Triage and Mass Casualty As a Travel Nurse

Rail -accident

2017 has been a year filled with disasters.  Disaster generally means mass casualty situations.  Mass casualty means someone has to triage/sort the victims.  Hospitals now conduct mass casualty training as well as drills for active shooter lock down.  Until you actually have to respond to this situation it is hard to know how you would react.  Would you know how to triage victims in the chaotic situation of a mass casualty.  When I served in the Army Reserve we trained annually for mass casualty situations since we were capable for quick deployment to a large disaster area.

Triage

The first step in a mass casualty situation is triage.  The best response to mass casualty is founded on the principle of triage.  Triage is the system of sorting and prioritizing casualties based medical needs and resources.  The priority is different for the military environment than in civilian situations.

Triage helps to establish order in a chaotic environment.  Nursing assessment skills will be helpful in the triage process.  To provide the greatest good to the greatest number it is important to understand how to triage victims.  Triage takes into account time, distance, and capability.  As casualties move within the system triage will be a constant process .

As an Army nurse I had to understand that triage for the military is different than for the civilian population.  The military goal is to get as many soldiers back into action as possible.  When triaging civilian population the goal is to maximize the survival of the greatest number of victims as possible.  So someone with the least serious wounds will be treated first by the military medical team.  As a civilian I would see that the person with the most serious but realistically salvageable injuries would be treated first.

Making the hard decision

 In our day to day work as a nurses treating emergencies we do our best for each individual that enters our door.  In a disaster we do the greatest good for the greatest number or to maximize survival.  As a nurse would you feel comfortable deciding if someone was salvageable?  Victims with clearly lethal injuries or those who are unlikely to survive even with extensive resource application are treated last.  These victims are treated as the lowest priority. As you move from victim to victim you assess and tag them for treatment.  Tags are used in order to know who has been assessed and who has not and the urgency of the treatment needed.  Tags are also a quick way to identify the order in which victims will move through the system.
Generally tag colors are universal:
  • Red -Life threatening but treatable injuries requiring rapid medical attention.
  • Yellow -Serious injuries that are stable enough to wait for medical treatment
  • Green -Minor injuries that can wait for longer periods of time for treatment
  • Black -Dead or still with life signs but injuries are incompatible with survival in austere conditions

Triage is a process that is done more than once.  Victims are reassessed frequently and their status may change if they begin to deteriorate.

The Travel Nurse in Mass Casualty

Mass casualty situations can occur anywhere and at anytime as we have seen.  When you travel from city to city and facility to facility you need to know what is your role.  What if you are in a situation where mass casualty crisis happens?  Do what you have been trained to do as a nurse.  You move from victim to victim assessing where you can do the most good until EMS arrives.

In today’s world the likelihood of either being a victim or being the first of the scene is more likely in your career as a nurse.  I myself have never been a victim but have been on the scene of a mass shooting shortly after it occurred.  Stay up to date with training and be aware of the resources in the city where you are assigned.

You need to be aware of what is your hospital, clinic, nursing home or home health agency is doing to prepare to help if your community has a mass casualty situation. Do you know what your role is? Who would you call if first on the scene? Can you go in and at a local facility  on short notice?

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Cheryl Roby, RN

Cheryl J. Roby is a retired RN and US Army Nurse Major. She has over 30 years of nursing experience and 26 years of military experience in the Army Nurse Corp. During her nursing career she has traveled as part of her military experience visiting many of the 50 states and once to South Korea. Her medical training began during the Vietnam era when trained as an army medic. She went on to train as an OR tech and then as a LVN/LPN. She completed nursing school and was direct commissioned into the reserve Army Nurse Corp. nurse. She appreciated the challenge of working in various specialties and expanding her clinical and professional skill sets. Her time in the Army Reserves and California National Guard gave her the opportunity to travel to most of the 50 states and working in other medical facilities. During her career she spent years as an OR nurse, Occupational Health Nurse, Hospice Nurse, Forensic Nurse, Nurse Case Manager for developmental disabilities, Parish Nursing as well as being a Nurse Entrepreneur.

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