Triage Question

Mike97

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I have a triage question regarding an MVA we had the other day. Vehicle had 3 occupants; 2 in cardiac arrest upon arrival and 1 injured. No extrication required. I was not on duty and don’t know the details (will discuss during my next shift). I work in a rural area; we are the only ambulance service in the county and normally have 2 trucks staffed.

So my question is who gets treated? Do you say this is an MCI, triage the cardiac arrests as black, and treat the single injured patient? Or do “make it work” so to speak, start CPR, and call for more resources? In classes they always give you an obvious scenario like a bus wreck with 10+ patients. In that case I get that you triage, but this seems a little more of a gray area.

From what I understand, you triage if you have more patients than resources. However, I would have a hard time leaving a patient in cardiac arrest to treat a patient that may be walking wounded if that’s your only other patient. Then again... if those are the rules, I understand the very poor survivability of a traumatic arrest.
 

NPO

Forum Deputy Chief
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There's no black and white. You treat the most savable person. If the injured person is a green tag with minor injuries, perhaps evaluate the two black tags and see if either of them have reversible causes of death.

CPR on a traumatic arrest doesn't make things better, in fact it may make things worse. Fact is, the black tag patients are probably beyond help. We simply cannot fix most causes of traumatic cardiac arrest in the field.

Most likely, even if it was a green tag and two black tags, I probably wouldn't put much effort into the two deceased unless I thought there was a chance I might fix their cause of death (airway for example)
 

PotatoMedic

Has no idea what I'm doing.
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An MCI is when you have more patients than you can manage. Sounds like this is a small MCI. If the living one won't die because you ignore them till more resources arrive than pick a coded person and work them. One will be black no matter what.
 

Peak

ED/Prehospital Registered Nurse
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From an ethical and legal perspective I would treat this as an MCI if you have more patients than immediate resources to care for them. A brief triage is necessary before you can decide how to care for all of the patients. We know that straying from appropriate triage algorithms statistically results in poorer outcomes.

Survival from trauma arrest, especially one that is unwitnessed, is very poor. That being said it has improved somewhat, although in case review typically these either had a medical etiology in addition to trauma (ex: MI precipitating the MVC), or a relatively simple etiology like tension pnx that can be resolved with decompression.

Survival also varies based on what resources are available immediately. Extended response times, limited provider scope, limited trauma experience, limited field equipment, long transport times, and lack of high acuity trauma centers will all result in poorer outcomes.

I would also encourage you to consider how sick the injured patient may be. Depending on the actual mechanism of the trauma there is a pretty good change that patient had a pretty high amount of force placed on them. A patient with a pretty good amount of injury may be compensating well until collapse, especially with the endorphin dump they are probably experiencing.
 

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