Prehospital Report (vs Triage?)

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I agree with Dr Mattox that field disaster manuals need updating based upon
learned experience, but I think to characteize triage tags as an "insult"
and dismiss them out of hand is a stretch of hyperbole even over the top for
"k". 

We have no national standard for triage in the U.S., something which the CDC
is seeking to remedy in cooperation with ACEP, NAEMSP, NAEMST, ACS COT and
others. Given that, we are apt to see a number of different triage
methodologies in an disaster if it is wide enough. The key ot success will
be flexibility. One would be foolish not to use the information at hand,
even if it is presented in (or on) a format with which you don't agree.

P.S. Along with CNS status and pulse, you might want to consider "B"
(breathing) from ATLS. I've seen more than a few patients who have a good
pulse, are alert and can talk, and tell me some variant of "I can't breathe"
or "I'm short of breath." 

Jeffrey Hammond MD, MPH
New Brunswick, NJ

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of KMATTOX at aol.com
Sent: Wednesday, January 30, 2008 10:49 PM
To: trauma-list at trauma.org
Subject: Re: Prehospital Report (vs Triage?)

For both routine EMS and during disaster, and I have been through my  share.

  I want to know two bits of information  first.      What is cerebral
status 
(can she talk and  understand) and is there a presence of a peripheral
pulse. 
    PERIOD.  THat is ALL.   I do NOT want to know the BP.    It does not
help 
me in the EC.   
 
I next want to know what injuries the pre hospital person found and what do

they think.    Is this person going to do OK, are they going to  die, will 
they need an operation or  hospitalalizaiton.       These evaluations are  
remarkable helpful.    If they are of the 3 later categories, I  head for
the 
OR/ICU/IR, etc.        
 
If there is any triage tag, I ignore it as it is misleading and a dis  
service to the patient and an insult to any nurse or  doctor.     If there
is a 
Sharpie or Magic Marker which  indicates pulse or no pulse or loss of CNS I
like  
it.       The field triage is essential if  FOCUSED, but ridiculously over 
rated it it gives me too much  information.        
 
The Disaster field manuals must be totally re written as they have very  
little resemblance to reality.   
 
k




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