The core principle of triage is to do the most for the most. The initial triage method in a multiple casualty situation is the triage sieve.
The triage sieve will identify immediately life-threatening problems based on the C < A B C > system and correctly prioritise the patients for treatment. Not doing this will potentially risk lives.
All fire and rescue services should be aware of this system and be prepared to employ it in a multiple casualty situation or at a major incident.
As a principle, in a poorly resourced scene, minimal casualty care is carried out in a multiple casualty situation. The following list provides guidance on what could be achieved without breaching the core principle of triage:
- Quickly turn a patient to protect an airway
- Encourage self help
- Encourage a bystander to apply direct pressure
With the publication of the 2013 Ambulance Clinical Practice Guidelines (JRCALC) it was acknowledged that now ambulance services are all practising C < A B C > in their initial patient assessment, the standard triage sieve needed to be updated to take account of the importance of initial assessment and treatment of catastrophic haemorrhage.
The diagram below is the new National Ambulance Service Medical Directors Group (NASMeD) Triage Sieve, which was published in 2013 for use by all ambulance staff at a major incident (NARU, 2013).
The priorities are described as:
- P1 or red tags (immediate) are used to label those who cannot survive without immediate treatment but who have a chance of survival
- P2 or yellow tags (observation) are for those who require observation (and possible later re-triage). Their condition is stable for the moment and they are not in immediate danger of death. These casualties will still need hospital care and would be treated immediately under normal circumstances.
- P3 or green tags (wait) are reserved for the 'walking wounded' who will need medical care at some point, after more critical injuries have been treated.
The JESIP casualty triage has an additional priority:
- P4 or P1E (expectant) is used for those whose injuries are so extensive that they will not be able to survive given the care/resource that is available. This is only to be used under authorisation of the Medical Incident Officer. They alone have the responsibility to match these patients' injuries with the number and type of the other casualties and the remaining resources available to the hospitals..
Figure 3: Triage Sieve
Source: National Ambulance Service Medical Directors Group (NASMeD)
The same triage principles apply to children. Paediatric triage tape is available, which groups children by length, weight and age and provides normal physiological values for respiratory rate and pulse in each of the groups to carry out the triage process.
Having labelled the casualty with their priority, casualties are handed over to an appropriately trained and competent practitioner. A record or log of the numbers of each priority should be kept.
When referring to casualties and the above categories at the scene of an incident, everyone should be sensitive to those who may be nearby, which could include relatives and other members of the public.