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Tue Jan 29 11:38:20 GMT 2008

Ruy,

I would have to side with your commanding officer on this 
one, but for a slightly different reason and it will be 
good for your reputation to approach your next meeting 
starting, “On reflection and consultation,  I must fully 
agree with your decision
I wonder if we could change 
something very slightly for the following reason..!”

There are 2 distinct parts to this argument:

1) Day to day vs Mass Casualty

In disaster/mass casualty situations the very last thing 
you want to do is deviate too far from the norm. Efficient 
surge management is all about keeping staff in the same 
routine that they are used to. Change forms, even 
slightly, and you will loose efficiency. Change routine 
for a rare event, and you will lose efficiency. 
 Additionally audit, which you will want to achieve post 
mass casualty, will be far more difficult. I could go on 
and on

So your prehospital (and hospital for that matter) 
paperwork should be very simple, ALL THE TIME! Have a 
minimal demographics (name + age) and clinical section 
(drawing only and space for free text) that you would 
expect to be completed in mass casualty and obviously all 
routine work. Then on the same card/paper have enough 
information for day to day audit and legal documentation 
purposes that you would expect to be completed in all 
routine work.

2) Simplicity of triage

Companies who make triage cards hate me, because I don’t 
believe in them!!! I believe in keeping your normal day to 
day prehospital paperwork as above for recording 
information and leaving with the patients. The act of 
triage should be conducted with nothing more expensive 
than a big thick permanent marker pen to write on the 
forehead or perhaps something really cheap and therefore 
uniformly distributable amongst all your first responders 
like coloured hair bands, tape etc. Think about it
 how 
many of your frontline troops would you expect to carry 
triage cards? Yet they are going to be the ones 1st on 
scene!!! Just add a big thick permanent marker to their 
kit and job is more than efficiently done

Happy to help further, just email off list

Dr. Jason van der Velde
EMDM-A
ATACC Disaster Response Coordinator
Trauma Research Fellow in Anaesthesia

Just finished a loooong discussion with the director
> of prehospital services at my institution (Mexican
> Army), we are implementing a new prehospital report
> but he insisted in using the triage tags (cards) but I
> insisted on using those only for multiple victims.  Is
> anybody on the list  aware of using just one report
> for all patients including disasters?  My opinion on
> the matter is that if we put a lot of information on
> the triage tags then the purpose of rapid filling of
> the form is lost.  Being in the army I could have
> ended the discussion with a: look this is the way we
> are going to do it! but I really want to have some
> data or input from you experts on the matter, thanks a
> lot in advance.
> 
> Ruy Cabello-Pasini MD, LTC
> Trauma Surgeon

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Prehospital Report (vs Triage?)