Ver el código de «Mass casualty incident triage»

==Background==
*Used by first responders to quickly classify victims during a mass casualty incident (MCI) based on the severity of their injury
*Unlike standard medical triage, MCI triage is more utilitarian (i.e. the greatest good for the greatest number of people)
*Multiple triage systems exist, however evidence regarding their effectiveness is lacking<ref>Culley JM, Svendsen E. A review of the literature on the validity of mass casualty triage systems with a focus on chemical exposures. American journal of disaster medicine. 2014;9(2):137-150. doi:10.5055/ajdm.2014.0150.</ref>
*In an effort to update and standardize MCI triage, the Model Uniform Core Criteria (MUCC) were created as a national guideline for MCI triage<ref>Model uniform core criteria for mass casualty triage. Disaster Med Public Health Prep. 2011;5(2):125-8.</ref>
**These criteria have been endorsed by all major national shareholders, including NAEMSP, ACEP, ACS, NAEMT, NASEMSO, AMA, CDC, and others.
**Currently, the SALT triage system is the only one that meets the Model Uniform Core Criteria

==Classifications<ref name="lerner">Lerner EB, Schwartz RB, Coule PL, et al. "Mass Casualty Triage: An Evaluation of the Data and Development of a Proposed National Guideline." ''Disaster Medicine and Public Health Preparedness'' 2(Suppl. 1) 2008, pp S25-S34.</ref>==
Minor (Green) – "Walking wounded" with minimal injuries

Delayed (Yellow) – Serious but non-life-threatening injuries

Immediate (Red) – Life-threatening injuries requiring urgent intervention

Deceased/Expectant (Black) – No signs of life or injuries incompatible with survival, based on current resources

==Sort, Assess, Lifesaving intervention, Treatment/Transport (SALT)==

* Utilitarian focus: Do the greatest good for the greatest number.
* 
* All-hazards applicable: Works for trauma, medical, and chemical/radiological events.
* 
* Incorporates bystanders, visible injuries, and movement in triage prioritization.
* 
* Prioritizes lifesaving interventions only when resources allow.
* 
===Triage Categories===
* Immediate (Red) – Life-threatening injury or condition requiring immediate care to survive
* 
* Delayed (Yellow) – Serious but not immediately life-threatening injuries
* 
* Minimal (Green) – Walking wounded with minor injuries
* 
* Expectant (Gray) – Likely to die despite maximal intervention
* 
* Dead (Black) – No signs of life

===SALT Triage Algorithm===
1. SORT
* Direct all patients: “If you can hear me and can walk, move to [safe location].”
* 
* Those who walk → Minimal (Green)
* 
* Assess remaining patients in the order of:
* 
* Still
* 
* Waving
* 
* Walking but unable to relocate

2. ASSESS (Remaining Patients One by One)

3. LIFESAVING INTERVENTIONS
Perform only if resources and time allow:

* Open airway (consider basic adjuncts)
* 
* Control major hemorrhage
* 
* Chest decompression for tension pneumothorax
* 
* Auto-injector antidotes (e.g., for nerve agents)
* 
* Use tourniquets or hemostatic dressings as appropriate

4. ASSIGN TRIAGE CATEGORY
==== Dead (Black) ====

* No pulse and not breathing after airway repositioning
* 
* Obvious signs incompatible with life (e.g., decapitation, massive head trauma)

==== Immediate (Red) ====

* Cannot follow commands, breathing with a pulse
* 
* Respiratory distress, uncontrolled bleeding, or signs of shock
* 
* Major burns without airway compromise

==== Delayed (Yellow) ====

* Can follow commands, has adequate perfusion and respirations
* 
* Does not meet immediate criteria, but injuries are still serious

==== Minimal (Green) ====

* Walking wounded
* 
* Minor injuries; requires delayed or minimal treatment

==== Expectant (Gray) ====

* Unlikely to survive given current resources
* 
* Still have signs of life; provide comfort measures when possible
* 
* May be reassessed if resource availability improves

===Special Considerations===
* Re-triage regularly as the situation evolves
* 
* SALT is designed for field use by trained personnel
* 
* Consider special tags, tape, or digital tracking to clearly mark patients
* 
* Clear communication with incident command and receiving facilities is essential

===Advantages of SALT over START/JumpSTART===
* Applicable across all ages and incident types
* 
* Includes expectant category (not present in START)
* 
* Emphasizes lifesaving interventions in line with resources
* 
* Fully meets MUCC national guidelines

==Simple Triage and Rapid Treatment (START)==
[[File:Flowchart START.jpg|thumb|START triage algorithm]]
''Always make sure you are safe. Then speak loudly and ask people to stand up and walk towards you. People who are:''
*Able to walk relocate to a certain area <span style="color:green">(minor)</span>
*Non-ambulatory patients are then assessed
**No respirations → re-position airway
***No respirations (deceased/expectant)
***Respirations <span style="color:red">(immediate)</span>
**Yes respirations
***>30/min <span style="color:red">(immediate)</span>
***<30 → check perfusion
****Radial pulse absent OR capillary refill >2 seconds <span style="color:red">(immediate)</span>
****Radial pulse present '''OR''' capillary refill <2 seconds → check mental status
*****Unable to follow simple commands <span style="color:red">(immediate)</span>
*****Follows simple commands <span style="color:#eec61f">(delayed)</span>

==JumpSTART (Pediatric Patients)==
[[File:JumpSTART Triage 3.gif|thumb|JumpSTART triage algorithm]]
*Able to walk relocate to a certain area <span style="color:green">(minor)</span>
*Non-ambulatory patients are then assessed
**No respirations → re-position airway
***Respirations <span style="color:red">(immediate)</span>
***No respirations → check pulse
****No pulse (deceased/expectant)
****Yes pulse → 5 rescue breaths
*****Still no respirations (deceased/expectant)
*****Respirations <span style="color:red">(immediate)</span>
**Yes respirations
***<15 or >45/min <span style="color:red">(immediate)</span>
***15-45/min → check perfusion
****Pulse absent or CRT >2 seconds
*****Control bleeding <span style="color:red">(immediate)</span>
****Pulse present or CRT <2 seconds → check mental status
*****Inappropriate <span style="color:red">(immediate)</span>
*****Appropriate <span style="color:#eec61f">(delayed)</span>

==Secondary Assessment of Victim Endpoint (SAVE)==
*Applies after patients have been triaged with START/jumpStart
*Designed for appropriation of limited resources for most gain in immediate on-scene care situations
*Three categories:
**Those who will die regardless of care
**Those who will survive whether or not they receive care
**Those who will benefit from limited immediate field interventions

==See also==
*[[Mass casualty incidents]]
*[[Combat triage]]

==References==
<references/>

[[Category:EMS]]