Address contamination at the point of triage
When your ED faces chemical attacks or certain nuclear and biologic exposures, you need "hot" triage for patients who have not yet been decontaminated and "cold" triage for those who have, advises Robert Suter, DO, MHA, FACEP, regional medical director for the North Texas region at Questcare Emergency Services in Plano.
Post-decontamination procedures can be more consistent with your usual mass casualty considerations, Suter says. "Precontamination procedures are slightly different, and staff will have to be trained differently," he adds.
Personnel in the hot zone will wear protective equipment that will effectively prevent them from performing patient assessments in the manner they are accustomed to, he notes. "You’ll be wearing gloves, so your palpatory capability will be diminished. You won’t have the triage assessment tools you normally would." For instance, it will be difficult to take a blood pressure because staff will have to go by breathing patterns or pulse, he says.
It has been many years since even the U.S. military has had to make large-scale decisions to triage potentially salvageable patients to "expectant" categories, which means victims are so severely injured they are expected to die, Suter notes. "We are accustomed to having the resources to try to save everyone. Decon tamination is a heavy expenditure of resources. In a large-scale incident, tough decisions may need to be made. Drills and training courses will help people to get experience with this."
Triage categories are dynamic and will change based on the size of an incident, he says. "What is expectant’ and what is immediate’ can vary depending on how many patients there are. If you only had five patients, they would probably all be immediate. But when you have 5,000 patients to take care of, if you take too much time trying to save one person, five people may die."
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