SOP 209.08A MEDICAL OPERATIONAL GUIDELINES

STAGING

All outside agencies responding to a medical incident should be dispatched to a Staging Area. This area should be at a sufficient distance to keep the scene clear and maintain access. Staging shall direct arriving units as directed by Command.

Units assigned to sectors, unless carryings special equipment, should park in staging configuration at a distance from the scene. This parking area should be located out of the access paths. Crews should report to Extrication or Treatment Sectors carrying their medical supplies and backboards. Supplies should be stockpiled adjacent to the treatment area.

Apparatus with extrication tools or other heavy equipment needed at the scene should be brought up closer to the actua1 incident site and park out of the way.

Ambulances may be directed to a separate staging area to provide service directly to the Treatment Area. This will be by the Transportation Sector and announced. This separate Area will usually be located close to the Treatment Area.

The first arriving company at a medical incident will proceed to the scene and assume Command. All other units will follow Level staging procedure unless Level 11 Staging is announced by Command.

TRIAGE

Triage is an ongoing process of patient evaluation that continues throughout the incident.

The initial triage should be performed when a patient is first seen by Fire Department personnel by utilizing the START method - "Life over Limb, Function over Appearance”. A triage tag should be attached to each patient at that time based on the following criteria: ventilation, perfussion/circulation, and mental status. Priorities for treatment and transport shall be based on patient conditions as indicated by: Priority 3 (green tag - hold), Priority 2 (yellow tag - delayed), Priority I (red tag - immediate), and Priority 0 (black tag - dead). If it is necessary to urgently remove patients from a hazardous area, triage tagging will be done at the entrance to the Treatment Area.

The START method is an acronym for “Simple Triage And Rapid Transit”. The evaluation criteria can be broken down as follows to help effective patient care, maintain performance standards, and to insure necessary transport of the injured.

Ventilation: If a patient can not maintain respiration by simple hyperextension he would be tagged with “Black Tag”; Respirations greater than 30 per minute, “Red Tag”; Respirations less than 30 per minute, but present, cannot be tagged at this point and continue to the next step.

Perfussion/Circulation: Check patient capillary refill. If color does not return within 2 seconds, “Red Tag”; if color does return within 2 seconds, consider normal and continue to check step 3. An alternative to this step if conditions do not permit capillary refill check, is to check for radial pulse. No radial pulse, “Red Tag”. Radial pulse present, then proceed to step 3.

Mental Status: If patient’s level of consciousness is impaired, “Red Tag”. If normal, “Green Tag”.