(Cross-posted here, on DailyKos and here on my site, Phillybits)

After work today, I got into my girlfriend’s mother’s car (the ‘rent are on vacation) and started heading back to the house to pick up my girlfriend. We had an apartment to look at tonight, as we can hardly pay the rent we have now.

As I usually do when I get in the car, I turned on NPR, 90.9 FM here in Philadelphia. The story I tuned into left me feeling absolutely empty during, and long after through dinner where I decided to do a little research into the topic and report back here.
After searching both NPR’s main search bar, and also searching by NPR programs, I cannot find the transcript or even a summary of the story, so I will jot down here what I remember of show.

What is going on down in the Gulf was the basis for the story. It was one of those shows where the narrarator is someone telling their personal experiences. In this case, it was a male triage nure, working in a Disaster Triage situation, discussing the real scenarios that the medical personnel are dealing with right now, as we speak.

There are these makeshift triage centers being set up all over the place and injured refugees are being taken here for evaluation and subsequent transport to proper facilities.

According to the narrarator, and using online sources as a reference, there are various levels of triage. In this case, given the situation, we’re talking Disaster Triage. Although this particular link deals with earthquakes, the gist of the article can apply equally here, I believe.

Triage of mass casualties in situations in which patients must remain on-scene for prolonged periods of time, such as after a catastrophic earthquake, differs from traditional triage. Often there are multiple scenes (sectors), and the infrastructure is damaged. Available medical resources are limited, and the time to definitive care is <u>uncertain</u&gt. Early evacuation is not possible, and local initial responders <u>cannot expect significant outside assistance for at least 49-72 hours</u&gt. Current triage systems are based either on a shorter time to definitive care or on a longer time to initial triage. The Medical Disaster Response (MDR) project deals with the scenario in which specially trained, local health-care providers evaluate patients immediately after the event, but <u>cannot evacuate patients to definitive care</u&gt.

There’s a much more informative set of information here; Start System. According to this, and I’m just going to cut to the meat of my post here, there are four levels (colors) or triage, what they mean, and how to respond to them.

Green – Minor – delayed care / can delay up to three hours
Yellow – Delayed – urgent care / can delay up to one hour
Red – Immediate – immediate care / life-threatening
Black – Dead – victim is dead / no care required

So how do you decide who meets what criteria? The above linked site explains…

<u>Green</u&gt
The first step in START is to tell all the people who can get up and walk to move to a specific area. If patients can get up and walk, they are probably not at risk of immediate death.

In order to make the situation more manageable, those victims who can walk are asked to move away from the immediate rescue scene to a specific designated safe area. These patients are now designated as MINOR (green tag). If a patient complains of pain on attempting to walk or move, do not force him or her to move.

The patients who are left in place are the ones on whom you must now concentrate.

<u>Red</u&gt
Begin the second step of START by moving from where you stand. Move in an orderly and systematic manner through the remaining victims, stopping at each person for a quick assessment and tagging. The stop at each patient should never take more than one minute.

REMEMBER: Your job is to find and tag the Immediate (Red Tag) patients –those who require immediate attention. Examine each patient, correct life-threatening airways and breathing problems, tag the patient with a red tag and MOVE ON!

The next section, <u>Immediate</u&gt, comes at the very end, but not after doing some initial checks which include:

The START system is based on three observations: RPM–Respiration, Perfusion and Mental Status. Each patient must be evaluated quickly, in a systematic manner, starting with Respiration (breathing).

Breathing:    It all STARTS Here.

If the patient is breathing, you then need to determine the breathing rate.  Patients with breathing rates greater than 30 per minute are tagged Immediate (Red Tag). These patients are showing one of the primary signs of shock and need immediate care.

If the patient is breathing and the breathing rate is less than 30 per minute, move on to the circulation and mental status observations in order to complete your 30-second survey.

If the patient is not breathing, quickly clear the mouth of foreign matter. Use a head-tilt maneuver to open the airway. In this type of multiple- or mass-casualty situation, you may have to ignore the usual cervical spine guidelines when you are opening airways during the triage process.

SPECIAL NOTE: The treatment of cervical spine injuries in multiple or mass casualty situations is different from anything that you’ve been taught before. This is the only time in emergency care when there may not be time to properly stabilize every injured patient’s spine.

Open the airway, position the patient to maintain the airway and — if the patient breathes — tag the patient Immediate (Red Tag). Patients who need help maintaining an open airway are Immediate (Red Tag).

If you are in doubt as to the patient’s ability to breathe, tag the patient as Immediate (Red Tag). If the patient is not breathing and does not start to breathe with simple airway maneuvers, the patient should be tagged DEAD (black tag).

Circulation: Is Oxygen Getting Around?

The second step of the RPM series of triage tests is circulation of the patient. The best field method for checking circulation (to see if the heart is able to circulate blood adequately) is to check the radial pulse.

It is not large and may not be easily felt in the wrist. The radial pulse is located on the palm side of the wrist, between the midline and the radius bone (forearm bone on the thumb side). To check the radial pulse, place your index and middle fingers on the bump in the wrist at the base of the thumb. Then slide it into the notch on the palm side of the wrist. You must keep your fingers there for five to ten seconds, to check for a pulse. If the radial pulse is absent or irregular the patient is tagged Immediate (Red Tag).

If the radial pulse is present, move to the final observation of the RPM series: mental status.

Mental Status: Open Your Eyes:

The last part of the RPM series of triage tests is the mental status of the patient. This observation is done on patients who have adequate breathing and adequate circulation.

Test the patient’s mental status by having the patient follow a simple command:

“Open your eyes.” “Close your eyes,” “Squeeze my hand.” Patients who can follow these simple commands and have adequate breathing and adequate circulation are tagged Delayed (Yellow Tag). A patient who is unresponsive or cannot follow this type of simple command is tagged Immediate (Red Tag). (These patients are “unresponsive” to verbal stimuli.)

That pretty much covers the levels of triage that are available for the sick, injured, and dying. To get back to the story, especially the part that made me sick, was this part.

As the narrarator continued and got to the part about Black Triage, he explained it like this. Suppose you have a person with an open head wound.  In a non-disaster situation, in a staffed hospital, sure…they could call a neurologist, perform a brainoscopy (??), some surgery, and the patient may or may not live.

That’s important wording – may or may not. Why? That’s what happens when you have the proper available care and you can be taken right to those people to perform that care. In the Gulf right now, they don’t have that level of care. As such, as explained by the narrarator, the dead aren’t the only ones being tagged BLACK. Those who are dying or for whom death is imminent are tagged BLACK.

They are then passed by. So in a row of people, even if you’re alive, but deemd to sick too help anyways, you get the black tag and are left alone.

How do you feel now about the refugees? How does it make you feel to hear people on the right say it’s the fault of the refugees for not leaving in the first place?

Sorry to ruin your buzz and bring you down. I just had to share this.

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