My name is Ian Adams.

I'm one of your cert instructors.

We're gonna go over one of the primary things we're gonna have you learn and also use in the field.

It's our triage system.

So triage is one of the very first things we're gonna have established in any type of mass casualty accident or incident, mass casualty incident being a situation where the victims outnumber the rescuers.

So once you get together, you can get put through the ICS system, get put into your teams, one team or multiple teams will be assigned triage.

Triage is a rapid assessment of patient status and then designating them a certain color so we can move them into medical operations at a soon point afterwards.

Treatment is all done in metal medical ops.

So the system we use, the system we teach in the class, same video you guys watched, is what they call a start.

Simple triage, rapid transport, uh rapid treatment.

So with that system in place, there's a couple simple parameters we use.

Very similar to what we use with the professionals, it follows the exact same guidelines and just teach it a little bit more down to earth, keep it simpler for our more our lay rescuers.

One of the first things we're gonna look at is respirations.

How are they breathing?

So to keep this simple, we're gonna we're gonna call them red flags and green flags.

So if the respiration rate is greater than 30 breaths per minute, which means it's greater than one every two seconds.

If it's greater than it, they get a red flag.

If it's less than 30, they get a green flag.

Keep it simple.

Capillary refill.

Capillary refill can be done in multiple locations.

What we're looking for is the perfusion to a capillary bed, most commonly the nail beds, on how fast from pushing down to blood regenerates in that area.

So if I were to take my thumbnail bed and squeeze it and let go, how long does go from being white back to pink?

If it's under two seconds, they get a green flag.

If it's greater than two seconds, they get a red flag.

Now there are some times and situations where getting capillary refill on an extremity hands being cold from weather, they have fingernail polish or something like that on.

There's other locations we can look at.

The entire body is a base of capillary beds.

So I can also do a thumb on a forehead.

Exact same situation.

I put it on, release, count how many seconds it takes for the blood to come back to a normal color in that area.

Exactly the same.

Greater than two seconds, they get a red, less than two, or they get a green.

Next thing we're gonna look at is mental status.

We want to know how the brain is functioning.

This tells us a lot about perfusion on how things function.

Brain being one of the early things that's affected by perfusion.

So the check mental status, we basically check what can they do?

Can they respond appropriately to what we need?

So that's where we come in with the can do, no can do mantra.

So can they do something?

Can you squeeze my hands?

Do you know what day it is?

Do you know a year it is?

Can you ample answer simple questions, which tells me if the mind is functioning correctly or not?

If they can respond appropriately, yes, they can answer the question appropriately.

Yes, they can squeeze my hand, yes, they can do some basic skills.

If they can do that, like they're supposed to, they get a green flag.

If they cannot do any of those things, we'd give them a red flag.

So this is the the mantra we use is 30 to no can do is the term we use.

Remember it.

30 respirations greater than they get a red.

Less than, they get a green.

Capillary refill, two greater than they get a red flag, less than, they get a green.

No can do, checks our mental status.

If they can respond appropriately, they get a green.

They cannot respond appropriately or follow commands, that's our no can do.

Same thing we talked about in class.

So based on that information, we can kind of start determining the status of our patient and how we're gonna classify them.

When we classify them, there's a couple, there's four primary classifications we use.

Green.

Green means everything is fine, they're probably a stable patient.

Most of the time for greens, I can actually have them come up, stand up and walk towards me or walk to a certain area because they're they're more of a normal status patient.

We can also use those greens to help us as we work our way through further assessment of more patients.

Then we have red.

Any one or multiple red flags, automatically a red flag.

One or more red flags, automatically a red.

And then the only other thing that kind of fits in the red, when we deal with the patient, if they're not breathing correctly, we may have to open the airway to try to get an airway open, that might be the reason why they're not breathing effectively.

So we attempt by different techniques, head tilt chin lift, a jaw thrust, something along those lines to open the airway.

If I do not get the airway open on the first attempt, I get one more attempt to try to open the airway and have them start breathing again.

If after the second time we open the airway and they're still not breathing, they become a black and we move on.

If I have to use a tourniquet, we've tried everything else to control the bleeding, direct pressure, compression dressing, whatever we can in a rapid sequence, and we have to move to a tourniquet because they're bleeding excessively a lot of a lot of blood, losing a lot of volume.

If we have to put a tourniquet on, they go automatic red.

If I get the airway open and they start breathing again, automatic red.

Automatic.

So if they if we get the airway open with one or two attempts, they go red.

If I get a tourniquet on them, they go red.

And if I open the airway two times and they're not breathing, they become a black.

Okay.

We leave all blacks in the field where they lie, we do not move them later.

So what is yellow come in?

Yellow is kind of the in-between.

Easiest way to remember, yellow.

If they meet all the green criteria, their respirations are below 30.

Their capillary refill is below two, and they have a mental status where they can answer my questions and obey all commands, but cannot move.

Broken leg, some type of injury that makes it hard or almost impossible for me to for them to move themselves, we classify them as a yellow.

Okay.

So we get that taken care of.

We move to the next patient.

The reason it's called simple triage rapid treatment is we try to spend no more than 15 20 seconds per patient in the triage system.

We move to our first patient.

We go through our algorithm.

What's their respiration status?

What's their cap refill status?

What's their mental status?

Do I have to use any one of these two means, open the airway or use the tourniquet?

Based on that information, they're gonna get either a red tag or a yellow tag, because green tags in most cases are gonna stand up and move or stand up and help us with our treatment of our patients.

Um we move to the next patient.

If we do this correctly and effectively, we can cover 20, 30, 40 patients in a very short time frame.

In this area, we do not provide extensive medical treatment.

We want to, but that's not the idea of triage.

Triage is rapid assessment, move to the next one, rapid assessment, and we have another team come behind us, some comprised of our greens that have helped us or other members of our team, and their job is to go pick out all the reds first and move them into medical operations.

Come back, grab all my yellows, move them to medical operations, and treatment of medical issues is handled in MedOps, not in triage.

So, kind of real quick summary.

We pull up, we see our patient.

We go through our rapid assessment, our simple triage, rapid treatment.

What do we see?

Respirations, cap refill, mental status.

Are they red flag?

Green flag.

All greens, they're probably gonna stand up, help us or stand up and move.

All greens cannot move, they get a yellow.

Any one or multiple reds are gonna be automatic red.

If we have to put a tourniquet on somebody, they automatically become a red.

If they're not breathing and we open the airway, and with opening the airway one or two times they start to breathe again, we have somebody help us hold their airway open, they become an automatic red.

And if after opening the airway two attempts and they're not breathing, they become an automatic black.