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This transcription is about a smart triage system used in emergency situations to prioritize patients based on their medical needs. There are different colored tags that indicate the priority level of patients: red for immediate care, yellow for delayed care, green for minimal treatment, and black for expected non-survival. The system also includes a hazmat card for handling patients exposed to hazardous materials. The transcription also discusses the concept of time of death and shares a story about a firefighter's experience with a decapitated body. Overall, the transcription provides information about the triage process and the use of tags to prioritize patients in emergency situations. to have a kit like this. This is a smart triage system. We use a SCART triage system, but it's the same basic thing. And what this is, this will handle 25 patients. So, every ambulance will be able to triage 25 patients, right? So, these are the, you know, the breakdowns. So, red, first priority, immediate patients who need immediate care and transport. These are the patients that are first and transported as soon as possible. When these are going to be in the ambulance, they're going to be transported one or two at a time. They're high priority. We don't pack the ambulance. Airway or breathing compromised, uncontrolled or severe bleeding, especially patients with truncate, severe medical problems, strokes, heart attacks, signs of shocks or hypoperfusion, especially with compensated shock, severe burns, severe or critical or patients who are over 55 or under 5, and open chest or abdominal injuries, right? Because those can be like that. So, those are the red tags. Those are immediate. They go right through from triage to treatment to transport out Yellow, delayed, second priority. These are patients who can be temporarily delayed up to an hour. We don't want it to be an hour, but it could be up to an hour. Burns without airway compromised, so no airway involvement. Burns, they could be serious burns, but they're not, no airway involvement. Major or multiple bone or joint injuries. They could have multi-system trauma, but they're stable. Back injuries with or without spinal cord damage, right? These are patients that, it's not going to, if you have deficits, it's not going to matter if you stay for an hour or go right away. This treatment's going to be the same. It's not going to get worse, so to speak. Green, we call these the walking wounded. It's the third priority, minimal. Patients who require minimal or no treatment and transport can be delayed until the last. So, your red tag patients go one or two in the ambulance. When they go to the hospital. Yellow tag, you can put three, four, as many as you can fit there. One on the bench, one on the stretcher, one sitting, one wherever. Green, you just load them up. Any place that's a place to put your butt, sit it. A lot of times, like C-Med has a bus. They have the ambulance bus, and they can take like 20 supine patients, but they can take like 40 green tag patients and just drop them off at the hospital. A lot of times, these patients, you go there, and they'll be waiting for an hour or two at the Cassidy Collection Point, and family members come and pick them up, and they go. Minor fractures, soft tissue injuries, and again, in between green and black, there's the gray. Gray are patients who are pulsus and apneic, or pulsus or apneic, but do not have definitive signs of death. You know, open thoracic trauma, open head trauma with exposed brain matter, decapitation, hemitransfection. I mean, you look at a patient and go, there's no way that patient's going to survive. That's black. But you look at a patient and go, I would work this if I were on an ambulance responding to a call. They have a gray. And then you come back to after you take care of all the others. So if you go to a scene and somebody's head is across the road, do you call time of death, or do you have to wait for somebody to arrive? No, but in a situation like that, you'd note the time. You don't actually know, because you don't know what time of death it was. You look at it now, they're dead, but by temperature, they could have been dead. Their head could have been amputated an hour and a half ago, or two hours ago. So you really can't call time of death, so you wouldn't even bother with it. Especially in a mass casualty, we wouldn't call that. We'd let the medical examiner do that. There's a condition called algorimortis. Algorimortis is the cooling of the body until it reaches ambient temperature. And it's about 1.4 to 1.5 degrees per hour. And they can measure that in the liver. They actually put a thermometer in the liver, and they can measure the temperature, and they can tell pretty accurately, within half an hour, they can tell when the person's actual time of death was. Don't chicken heads, like, stay alive for, like, a while? Like, after you've cut it? I'm sorry that's so random, but, like, isn't... That is random. I don't know about chicken heads. I know that you could cut a chicken, cut a head off a chicken, and it'll run around. I've seen that. Oh, okay, so the whole thing, maybe? Okay. Yeah, not the head? But they actually, they actually did. This is the thing. All right, let's talk about this a little bit. There's no such thing as instantaneous death. Good word. Because the brain still has a small amount of oxygen and glucose, and the cells are still functioning. So there's no such thing as immediate death. The French, the French execution method for many years was the guillotine. It was a French physician who invented it as a more humane way to do executions. His name was guillotine, so they would chop the head off. So this one, I think his name was Algiers, but there was this one man who wanted to know the actual, if you died, or if you were still alive after you, so he did a test. One man, a prisoner who was being executed, he had an agreement with this man. He said, after your head is amputated, I'm going to say things to you and call your name. If you could blink your eyes, if you could hear me. And they lopped his head off, and he picked up the head, and he said the person's name, and the head blinked the eyes. So they're saying, even though they lopped your head off, you may not be dead right away. You may be, you know, it's not going to be long after, you know, 30 seconds or so, you're going to, but for that 30 seconds, who knows? So with that idea with the chicken head and the body, again, the body doesn't know what the head did. I can remember my uncle was a firefighter in all the stories. My uncle was a firefighter in Providence, and one time they responded to a house fire, and the house was fully involved, and so the house was actually beginning to collapse. And so they ran in, looking for, they knew there was a man on the second floor, and as they ran up, and they just came up to the door, he said there was a man lying, it must have been a man lying in bed, and a beam came down and amputated his head. The body got up and ran past him and went down the stairs, fell down the stairs. How's that? You guys holding good tonight? I'm going to go sell ice cream now. Your fourth priority is expected. These are patients like that guy. You're not going to work them no matter what, right? So they're the ones that are going to go to the ward. Obvious death with, you know, definitive signs of death, obvious non-survival injuries such as open brain matter, respiratory arrest with limited resources, and cardiac arrest. Although respiratory and cardiac arrest without obvious non-survivable signs, they become gray. That's why we added that gray in that. Now this is basically the triage system, so this is one type here. This is the type that we have here. You carry these on the ambulance. You open it up, and it's got these tags like this, okay? And what you do is this goes, you wrap this onto the ankle or on the wrist or put it around the neck, and this tag, whichever one it is, because you'll see they have different colors, is it green, is it yellow, or is it red? And whichever one sticks out, that's the way you have it. On the back, it's got patient detail information. And again, if you don't know name, if you don't know age, you put approximate. You know, if you have time to talk to the patient, you can, but you're not going to spend time filling this out because you have to triage other people. So this is done really quickly, usually by somebody you're working with. And then it's got places like you can fill out priority. You can mark down the vascular coma scale, respiratory rate, systolic blood pressure. You can do those things, but those are obviously done afterwards. Basically, the triage, all I'm going to do is pull out this tag, set it to where it is, insert it, and then I'm good to go. And then somebody can come in the secondary triage and in the treatment area, they can fill out all the extra stuff. And then let's say I do a one. I think this guy is high priority, but when we get them to secondary triage, they're like, no, this guy can wait. He's not that serious. All you have to do is just fold that over. And now it becomes a yellow. Okay. And it's got diagrams so you can see, you can fill out where the injuries are. You can explain them. You can put vital signs on the back here, any intervention, the more you do. But this would be handled in the treatment area, not in the triage area. The triage area would just basically be picking red, yellow, or green. Yes? So, the colors can just go in either way. You think it's a one, but the treatment area could have two. It can go up or it can go down. You could have two, like the yellow one, but the treatment is like military emergency. Then they just change it. That's why you do a secondary treatment. It can go either way. And that's why the secondary triage is so important. And then, let's say it's a hazmat situation, then you also have this, which is the hazmat card. So, is it contaminated? Are they decontaminated? And then any information on the chemicals? And then what you do is you take this card and you slip it in this pocket. So, if they're contaminated, you see red contaminated. This means that this patient is a red patient. They're high priority, immediate, but they're not decontaminated yet. Or, it might look like this. The patient's been decontaminated, and then whoever decontaminates them would fill this out. So, you'd know what they were exposed to and they would decontaminate it. Okay? How would you decontaminate a person? And then, we have the... Done. How would you decontaminate a person that happened in Chernobyl? I don't know. You'd have to ask somebody who decontaminates. Sure. Light sticks? I mean, I shouldn't say that because if you're exposed to radiation, you remove the clothes and wash the body down, that does it. Because as long as you get off the radioactive material, you don't off-gas radiation. You still have radiation poisoning, but it's in Chernobyl, it's not going to affect it. And then, here are the black tags. Oh. All right? And technically, with the start triage, we actually have also the gray tags. So, this is going to be up there. It's up in the cabinet. Right where you normally see it on the top shelf over there. So, it'll be up there if you guys, when you're doing your next two days of practice, when you're practicing around, if you want to go in the ambulance, you want to pull out and take a look at it, feel free to. Just do me a favor, when you take it apart, put it back together the way you took it apart, because I use that, obviously, to demonstrate. How about you? How about you again? Tagging patients early, assistant tracking them, and keep an accurate count of their decisions. And then, if you look at that, there's a number on it. And the transportation officer will rip a portion of that tag off, and he keeps that. Or he writes down the number on his log. So, male patient, number 1, 2, 3, 4, 5, 6, 8, transported by coastal to state B. So, we can track that. And then we know. And then when the patient gets to the hospital, that triage number gets put in the computer until they identify the patient. When they identify the patient, the triage number will actually have a name next to it. We'll get that information. So, we can actually track from where the patient went, to where they came from, to where they went. Start triage, simple triage, and rapid treatment. First step is to call out the patients. You get that PA, the public address system. You say, everybody who can hear my voice, walk to my voice. Those that get up to walk, those are green. Now, it may turn out that they're red, or they may turn out to be yellow, or maybe even red. But when they walk to you, we consider them green, the walking wounded. Then those that are left are the ones we have to go through and triage. Those would be yellow or red. And then the jumpstart triage, we talked about that. The jumpstart triage is for those who are less than eight years old. I like to go to 100 pounds, and I like to be pretty generous with it. So, if the patient may be, yeah, maybe they're a little over 100, I'd still use the jumpstart. Children have a great compensatory mechanism. They may not be breathing. You open the airway, give them a couple of breaths, and all of a sudden they start breathing. Or you open the airway, give them a couple of breaths, and their heart rate starts. So, I always like to be generous with that. But that's with the jumpstart. Unlike a regular patient where I'm going to go, I'm going to assess, I'm going to look at them, I'm going to assess pulse and breathing. If I had no pulse, no breathing, I move on to the next one, and we keep going like that. If they've got pulse and breathing, then I can assess whether they're red, yellow, green. With a pediatric, I'm actually going to open the airway and maybe give a couple of breaths if they're not breathing, or I don't feel a pulse. I'm going to give them that chance. Because, again, children have a great compensatory mechanism. I spend a little bit more time with them because they have more of a chance of coming back. So, the jumpstart triage for pediatric patients. First, identify the walking wounded. There are several differences with respiratory status compared to the start triage. Assess the approximate respiratory rate, hemodynamic status, and neurological assessment. And, again, like I said, triage special considerations. Patients who are hysterical and disruptive to rescue efforts may need to be handled as immediate. Crazy people, bye. You're immediate. Even if you're a walking wounded, if you're hysterical, we're going to get you out of the scene. Why? Because you're going to make it worse for everybody. Any first responder who comes injured, even if it's minor, if it can't be fixed on scene, you're immediate. And the reason why is because it can be demoralizing to both the rescue responders as well as patients to see responder personnel injured. So, if you're injured badly enough where you can't be treated on scene, you're going to go high priority. We have to identify patients who are contaminated and or decontaminated. We talked about that. Destination decisions or patient triage as immediate, red, delayed, yellow, should be transported by ground or air ambulance. Again, if you have a mass casualty incident, you can call white flight. You can call med flight. You can call DART. Right? You call as many ambulances as you can. You can have five helicopters land. There's five patients. Take the five sickest patients and bring them to the hospital. That's the beauty of the helicopters is they can come quick, go, and come back again. They can make three or four runs in the time it takes you to make one. In a lot of situations, a bus may transport the walking wounded like the Ambu bus that CMED has, which is basically a converted Worcester, it was a Worcester public, Worcester transport. It was a Worcester, WRTA bus that they bought, or it was donated, and they did it over, converted it, and then it became a... Anything good? You heard a siren, right? So immediate priority patients should be transported one to two at a time until all are transported from the site. And that's the beauty. You can take, as a BLS unit, you can take ALS-level patients. You can take a patient that has blood products, antibiotics running. It doesn't matter. All vets go out the window when it comes, because your job is basically to get them from the scene to the hospital as quickly as possible so you can get back and do more. So destinations and patients that are delayed category can be transported two to three, maybe even four if you can squeeze them in. Finally, the slightly injured are transported again many times. They're either on a bus, you stuff the ambulance like a clown car, or they go by their own family numbers. Expected patients who are still alive should receive treatment and transport last. Again, those are the gray patients. The black patients you're not going to assess at all. Dead victims are handled in the mortuary area. A disaster is a widespread event that disrupts the function and resources of an entire community and threatens lives and properties. Many disasters do not involve personal injury. They get those wildfires that happen yearly in California and Oregon and Washington. Thousands of acres, but nobody's hurt. But it's a disaster. Only an elected official can call disasters. A mayor, a governor, a senator, a police chief, or a fire chief, or they cannot. It's got to be an elected official that calls a disaster, because that stimulates federal funds. So just a clarification on the triaging. You said there's a separate area. If you've got someone who's got life-threatening bleeding, you're not going to wait to put a tourniquet on them until they get to some other area. No, no, no. See, things like that, anything that you can treat immediately, you're going to do, but you're not going to spend a lot of time treating. Something like that. The beauty of that is if they've got an arterial bleed, if they're bleeding, they've got a heartbeat. Because you don't bleed if you don't have a heartbeat. So I know they've got a pulse, so yes, I'm going to put a tourniquet on them. Or I'm going to put some kind of pressure dressing on them. I'm going to stop that right away. That's why you hopefully have two or three people. But something like that, you would treat right away. So your role is to respond to what's requested and report either to the IC or a supervisor for your task. You might go to a casualty collection area that may be established for overwhelming numbers of casualties with a triage, and then your job might be to transport them or treat them, whatever the case may be. Disaster management is coordinated through the ICS in the same way that all the other branches are coordinated. Hazardous materials, when you arrive at a possible HAZMAT incident, the first step is to take that step back and assess the situation. We kind of talked about HAZMAT a little bit, right? So you guys are going to take the HAZMAT awareness course. The HAZMAT awareness course is about two, it should be like eight hours. There's a lot of exit information you need. Now it's about two hours. And basically all it does is it tells you to recognize, oh my God, there's a potential HAZMAT situation, let's call HAZMAT. That's really all it is. We use the rule of thumb. I arrive on scene, I put my hand up, my thumb out, I close one eye. If my thumb can cover the entire scene, I'm safely away. I get my binoculars and I look to see, I try to find any kind of pocket or any kind of sign that there's a HAZMAT situation, I refer to my response guide and I call the appropriate response. Are binoculars typically in every ambulance? It has to be. It has to be. Okay. It doesn't mean it always works. It means it's constantly in the book. Yeah, it has to be on. You have to have a hazardous response guide and binoculars on every ambulance. It's required. Rushing into unsafe scenes can be catastrophic. I told you that story about the deputy sheriff and that overturned truck, right? You don't look at me. No. I didn't tell you that story? Other class. Okay. Other class. So I'm going to tell you the class then. There's a YouTube video. I don't know if you can still find it, but there's a YouTube video of a deputy sheriff. He's got his dash cam and his microphone on and he pulls up to an overturned truck. And you can see what looks like heat waves coming out. It's really hot. You look down the road, you can see heat waves coming off. And so he sees a man bleeding from the head lying in the road away from the truck. So he gets out of the truck and runs over to him. And he's on the radio kneeling down to the patient and he says, Unit 35, I have an overturned tractor trailer. I have a man. And he starts coughing. Drops right over. Falls right onto the patient. So you see a fire department about two minutes later. The fire truck comes up. You see them in the side of the camera. And then they stop and they back up. What happened was the tractor trailer was an overturned truck. It had chlorine in it. So it was chlorine gas, which is heavier than air and settles along the ground. The man got out of the truck and ran away from the truck and succumbed to the fumes. And that's why he was lying in the road. The deputy sheriff died right on the camera because he went to try to save the guy and didn't know what it was. So this is why we don't just run into scenes. We have to make sure it's safe. And believe me, there's stories like that that happen all the time. According to the HAZ blocker, which is hazardous waste operator level, first responders at the awareness level should have sufficient training or experience to demonstrate the following competencies. Understanding of what a hazardous substances are and their risk as well as understanding the potential outcomes of an incident. Recognizing, yep, that's a hazardous incident. Yep, it's dangerous. Yes, people could die. Yes, I'm not going into it. Yes, I'm calling HAZMAT. Areas of training are the ability to recognize the presence of a hazardous substance. The ability to identify, you may be able to identify what that substance is. The more information you have, information is life. The more information you have, the better life you'll save, including your own. An understanding of the role of what you're supposed to do and the ability to communicate with your communications center. A hazardous material poses an unreasonable risk of damage or injury if it is not properly controlled during handling, storage, or manufacturing processes, packaging. Abuse of disposal. Abuse of disposal or transportation. Most of your hazardous material incidences, the vast majority of them, happen during transport. Many happen during training. But it can be a truck. It can be a car. Take time to look at the whole scene and identify visual indicators. Things like, like I said, vapors. You know, if it's a cool, if it's a 50 degree day, you shouldn't have heat vapors coming off the ground. Maybe that's some kind of a gas. Look for smoke, especially discolored smoke. Accurate smells. Birds. If you see a lot of dead animals, a lot of dead birds around a particular scene, that's a bad sign. The canary in the coal mine type of thing. If, if you, if you see multiple patients lying around, right, all of these things are warnings to you. You see fire. Many times, if you smell something, you're already too close. Like if you smell almonds, that can be cyanide. Hazardous materials may be involved in any of the, unless you're eating almonds, that's true. Truck or train crash in which the substance is leaking from the tank, truck, or tank car. Even if the truck says milk, I don't trust it. Leak, fire, or other emergency at an industrial plant, refinery, or other chemical complex, remember that within a 30 mile radius of this building, every chemical complex,