This article is about the er diagram for hospital management system pdf of triage as it occurs in medical emergencies and disasters. Triage may result in determining the order and priority of emergency treatment, the order and priority of emergency transport, or the transport destination for the patient.
Those for whom immediate care might make a positive difference in outcome. In the earliest stages of an incident, such as when one or two paramedics exist to twenty or more patients, practicality demands that the above, more “primitive” model will be used. As medical technology has advanced, so have modern approaches to triage, which are increasingly based on scientific models. This section is for concepts in triage. This step can be started before transportation becomes available. Triage tags may take a variety of forms. 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.
Some of these tracking systems are beginning to incorporate the use of handheld computers, and in some cases, bar code scanners. For classifications, see the specific section for that topic. In advanced triage, doctors and specially trained nurses may decide that some seriously injured people should not receive advanced care because they are unlikely to survive. It is used to divert scarce resources away from patients with little chance of survival in order to increase the chances for others with higher likelihoods.
The use of advanced triage may become necessary when medical professionals decide that the medical resources available are not sufficient to treat all the people who need help. The treatment being prioritized can include the time spent on medical care, or drugs or other limited resources. In these cases some percentage of patients will die regardless of medical care because of the severity of their injuries. Others would live if given immediate medical care, but would die without it. It becomes the task of the disaster medical authorities to set aside some victims as hopeless, to avoid trying to save one life at the expense of several others. Triage should be a continuous process and categories should be checked regularly to ensure that the priority remains correct given the patient’s condition.
A trauma score is invariably taken when the victim first comes into hospital and subsequent trauma scores are taken to account for any changes in the victim’s physiological parameters. Continuous integrated triage combines three forms of triage with progressive specificity to most rapidly identify those patients in greatest need of care while balancing the needs of the individual patients against the available resources and the needs of other patients. Hospital Triage system can be used at the appropriate level of evaluation. Usually, triage refers to prioritising admission. A similar process can be applied to discharging patients early when the medical system is stressed. This process has been called “reverse triage”. During a “surge” in demand, such as immediately after a natural disaster, many hospital beds will be occupied by regular non-critical patients.
In order to accommodate a greater number of the new critical patients, the existing patients may be triaged, and those who will not need immediate care can be discharged until the surge has dissipated, for example through the establishment of temporary medical facilities in the region. Some studies suggest that overtriage is less likely to occur when triaging is performed by hospital medical teams, rather than paramedics or EMTs. Alternative care facilities are places that are set up for 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 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.
Some crippling injuries, even if not life-threatening, may be elevated in priority based on the available capabilities. During peacetime, most amputation injuries may be triaged “Red” because surgical reattachment must take place within minutes, even though in all probability the person will not die without a thumb or hand. This section is for examples of specific triage systems and methods. For general triage concepts, see the sections for types of triage, treatment options, and outcomes. During the early stages of an incident, first responders may be overwhelmed by the scope of patients and injuries.
This does several things at once, it identifies patients that are not so severely injured, that they need immediate help, it physically clears the scene, and provides possible assistants to the responders. Now the responders can rapidly assess the remaining patients who are either expectant, or are in need of immediate aid. From that point the first responder is quickly able to identify those in need of immediate attention, while not being distracted or overwhelmed by the magnitude of the situation. Using this method assumes the ability to hear. Deaf, partially deaf, or victims of a large blast injury may not be able to hear these instructions. Each category is scored from 0 to 5 using the Abbreviated Injury Scale, from uninjured to critically injured, which is then squared and summed to create the ISS.
A score of 6, for “unsurvivable”, can also be used for any of the three categories, and automatically sets the score to 75 regardless of other scores. Depending on the triage situation, this may indicate either that the patient is a first priority for care, or that he or she will not receive care owing to the need to conserve care for more likely survivors. It is not intended to supersede or instruct medical personnel or techniques. These people are not breathing and an effort to reposition their airway has been unsuccessful. These people are in critical condition and would die without immediate assistance.