Triage, Stabilization And Transfer Process For Page 1
Triage, Stabilization and Transfer Process forIndividuals with TraumaPage 1 of 7Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure,and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances todetermine a patient's care.Note: For emergencies occurring on MD Anderson campus locations not supported by the Code Blue Team, contact 911 (Code Blue Team vs. 911 Response Map)DISPOSITIONPRESENTATION AND ASSESSMENT MaintainPatient, visitor, oremployee with blunt orpenetrating traumaAcute CancerCare CenterInpatientHemodynamic orrespiratorycompromise1 or alteredmental status2?Yesindicated Consider surgical team consult (General Surgery,Thoracic Surgery, Neurosurgery and/or Orthopedics) Imaging as determined by medical teamsYesSee Box Abelow3Stabilized ?NoManage individual asclinically indicatedASee Page 2Outpatient/MD Andersonpublic spacesTransfer individualairway with cervical spine stabilization asNoSee Page 3YesEvidence ofanatomicalinjury4?Transfer to outside hospital for higher level of care[see Appendix B: Texas Medical Center (TMC)Hospital Contact Information]Emergency transferadministrativeprocess, see Page 4Note: Comorbid factors may increase the severity of injury Age 5 or 70 years PregnancyYes Significant cardiac or respiratory disease ImmunosuppressionNoEvidence of Diabetes, cirrhosis, end-stage renal disease, morbid obesity Bleeding disorders or currently taking anticoagulantshigh-energy1Hemodynamic or respiratory compromise is defined as: SBP 90 mmHg, respiratory rate 10 bpm or 29 bpmevent5?2NoAltered mental status is defined as Glasgow Coma Scale 14 or motor score 5 [see Appendix A: Glasgow Coma Scale (GCS)]Medical management and disposition per3If patient is not stabilized prior to transferring to another facility, continue to pursue a transfer if the individual requests the transferAcute Cancer Care Center and/or Primaryor the expected benefits outweigh the increased risks of the transfer (See MD Anderson Institutional Policy #CLN3280 – Emergency Medical Screening Examinationteams as indicatedStabilization, and Appropriate Transfers Policy)4Anatomic injury includes the following: Open or depressed skull fracture Crushed, degloved, or mangled extremity Paralysis or suspected spinal cord injury Penetrating injury to head, neck, torso, and/or extremities Amputation proximal to wrist and ankle Flail chestproximal to elbow and knee Pelvic fractures Long bone fracture5Evidence of high-energy event includes the following: Falls 20 feet (6 meters) in adults and 10 feet (3 meters) or 2-3 times height in children Auto vs. pedestrian/bicyclist thrown, run over, or with significant ( 20 mph) impact High-risk auto crash: High-energy electrical injury Intrusion 12 inches occupant site or 18 inches any site Burns 10% total body surface area and/or inhalation injury Ejection (partial or complete) from vehicle Tender or rigid abdomen Death in same passenger compartmentDepartment of Clinical Effectiveness V2Approved by the Executive Committee of the Medical Staff on 03/24/2020
Triage, Stabilization and Transfer Process forIndividuals with TraumaPage 2 of 7Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure,and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances todetermine a patient's care.Note: For emergencies occurring on MD Anderson campus locations not supported by the Code Blue Team, contact 911 (Code Blue Team vs. 911 Response Map)DISPOSITIONPRESENTATION AND ASSESSMENTInpatient MaintainCall Code Blue Team(713-792-7099)Hemodynamic orrespiratorycompromise1 or alteredmental status2?Yesairway with cervical spine stabilization asindicated Transfer to ICU and notify Primary Team Consider surgical team consult (General Surgery,Thoracic Surgery, Neurosurgery and/or Orthopedics) Imaging as determined by medical teamsTransfer patientSee Box A belowYesStabilized3?NoManage patient as clinically indicatedANoTransfer to outside hospital for higher level of care[see Appendix B: Texas Medical Center (TMC)Hospital Contact Information]Yes CallMERIT (713-792-7090) Notify Primary TeamEvidence ofanatomicalinjury4?Emergency transferadministrativeprocess, see Page 4YesNote: Comorbid factors may increase the severity of injury: Age 5 or 70 years Significant cardiac or respiratory disease Pregnancy Diabetes, cirrhosis, end-stage renal disease, morbid obesity Immunosuppression Bleeding disorders or currently taking anticoagulants1NoHemodynamic or respiratory compromise is defined as: SBP 90 mmHg, respiratory rate 10 bpm or 29 bpm2Altered mental status is defined as Glasgow Coma Scale 14 or motor score 5 [see Appendix A: Glasgow Coma Scale (GCS)]3If patient is not stabilized prior to transferring to another facility , continue to pursue a transfer if the individual requests the transferor the expected benefits outweigh the increased risks of the transfer (See MD Anderson Institutional Policy #CLN3280 – EmergencyMedical Screening Examination Stabilization, and Appropriate Transfers Policy )4Anatomic injury includes the following: Open or depressed skull fracture Crushed, degloved, or mangled extremity Penetrating injury to head, neck, torso, and/or extremities Amputation proximal to wrist and ankleproximal to elbow and knee Pelvic fractures Flail chest Long bone fracture Paralysis or suspected spinal cord injuryEvidence ofhigh-energyevent5?5NoMedical management and dispositionper Primary teams as indicatedEvidence of high-energy event includes the following: Falls 20 feet (6 meters) in adults and 10 feet (3 meters) or 2-3 times height in children High-risk auto crash: Intrusion 12 inches occupant site or 18 inches any site Ejection (partial or complete) from vehicle Death in same passenger compartment Auto vs. pedestrian/bicyclist thrown, run over, or with significant ( 20 mph) impact High-energy electrical injury Burns 10% total body surface area and/or inhalation injury Tender or rigid abdomenDepartment of Clinical Effectiveness V2Approved by the Executive Committee of the Medical Staff on 03/24/2020
Triage, Stabilization and Transfer Process forIndividuals with TraumaPage 3 of 7Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure,and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances todetermine a patient's care.Note: For emergencies occurring on MD Anderson campus locations not supported by the Code Blue Team, contact 911 (Code Blue Team vs. 911 Response Map)PRESENTATION AND ASSESSMENTDISPOSITIONOutpatient1/MD Andersonpublic spacesTransfer individualYesMaintain airway with cervicalspine stabilization as indicated4Stabilized ?YesCall Code Blue Team(713-792-7099)NoManage individual as clinically indicatedHemodynamic orrespiratorycompromise2 or alteredmental status3?Note: Comorbid factors may increase the severity of injury: Age 5 or 70 years Significant cardiac or respiratory disease Pregnancy Diabetes, cirrhosis, end-stage renal disease, morbid obesity Immunosuppression Bleeding disorders or currently taking anticoagulants1See Box A belowANoEvidence ofanatomicalinjury5?YesTransfer to outside hospital for higher level ofcare [see Appendix B: Texas Medical Center(TMC) Hospital Contact Information]NoYesEmergency transferadministrativeprocess, see Page 4Evidence ofFor outpatient areas not covered by Code Blue services, call 911 and provide supportive care until EMS arriveshigh-energy2Hemodynamic or respiratory compromise is defined as: SBP 90 mmHg, respiratory rate 10 bpm or 29 bpmevent6?3Altered mental status is defined as Glasgow Coma Scale 14 or motor score 5 [see Appendix A: Glasgow Coma Scale (GCS)]No4If patient is not stabilized prior to transferring to another facility, continue to pursue a transfer if the individual requests the transferMedical management and disposition peror the expected benefits outweigh the increased risks of the transfer (See MD Anderson Institutional Policy #CLN3280 – Emergency Medical ScreeningCode Blue and/or Primary teams as indicatedExamination Stabilization, and Appropriate Transfers Policy)5Anatomic injury includes the following: Open or depressed skull fracture Crushed, degloved, or mangled extremity Paralysis or suspected spinal cord injury Penetrating injury to head, neck, torso, and/or extremities Amputation proximal to wrist and ankle Flail chestproximal to elbow and knee Pelvic fractures Long bone fracture6Evidence of high-energy event includes the following: Falls 20 feet (6 meters) in adults and 10 feet (3 meters) or 2-3 times height in children Auto vs. pedestrian/bicyclist thrown, run over, or with significant ( 20 mph) impact High-risk auto crash: High-energy electrical injury Intrusion 12 inches occupant site or 18 inches any site Burns 10% total body surface area and/or inhalation injury Ejection (partial or complete) from vehicle Tender or rigid abdomen Death in same passenger compartmentDepartment of Clinical Effectiveness V2Approved by the Executive Committee of the Medical Staff on 03/24/2020
Triage, Stabilization and Transfer Process forIndividuals with TraumaPage 4 of 7Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure,and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances todetermine a patient's care.EMERGENCY TRANSFER ADMINISTRATIVE PROCESSCase Management or OSA will: Contact Transfer Center at the receivinghospital to obtain approval and bed availability 3 Provide attending physician with contactnumber for physician at outside hospital Attending Physician will discuss case withphysician at outside hospital Attending Physician to notify patient and familyof intent to transfer Acute CancerCare Center/InpatientAttending Physician willnotify Case Management orOff Shift Administrator1 (OSA)(outside of business hours) tocoordinate acceptance atoutside hospital 2YesTransferaccepted?NoCase Management or OSA will: Identify and coordinate appropriatetransportation service to be used Complete the Memorandum of Transfer4 Ensure proper documentation accompaniespatient Notify appropriate nursing unit when theapproval to transfer has been obtained alongwith information such as address and phonenumbers for calling clinical report Inform patient and family of accepted transferInform patient and family that care willcontinue at MD Anderson Manage patient as clinically indicated Outpatient/MD Andersonpublic spaces CodeBlue team contacts EMS for transfer Code Blue team to notify outpatient area of patient disposition Outpatient team to notify available family and primary team as appropriateEMS Emergency Medical Services1Contact Case Management or OSA via operatorRefer to MD Anderson Institutional Policy #CLN0614: Transfer of Patients to, from and Within MD Anderson Cancer Center Policy3Discuss with Attending Physician regarding preference for receiving hospital based on clinical scenario. See Appendix B: Texas Medical Center (TMC) Hospital Contact Information. If transfer approval is not promptlyobtained, Case Management to contact alternate hospitals to avoid delay.4Documentation: “Face sheet” Medical records to include a current reconciled medication list and transfer orders per primary care team Others as appropriate2Department of Clinical Effectiveness V2Approved by the Executive Committee of the Medical Staff on 03/24/2020
Triage, Stabilization and Transfer Process forIndividuals with TraumaPage 5 of 7Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure,and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances todetermine a patient's care.APPENDIX A: Glasgow Coma Scale (GCS)1ItemEye Opening ResponseVerbal ResponseMotor Response1DescriptionAPPENDIX B: Texas Medical Center (TMC) Hospital Contact InformationScoreSpontaneous4To verbal stimuli, command, speech3To pain only (not applied to face)2No response1Oriented5Confused conversation, but able to answer questions4Inappropriate words3Incomprehensible speech2No response1Obeys commands for movement6Purposeful movement to painful stimulus5Withdraws in response to pain4Flexion in response to pain3Extension in response to pain2No response1Memorial Hermann TMCFor Transfers:Transfer Center (713) 704-2500Ben Taub HospitalTransfer Center (713) 873-8601GCS is obtained by adding the score from each parameterDepartment of Clinical Effectiveness V2Approved by the Executive Committee of the Medical Staff on 03/24/2020
Triage, Stabilization and Transfer Process forIndividuals with TraumaPage 6 of 7Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure,and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances todetermine a patient's care.SUGGESTED READINGSATLS Algorithms. (2010). Retrieved from /Pocket-ICU-Management/534159/all/ATLS AlgorithmsGalvagno, S. M., Nahmias, J. T., & Young, D. A. (2019). Advanced Trauma Life Support update 2019: Management and applications for adults and special populations. AnesthesiologyClinics, 37(1), 13-32. doi:10.1016/j.anclin.2018.09.009MD Anderson Institutional Policy #CLN0614 – Transfer of patients to, from and Within MD Anderson Cancer Center PolicyMD Anderson Institutional Policy #CLN3280 – Emergency Medical Screening Examination Stabilization, and Appropriate Transfers PolicyNB Trauma Program. (2018). Trauma Transfer Guidelines. Retrieved from uma-Transfer-Guidelines-Aug-2018-bil.pdfSoutheast Texas Regional Advisory Council SETRAC (TSA Q). (2018). Emergency medical services/trauma system plan. Retrieved /09/Trauma-Plan-2018-revisions.pdfDepartment of Clinical Effectiveness V2Approved by the Executive Committee of the Medical Staff on 03/24/2020
Triage, Stabilization and Transfer Process forIndividuals with TraumaPage 7 of 7Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure,and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances todetermine a patient's care.DEVELOPMENT CREDITSThis practice consensus statement is based on majority opinion of the Emergent Triage/Transfer Process workgroup experts at the University of Texas MD Anderson Cancer Center for thepatient population. These experts included:Ginny Bowman, MSN, RN (Nursing Administration)Patricia Brock, MD (Emergency Medicine)ŦJohn Crommett, MD (Critical Care & Respiratory Care)ŦRobert Drew, MBA, RN (Nursing – Acute Cancer Care Center)Wendy Garcia, BS Marina George, MD (General Internal Medicine)Petra Grami, DNP, RN (Nursing Administration)Amanda Hamlin, MS, PA-C (Houston Area Locations)Angela Hayes-Rodgers, MBA (Off-Shift Administration)Colleen, Jernigan, PhD, RN (Nursing Administration)Pauline Koinis, BSMT Jeffrey Merlin, MD (Emergency Medicine)Karen Plexman, MSN, RN (Emergency Readiness)Regina Smith, MSN, MBA, RN (Houston Area Locations)Jenise Rice, MSN, RN (Perioperative Nursing)Donna Ukanowicz, MS, RN, ACM (Case Management)Delmy Vesho, MSN, RN (Nursing Administration)Marian Von-Maszewski, MD (Critical Care & Respiratory Care)Mary Lou Warren, DNP, APRN, CNS-CC Suzanne M. Wilson, BSN, DBA, RN (Case Management)Ŧ Core Development TeamClinical Effectiveness Development TeamDepartment of Clinical Effectiveness V2Approved by the Executive Committee of the Medical Staff on 03/24/2020
Note: Comorbid factors may increase the severity of injury . EMERGENCY TRANSFER ADMINISTRATIVE PROCESS Acute Cancer Care Center/ Inpatient 1 Contact Case Management or OSA via operator 2 Refer to MD Anderson In
The scene is safe and you are wearing the proper PPE, triage all the victims. After you complete your triage process, report the number and triage categories to your Triage Unit Leader. MCI Triage Drill Demonstration [In a live presentation, a video would play here.] MCI/Triage Summary .
Oct 04, 2018 · ED/Hospital MCI Triage and Interface with Pre-hospital Triage: Facilitated discussion with hands-on practice of MCI hospital triage using ultrasound as adjunct. In addition, covers how to use MCI hospital triage system with patents who have a prehospital assigned triage
D. Lecture: Triage Categories/ START Practice (Slides 18-26) E. Triage Assessment Exercise I F. Demonstrate Use Arizona Triage System G. Lecture: Triage Goal & Priorities/ Triage Tag Field Trial/Tactical Benchmarks (Slides 27-38) H. MCI Review (self-graded quiz) Session II (90 minutes)
Triage/Front-end Process Improvement Created quick registration processes Hardwired rapid triage protocols Implemented direct bedding Dedicated an RN to triage 24/7, minimum 2 staff Revised EPIC triage templates Triage was aligned with Emergency Services Index (ESI) guidelines
Objective triage criteria for children will help to eliminate the role of emotions in the triage process. Objective triage criteria will provide emotional support for triage personnel forced to make life or death decisions for children in the MCI setting. DPT 8.0 Case Studies Patient 1 - 7 y/o female - Non-responsive .
“triage” as a nursing role and responsibility 2. Describe how a standardized approach to obstetric triage can improve processes and outcomes 3. Explain the development and use of AWHONN’s Maternal Fetal Triage Index (MFTI) @2015 AWHONN 3 Quality Triage Care @2015 AWHONN 4 Should women have to wait to be triaged?
Course Terminal Objectives Define Mass Casualty Incident (MCI) Identify the features of the "All Hazard Triage Tag" Use the "START" triage system Perform Chemical & Trauma triage Identify the EMS resources needed for MCI response Identify the procedures and equipment requirements of mass decontamination Identify and describe the functions of Triage .
Animal Triage Procedures Wyoming Department of Health Adapted from “Veterinary Disaster Triage: Making the Tough Decisions” by Wayne E. Wingfield, MS, DVM, Colorado State University Veterinary Triage Veterinary disaster triage begins with the assessment of: 1) The medical nee
