are stabilized first are evacuated first’
- Priority of evacuation must be given to those victims who are
most critically injured.
 STABILIZATION
- Based on two principles :-
1. Stabilization of the Physiological Function.
A) Respiratory
- Insert airway / E.T tube.
- Oxygen administration - rate & methods.
- Suction.
- Mechanical ventilation if needed.
- Chest tube if necessary.
- N.G tube - to prevent aspiration.
 STABIIZATION
B) Cardiovascular
- Control external bleeding.
- 2 large i.v lines - start infusion.
- Restore blood volume losses.
- Indwelling urinary catheter - monitor output.
- Monitor B.P / P.R.
C) Central Nervous System
- Control hyperventilation (head injury patients).
 STABILIZATION
2. Stabilization of the Anatomical Function
- Wound dressing
- Cervical immobilization - cervical collar
- Appropriate splintage of fractures.

* Do not splint a deformed limb before reduction.

 COMMUNICATION
- Prior to transport, it is advisable to ensure proper
communication has been established between sender and
receiver.
- Objectives of communication are:
1. To obtain help and assistance from a resource centre.
2. To relay information for further management and preparation
for receiving patients.
3. To facilitate transportation of the patient in order to render
treatment as soon as possible.
4. To facilitate delegated medical acts.
 COMMUNICATION
GUIDELINES FOR RADIO TRANSMISSION
1. Clarity of Transmission
- The person at the other end must be able to hear & understand
what is being said.
2. Contents of Transmission
- Transmission should be concise, accurate & professional.
3. Communication Policy
- Divided into 4 parts:-
 COMMUNICATION
1. CONTACT PHASE
- Step I - Identification
- Step II - Facility response

2. ON THE FIELD REPORTS

- Step I - Re-identification
- Step II - Chief Complaint / On-scene Reports
- Step III- Life-saving Procedures
- Step IV- Vital signs / Primary Survey Abnormalities
- Step V - Re-evaluation of Patient’s Data, Physiological & Anatomical Status
- Step VI - Estimated Time of Arrival (ETA)
 COMMUNICATION
3. REQUEST FOR ORDERS / MANAGEMENT PLAN
- The caller may request for orders and a management plan during this phase.
- Clarification of any order or therapy must be made in this phase.

4. SIGN OFF
- The final phase of communication.
- Step I - Base Station Closing
- Step II - EMS unit Sign Off
 TRANSPORT
-The next step is to prepare patient for transport for the purpose
of definitive care.
- The patient should be sent to the closest appropriate hospital
depending on the patient’s needs.

1. Responsibility for determining transfer

a) Field to Hospital - Usually the triage officer.
b) Hospital to Hospital - The attending doctor is responsible.
 TRANSPORT
2. Transfer responsibilities
a) Referring Physician
- responsible for - initiation of transport
- selection of an appropriate mode of transport
- level of care required
- stabilizing the patient’s condition

b) Receiving Doctor
- must be consulted on the transfer of patient.
- determine whether the institution is able to accept the patient.
 TRANSPORT
3. Modes of Transportation
- Choice of transport is based on the availability of
trained personnel and proper equipment & which mode
provides the safest and most rapid method of
transportation.
 TRANSPORT
4. Transfer Protocol (guidelines)
a) Referring Physician
- should speak directly to the receiving doctor and provide the
following information:-
i. Identification of patient.
ii. Brief Hx of incident,mechanism of injury and any pertinent
hospital data.
iii. Initial findings and patient’s response to therapy administered.
b) Information to transferring personnel.
Should be informed regarding the patient’s condition
includes:-
i. Airway maintenance/ventilation.
ii. Fluid therapy / volume replacement.
iii. Special procedures done.
iv. Resuscitation procedures & any changes that may
occur.
 TRANSPORT
5. Management during transport
a. Continued support of cardiorespiratory system.
b. Continued blood volume replacement.
c. Monitoring of vital signs.
d. Use of appropriate medication as ordered by a doctor.
e. Maintenance of communication with a doctor during transfer.
f. Maintenance of accurate records during the transport.

* Proper documentation of problem, treatment given and patient

status must accompany the patient.
Thank you