MAJOR INCIDENT458 Administrative and Legal Issues
(v) Triage
(a) most ambulance or site medical services utilize some form of
standardized triage that divides patients into certain categories- red: severely injured but salvageable; in need of urgent care
- yellow: non-ambulant significant injuries, but stable
- green: walking wounded; hospital admission unlikely
- black: not expected to survive
(b) however, patients may make their own way to hospital
without utilizing the ambulance and thus arrive untriaged
(c) triage is a dynamic process that is repeated after any
significant intervention at each stage of patient care.
(vi) Treatment
(a) key principle is to do ‘the most for the most’
(b) can involve delivering minimum acceptable care at certain
stages to facilitate enhanced flow through the system
(c) definitive care may be delayed until the surge in patients is
abating and the major incident is resolving
(d) this time period can vary from hours to days.
(vii) Transport
Flow through the system is vital to prevent the ED becoming blocked
to further patients
(a) efficient, rapid but safe transfer of patients from the ED to
theatre, intensive care unit (ICU), inpatient wards or home is
vital.
6 Portions of the external disaster plan pertinent to individual members of
staff are summarized on action cards.
(i) Those concerned with the medical and nursing roles within the
ED should be distributed to, and read by, all members of staff.
7 New ED doctors must also make certain that the switchboard has a reliable
contact telephone number for the purpose of an emergency call-out. In
addition, make sure you:
(i) Know the call-out procedure, the different states of alert, and the
significance of being the designated hospital or the supporting
hospital.
(ii) Understand your role within the department, which senior doctor
you are responsible to, and from whom you should receive advice.
(iii) Can operate any equipment reserved for a major incident,
including that used by the Mobile Medical Team.
(iv) Are familiar with the special stationery and records used in a
major incident, including the significance of the triage labels and
where to find details of any pre-hospital care given, particularly
drugs and fluids.
(v) Know where to obtain social and psychological support following
the incident to minimize the potential for post-traumatic stress.