Medical sorting

The tri medical is a concept which intervenes when one has many victims, in particular in the event of accident of great width or catastrophe. It is the fact of determining the degree of gravity of the casualties, and thus of determining the order in which these casualties will be treated. The sorting is made by a doctor screening machine , or by ancillary medical trained personnel (ancillary medical first-aid worker, male nurse).

Contrary to the regulating doctor , which directs the sending of the medical means and the evacuations towards the hospitals, the doctor screening machine is on the ground and examines the victims directly. Its role approaches that of doctor orientator of the services of the urgencies.

Sorting in the event of massive surges of wounded in France

In the event of massive surge of casualties, for example within the framework of a Hospital of countryside set up for a Plane red or with the reception of a hospital in the event of Plane white, one carries out a total sorting in four emergency degrees:

  • exceeded urgency (DCD): under the conditions of catastrophe, it is not possible to save this person, she is declared died and evacuated towards the mortuary;
  • top priority (UA): the person must be treated (even operated) immediately and on the spot;
  • relative urgency (UR): the person is stable and transportable, it can be evacuated towards a structure of care traditional, either put on standby before the care or transport;
  • médico-psychological urgency (UMP): slightly injured or implied, the person is directed towards a parallel structure for his material assumption of responsibility (provisional housing) and psychological (Cellule urgently médico-psychological).

Levels UA and UR are sometimes developed in four levels:

  • HAVE: extreme urgency
  • U1: seriously injured
  • U2: serious casualty
  • U3: slightly injured
HAVE and U1 forming the top priorities (UA), U2 and U3 relative urgencies (UR).

Location first-aid worker

The first-aid workers are sometimes the first present on the spot, either which it acts voluntary first-aid workers who held a preventive device, or which it acts of the first team of fireman present on the spot (see the article Secourisme of before ).

In waiting of the installation of the emergency plan (Plane red), a first sorting can be made by the first-aid workers; one speaks about “location first-aid worker”. In 2007, the new reference frame of formation (PSE2) indicated a procedure of location for the situations with multiple victims (SMV); however, the text seems to pose problem with the ministry for Health, sorting being a prerogative of the doctors. In addition, of many first-aid workers are them-even perplexed as for the utility of the thing: time that the isolated team sets up the first measurements (protection, regrouping of the valid victims, dealt with of the first wounded victims), the reinforcements will have arrived.

The procedure is inspired by the procedure Start:

  1. regrouping of the valid victims (being able to go), to which one allots the green color (bracelet, self-adhesive ribbon,…) ;
  2. for the not-valid victims: brief assessment:
    1. victim which does not breathe: black color,
    2. unconscious victim which breathes: red color (and setting in PLS),
    3. conscious victim which breathes with a frequency higher than 30 movement per minute: red color,
    4. conscious victim which breathes with a frequency lower than 30 movement per minute but which has a pulse higher than 120 pulsations per minute: red color,
    5. conscious victim which breathes with a frequency lower than 30 and one pulse lower than 120: yellow color.
Some propose a procedure more simplified even:
  1. regrouping of the valid victims;
  2. for the not-valid victims:
    1. the lengthened victims conscious are covered with a cover of survival, face and lesions visible,
    2. the unconscious vitimes and which breathe are put in PLS and are covered with a cover with survival, face and lesions visible,
    3. the victims which do not breathe are covered with a cover of survival, hidden face.

In the event of contamination

In the event of contamination NRBC (accident or attack), the sorting is all the more important as it determines also the order of decontamination. Two chains of decontamination are installation: a chain upright, for the victims being able to go, and a chain lengthened for the victims impotentes. Within the framework of lengthened decontamination, the unconscious people and who breathe have priority on the people not breathing.

The Canadian ÉTG

Medical sorting calls mainly upon the Infirmier (E) S. In 1994, the Order of the nurses and male nurses of Quebec published the document Standpoint - Care male nurses in the emergency services and of first line - an effective sorting and a total assumption of responsibility . In 1999, the Association of the emergency doctors published the Guide of sorting, the Scale of sorting and gravity for the emergency departments (É.T.G.) .

Procedure Start states-unienne

On the site even of a catastrophe (before raising), the states-uniens use the procedure of sorting Start ( Simple sorting and rapid treatment ). The scale also comprises four levels:

  • deceased : deceased;
  • immediate , immediate priority (fast treatment for respect of the Hour of gold);
  • delayed , can wait;
  • minor , slightly injured.
The sorting is done in five stages:
  1. the people being able to walk are initially classified minor , and will be revalued later;
  2. one controls the vital Fonctions lengthened people:
  3. * 2R: breathing, in absence of breathing, the person is declared deceased (deceased);
  4. * 2P: pulse, if the person presents signs of Collapsus and is not perfusée, it is classified immediate
  5. * 2M: conscience ( mental state ), if the person unconscious or is disorientated, it is classified immediate ;
  6. * if a hemorrhage is detected, it is controlled by the usual means;
  7. diagnosis and immediate evacuation of the marked people ;
  8. diagnosis of the marked people delayed ;
  9. diagnosis of the marked people minor .

In the services of the urgencies, the patients are classified according to a code color:

  • black: failing, death is certain in the hours or the days to come, installation of palliative care;
  • red: immediate, must undergo an surgical operation urgently; priority patient for the operating room or the evacuation towards an adapted technical plate;
  • yellow: observation, the patient is left under monitoring while waiting for that a medical team releases itself;
  • green: can wait, must see a doctor in the hours or the days which follow; can possibly return at his place;
  • white: with congédier, possibly after minor care so of the personnel is available.

See too

External bonds

  • Hospital, urgency and catastrophe, conference Hospital expo, May 23rd 2002

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