This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS Agency

Transcription

1 This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS Agency

2 Have on hand: Hard copy of SBC 2013 MCI Plan Triage tags Review this MCI PowerPoint while referencing the MCI Plan Watch triage tag video using link at end of this PowerPoint (from DMS) Complete JumpSTART Triage Training via link at end of this PowerPoint You MUST complete quiz and submit to your agency training officer

3 This plan was reviewed and revised by the MCI Plan Revision Team March- August 2013 Montecito Fire, SB County Fire, City of Santa Maria Fire, Santa Barbara City Fire, Fire Chief Association Training Officers, AMR, SBC EMSA The California Health and Safety Code, Division 2.5, Chapter 4Local Administration provides authorities for the development and implementation of this plan by the Santa Barbara County Emergency Medical Services Agency The authorities include sections , , , and SB County This course MCI Plan is approved 1.2 for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2

4 FIRESCOPE Field Operations Guide This plan is based on the FIRESCOPE ICS Chapter 15 Multi-Casualty Document December 2012 This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2

5 Revisions Include: Consistent with FIRESCOPE MCI model (Chapter 15, Multi-Casualty) Sets minimum ICS training requirements Places new MCI kits on Battalion Chief and Ambulance Supervisor vehicles. Specifies procedure to declare MCI at Level 1-3 Tasks ambulance supervisor to immediately begin Med Comm poll of hospital ED availability via ReddiNet This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS Agency

6 Revisions Include: Tasks ambulance supervisor to initiate communication with IC via Fire radio Requires use of triage tags for all MCI Levels (1-3) Requires use of START/Jump START triage Requires ALS personnel to utilize County Trauma Triage Guidelines (P510)for patient destination decisions This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS Agency

7 Revisions include: Clarifies role of dispatch centers and transfer to County PSAP in a Level III Provides an after action form to be completed by IC for every MCI Requires an after action meeting for every MCI This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS Agency

8 All personnel responding to an MCI incident in the County of Santa Barbara will be able to utilize the current MCI Plan to ensure adequate and coordinated efforts to minimize loss of life and disabling injuries. SB County MCI Plan 1.2

9 Upon completion of this course participants will be able to: Define a Mass Casualty Incident Identify initial priorities related to an MCI response Identify communication methods specified in MCI Plan. Identify roles and responsibilities of MCI responders as specified in MCI Plan Identify priorities related to Triage, Treatment and Transport Each slide specifies the appropriate sections of the MCI Plan for you to review during the training. This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2 SB County MCI Plan 1.2

10 MCI PLAN OVERVIEW This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS Agency

11 Outlines the scope of responsibility for each agency that responds to a multi casualty incident Does NOT detail all the duties entrusted to a particular organization This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2

12 A suddenly occurring event that overwhelms the routine first response assignment. All casualties originate from the same scene (vs. widespread such as earthquake or flood) The number of patients is known or can be closely estimated, it is limited in scope. Operational Management is maintained at the scene. SB County This MCI course Plan is 1.4 approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2

13 This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2

14 Level 1: 5 14 patients OR Any response that overwhelms the routine first response assignment The system may have adequate resources to respond and transport the patients Examples are: Vehicle accident, active shooter SB County MCI Plan 1.5 This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS Agency

15 This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS Agency

16 This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS Agency

17 Level 2: patients Regional medical mutual aid system will be activated Adequate number of ambulances are not likely to be available Receiving hospitals may be overwhelmed Duration = greater than an hour Examples: Bus crash, Train accident, IED SB County MCI Plan 1.5

18 This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS Agency

19 Level 3: 50+ patients It is not possible to respond an adequate number of ambulances to this incident. Regional medical mutual aid is activated. Receiving hospitals will be overwhelmed. The area operational EOC and disaster plan will be activated. Examples: Commercial airline crash, Building collapse This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS Agency SB County MCI Plan 1.5

20 INITIAL MCI ACTIONS This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2

21 First report may come from Dispatch, or from the first arriving unit If known, Dispatch will inform all responding potential number of patients an MCI to Dispatch using the assigned command and tactical channels This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS SB County MCI Plan 2.2, 3.2 AgencySanta Barbara County MCI Plan 1.2

22 Notify all lead agencies according to Dispatch protocols Relay the assigned tactical channel to all involved agencies Relay pertinent information to responding units (including ambulances) The dispatch agency with jurisdiction operates as the lead dispatch for the incident. Exceptions include: SBC Public Safety Dispatch Center is the designated IC request for change to SBC PSAP for any level MCI SB County MCI Plan 2.1 This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2

23 Incident command is assumed by the Agency with jurisdictional responsibility. The command structure will be built off of the ICS FIRESCOPE model.* Unified Command will be used in multiagency and/or multi-jurisdictional incidents. Agencies/jurisdictions in unified command should have statutory responsibility for some part of the event. *Note: Refer to FIRESCOOPE. December 2012, Field Operations Guide, ICS-420-1, Chapter 15, Multi-Casualty, pages 15-4 to 15-7, for additional examples illustrating the modular development of the command organization for initial, reinforced, multi-division/group, and multi-branch incident responses SB County MCI Plan 3.2 and organizational charts in Attachment C This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2

24 The First Responder vested with Incident Command shall: Assume Command Size up and estimate number of patients Activate the MCI plan by notifying dispatch of the MCI and appropriate level (I-III) Use assigned command and tactical channels, request additional channels as needed SB County MCI Plan 2.2 and 3.2 This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2

25 Assign initial ICS Positions Ensure distribution of triage tags, vests, position checklists, and forms from MCI Kits Designate staging areas for equipment and personnel that are away from ingress and egress pathways for response operations SB County MCI Plan 5.3

26 MCI KITS with Vests, Triage Tags, Position Checklists, and Forms AVAILABLE ON BATTALION CHIEF AND AMBULANCE SUPERVISOR VEHICLES This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS Agency

27 Determine and order resources Fire Apparatus/Air Resources/Ambulances Out of area ambulance resources are ordered from the Med Mutual Aid Region 1 Via EMSA MHOAC This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS SB County MCI Plan 5.3 Agency

28 First units on scene: Report to the IC for assignment, vests, forms Additional responding units may be directed to a staging area for assignment Potential MCI Assignments Include: Medical group supervisor Triage Unit Leader Treatment Unit Leader Patient Transport Unit Leader Medical Communications Coordinator Ambulance Coordinator SB County MCI Plan 3.2

29 Medical Group Positions START/Jump START Triage Tags And Trauma Triage This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2

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31 Gets briefing from IC Establishes a Medical Group Designates his/her unit leaders and treatment areas Determines the amount and type of resources still needed Establishes communication and coordination with Transportation Group Supervisor Maintain Activity Log (ICS Form 214) Reference Job Action Sheet for full job details. SB County MCI Plan 3.2, Attachment C This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2

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33 Reports to the Medical Group Supervisor Assumes responsibility for: providing triage management (not direct triage) movement of patients from triage area to treatment or morgue areas Ensures adequate patient decontamination Establishes the number of involved vs. the number of injured This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS SB County MCI Plan 3.2, Attachment AgencySanta C Barbara County MCI Plan 1.2

34 Tracks number and categories of victims using the Triage Count Worksheet (must be used in II or III level MCI) Receives and maintains all triage tag stubs until passing stubs on to Treatment Unit Leader

35 Maintains security and scene control Initiate triage as soon as possible Provides updates on patient numbers and status to Triage Unit Leader Gives Triage Unit Leader triage tag stubs, with final count, sorted by category Triage is usually performed by initial response units Directs movement of patients to proper Treatment Areas This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2 SB County MCI Plan 2.2

36 In Level II and Level III Triage tags may be used in lieu of a patient care report (PCR) Any care provided will be documented on triage tag Triage tags stay with patient and become part of hospital medical record Use JumpSTART triage for pediatric patients See next slide for JUMPSTART algorithm. This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2

37 View additional Jump Start Powerpoint at conclusion of training

38 This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan Triage tag is placed 2. ½ of colored patient condition tag is collected 3. Triage Unit Leader collects triage stubs 4. Triage Unit Leader gives stubs to Treatment Unit Leader 5. Patient is placed in the appropriate treatment area

39 6. Treatment Unit Leader maintains triage tag stubs in: Triage Tag Receipt Holder

40 7. Treatment Unit staff record patient vitals and other information on the triage tag

41 TRANSPORTATION RECEIPT HOLDER 8. Patient Loading staff tear leaves the scene. 9. Med Com is advised 10. Receipt is maintained in Transportation Receipt Holder by Transportation Unit Leader 11. Triage stubs and transport receipts are compared to ensure an accounting for all patients.

42 Triage Tag at Hospital 12. Upon arrival at hospital patient triage tag number and name (if available) is entered into ReddiNet

43 This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS SB County MCI Plan Attachment AgencySanta C Barbara County MCI Plan 1.2

44 When possible, Unit Leader will be ALS Trauma Triage personnel will be ALS Supervises treatment and loading managers Responsible for: Coordinating movement from triage to treatment areas Assuring adequate decontamination Ensure that ALS Treatment Unit personnel use the SB EMS Trauma Triage Criteria and Patient Destination policy Continued assessment and care of patients Preparation of patients for transport SB County MCI Plan 3.2 Triage and Treatment and Attachment C

45 Treatment Unit Leader Count Worksheet This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2

46 Establishes communication with Patient Transport Unit/Med Com Receives and maintains triage tag stubs from Triage Unit Leader. Maintains Treatment Unit Leader Count Worksheet Assures Med Com receives basic patient information and condition from Treatment Area Managers Requests medical resources such as DMSU or Regional Aid via MHOAC Reference Job Action Sheet for full job details. This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2

47 1. Level I MCI: Trauma patients will be transported to a designated trauma hospital. May be OOC. Level II or III every effort will be made but may not always be possible to transport to designated trauma hospital. 2. Initial START/JUMPSTART triage will be used 3. ALS Treatment Unit personnel doing secondary triage will use: SB County Trauma Triage Policy 510 and the MCI Destination Decision Algorithm (attachment E) to determine trauma patient destinations This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2 SB County MCI Plan 3.2, Attachment E

48 This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2 SB County MCI Plan 3.2, Attachment E

49 This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2 SB County MCI Plan 3.2, Attachment E

50 PATIENT TRANSPORTATION AND MEDICAL COMMUNICATIONS This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2

51 This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2 SB County MCI Plan Attachment C

52 Designates ambulance staging area away from ingress and egress pathways for ground/air resources Establishes communication with Ambulance Coordinator Coordinate the establishment of Landing Zone (LZ) with Medical Group Supervisor and Helispot Manager SB County MCI Plan Attachment C

53 Coordinates requests for additional ambulances with the IC Coordinates requests for air ambulance transport Assures hospital communications via ReddiNet or other coordinating facility/agency with pertinent incident information Maintains Transportation Receipt Holder with all triage tag transportation receipts following patient departures from scene SB County MCI Plan Attachment C

54 This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2 SB County MCI Plan Attachment C

55 Confirm that an AMR Supervisor, utilizing ReddiNet, has notified hospitals and initiated an MCI poll. If ReddiNet is unavailable, hospital communication will be initiated using section 4.1 in the MCI Plan. Maintain current status of hospital/medical facility availability including designated trauma hospitals Identify availability of out of area trauma/non-trauma hospital services as needed to accommodate all patients This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2 SB County MCI Plan Attachment C

56 Receives patient information: Number of Red, Red Trauma, Yellow, etc. from Treatment Unit Leader or Treatment Manager Determines which hospitals can receive the patients Coordinates methods of transportation with Transportation Unit Leader Tracks patients and updates ReddiNet to inform hospitals of incoming patients Maintains MCI Hospital Availability Worksheet This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2 SB County MCI Plan Attachment C

57 This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2 Sample Hospital Availability Worksheet

58 MCI LEVEL Trauma Center RED TAG YELLOW TAG GREEN TAG Marian Medical Ctr. Level 3 Level I Level II Level III SBCH Level 2 Level I Level II Level III GVCH No Level I Level II Level III LVMC No Level I Level II Level III SYVCH No Level I Level II Level III This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS Agency

59 On smaller incidents, patient transportation will be coordinated by the Treatment Unit Leader and Med Com. On larger incidents, additional positions may be assigned: Patient Loading Coordinator Ambulance Coordinator This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2

60 Med Comm must be established All hospital communication should be done via ReddiNet Utilize assigned tactical channels Ensure proper use of the chain of command structure at all levels. Transporting units shall provide a brief radio report to hospital per section in the MCI plan This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2

61 A Web-based emergency medical communications system linking hospitals, EMS agencies, first responders and public health officials, within local and regional communities, in times of both crisis and daily operations. This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2

62 Is maintained 24/7 by hospital facilities in Southern California Unit is located in every ED in Santa Barbara County Provides current status information about each hospital This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2

63 In SB County AMR Supervisor sends alert of MCI to all hospitals Requests current availability status This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2

64 Hospitals provide their real time availability (within 5 minutes or less of being polled) directly to the incident using ReddiNet The field has a single view of all facilities and their current availability This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2

65 The field notifies each hospital via Reddinet when a unit is loaded and has been sent to their facility After the unit is enroute to the facility, transporting personnel make base contact via radio/cell to provide a brief patient status report

66 Upon transport arrival, hospital confirms receiving patient and inputs patient information (including triage tag number) Field now knows the status of each patient as well as all transporting units This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2

67 After Action checklist to be completed by IC after every MCI (levels 1-3). Checklist submitted to EMS Agency by IC within 24 hours of the event. Operational debrief of incident response will be facilitated by the agency vested with IC responsibility and will include all agencies involved. After Action Report may be prepared by the agency in consultation with EMS Agency. This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2

68 This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2

69 Declare MCI. Set up the ICS/FIRESCOPE structure early Use Initial START/JUMPSTART triage efficiently Secondary triage will include Santa Barbara County EMS Trauma Triage Criteria and Patient Destination Policy, and MCI Destination Decision Algorithm Maintain assigned position within the ICS structure This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2

70 Triage Tag Video watch only 4 Jump START PowerPoint (begins on next slide) This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS AgencySanta Barbara County MCI Plan 1.2

71 Jump START Pediatric Multicasualty Triage System Lou Romig MD, FAAP, FACEP Miami Dade Fire Rescue South Florida Regional DMAT/IMSuRT South Medical Director, South Florida Area National Parks

72 Tsunami, Indonesia Building collapse, Jerusalem Tornado, Kansas Bus crash, Michigan

73 Beslan school siege Moscow theater siege OKC Bombing

74 We must assume each MCI will include children. We must be able to assess and treat victims of all ages with equal confidence and competence.

75 Photos by Bryan Patrick, The Sacramento Bee, 2000

76 Goal of Multicasualty Triage

77 Primary Disaster Triage Goal: to sort patients based on probable needs for immediate care. Also to recognize futility. Assumptions: Medical needs outstrip immediately available resources Additional resources will become available with time

78 Primary Disaster Triage Triage based on physiology How well the patient is able to utilize their own resources to deal with their injuries Which conditions will benefit the most from the expenditure of limited resources

79 The physiology of adults and children are not the same.

80 Why do we need a pediatric tool? To optimize triage effectiveness to the benefit of all victims, not just children.

81 Why do we need an objective pediatric tool? Photo by Bryan Patrick, The Sacramento Bee, 2000 The pediatric knowledge base and confidence levels of many EMS providers are not as good as they can and should be.

82 Pediatric multicasualty triage may be affected by the emotional state of triage officers.

83 Ambulatory = Green RESPIRATIONS NO START Triage YES Over 30/min Under 30/min PERFUSION Position Airway Immediate Cap refill > 2 sec Cap refill < 2 sec. NO Dead or Expectant YES Immediate Control Bleeding Immediate Failure to follow simple commands MENTAL STATUS Can follow simple commands Immediate Delayed

84 START: Potential Problems with Children An apneic child is more likely to have a primary respiratory problem than an adult. Perfusion may be maintained for a short time and the child may be salvageable. RR +/- 30 may either over- triage or under- triage a child, depending on age.

85 START: Potential Problems with Children Capillary refill may not adequately reflect peripheral hemodynamic status in a cool environment. Obeying commands may not be an appropriate gauge of mental status for younger children.

86 JumpSTART Goals Modify an existing tool for use with children Utilize decision points that are flexible enough to serve children of all ages and reflective of the unique points of pediatric physiology Minimize over- and under- triage Accomplish triage within 30 second/pt goal

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88 JumpSTART: Age Initially ages 1-8 years chosen Less than one year of age is less likely to be ambulatory. The pertinent pediatric physiology (specifically, the airway) approaches that of adults by approximately eight years of age.

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90 JumpSTART: Age Current recommendation: If a victim appears to be a child, use JumpSTART. If a victim appears to be a young adult, use START.

91 JumpSTART: Ambulatory Identify and direct all ambulatory patients to designated Green area for secondary triage and treatment. Begin assessment of nonambulatory patients as you come to them.

92 Modification for nonambulatory children All children carried to the GREEN area by other ambulatory victims must be the first assessed by medical personnel in that area.

93 JumpSTART: Breathing? If breathing spontaneously, go on to the next step, assessing respiratory rate. If apneic or with very irregular breathing, open the airway using standard positioning techniques. If positioning results in resumption of spontaneous respirations, tag the patient immediate and move on.

94 If no breathing after airway opening, check for peripheral pulse. If no pulse, tag patient deceased/nonsalvageable and move on. If there is a peripheral pulse, give 5 mouth to barrier ventilations. If apnea persists, tag patient deceased/nonsalvageable and move on. patient immediate and move on.

95 JumpSTART: Respiratory Rate If respiratory rate is 15-45/min, proceed to assess perfusion. If respiratory rate is <15 or >45/min or irregular, tag patient as immediate and move on.

96 JumpSTART:Perfusion If peripheral pulse is palpable, proceed to assess mental status. If no peripheral pulse is present (in the least injured limb), tag patient immediate and move on.

97 JumpSTART: Mental Status Use AVPU scale to assess mental status. If Alert, responsive to Verbal, or appropriately responsive to Pain, tag as delayed and move on. If inappropriately responsive to Pain or Unresponsive, tag as immediate and move on.

98 Modification for nonambulatory children Children with developmental delay Children with acute injuries preventing them from walking before the incident Children with chronic disabilities

99 Modification for nonambulatory children Evaluate using the JS algorithm If any RED criteria, tag as RED. If pt satisfies YELLOW criteria: YELLOW if significant external signs of injury are found (ie. deep penetrating wounds, severe bleeding, severe burns, amputations, distended tender abdomen) GREEN if no significant external injury

100 Individuals with special health care needs may also be MCI victims!

101 Note for Black Category Victims Unless clearly suffering from injuries incompatible with life, victims tagged in the BLACK category should be reassessed once critical interventions have been completed for RED and YELLOW patients.

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103 Putting it into practice

104 A young school aged boy is found lying on the roadway 10 ft from the bus. Breathing 10/min Good distal pulse Groans to painful stimuli

105 A school aged girl crawls out of the toward you crying. Jacket and shirt torn No obvious bleeding

106 A toddler lies with his lower body trapped under a seat inside the bus. Apneic Remains apneic with modified jaw thrust No pulse

107 Adult female driver still in the bus, trapped by her lower legs under caved- in dash. RR 24 Cap refill 4 sec Moans with verbal stimulus

108 A toddler lies among the wreckage. RR 50 Palpable distal pulse Withdraws from painful stimulus

109 A woman is carrying a crying infant. She is able to walk. RR 20 CR 2 sec Obeys commands

110 An infant is carried by the previous victim. him to RR of 34 Good distal pulse Focuses on rescuer, reaches for mom. No obvious significant external injuries.

111 A school aged girl lies among the wreckage. RR 40 Absent distal pulse Withdraws from painful stimulus

112 A screaming infant is found among the bushes at the side of the road. RR 38 Good distal pulse Focuses and reaches for you. Has a partial amputation of the foot without active bleeding.

113 A school aged boy lies close to the bus. RR 36 Absent distal pulse Sluggishly looks at you when you talk to him

114 A young teen girl lies among the wreckage, crying for someone to help her up. A man with her says she needs her wheelchair. RR 22 Palpable distal pulse Alert Has minor cuts and bruises

115 Advantages JumpSTART provides a rapid triage system specifically designed for children, taking into consideration their unique physiology. The algorithm is modified from an existing system widely accepted for adult triage. For most patients, triage can be accomplished within the 30 second goal.

116 Triage is a dynamic process and is usually done more than once.

117 For more information on JumpSTART: Lou Romig MD

118 Complete the MCI quiz. Submit quiz to your agency. Agency will track completion of the MCI training and submit to the EMS Agency. Thank You! This course is approved for 1 CEU for EMT's and EMTP's by SBC EMS Agency