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We have all come to be familiar with the black, red, yellow and green triage tags and train repeatedly on thier application.  Whether it's a neumonic a 5th grader can follow or based on common sense assessment, we know the green are slightly injured and the black tagged folks are dead.  The red and yellow cover everything else from a respiratory rate of 31 to myself, with a natural cap refill of 3-5 seconds.

We are trained to assess, tag and go to the next person.

The system works great on table top scenarios, in drills and even in the field at mass casualty incidents, but I was inspired recently to introduce a new color/tag/classification to the triage kit.

I know, exactly what we need, right? Another confusing category.

 

Well, this one makes it even easier, believe it or not.

White.

White Flag by erix!I am officially adding WHITE to the triage category here at HMHQ.

When triaging you will no doubt come across persons with no injury, illness or complaint, but see the opportunity to become part of what they believe will be a chance to make a few bucks.  This is not uncommon in my area during bus incidents.  A bus will have a minor collision or hard stop and call for help.  Before help arrives, people will climb on the bus and create injuries inconsistent with the collision or direction of hard stop.

These people will fall into the NEW classification of WHITE or "I surrender."

When in a triage situation, if I encounter someone who is uninjured and ambulatory, they are not "walking wounded" but simply "walking."  Last I checked we can do very little for the "walking" other than sitting them down, tagging them green and wasting what few resources we have on them.

Same goes for persons displaced after a fire in their building or adjoining buildings.  They should be triaged WHITE and told to wait nearby for information from the Red Cross or other agency who can help them.  If there is no injury, a green tag seems wasteful, does it not?

Have you ever encountered an MCI with a crowd?  How do you know who is hurt and who is not?  By asking?  Great assessment skills there, Sparky.  Don't let your mind get lost in the sea of "Oh my God there's 10 of them!" and remember that you are doing triage based on your agency's instructions.  Chances are you're using the START Triage system, which assumes by the time you arrive and assess that life threats will be already changing mentation, respirations and perfusion.  Keep in mind that an ambulatory person missing an arm, breathing 22 times a minute with good cap refill on the remaining arm is a green under this system.

But let's get back to the lady wandering the triage area asking who to talk to about suing the building owner/bus company, or who states they were hit by debris but show no signs?  Are they GREEN or are they something less?

Currently the system does not let you make that determination.  After all, what do you know anyway.  Just tag them and deal with it later.  And by later, I mean let treatment sort it out, right?  While it does take a short amount of time to properly tag a person with name, age, allergies, medications, pulse, respiration and mentation status, we could be helping the next person who actually needs us.

Getting to them later is not a liability, spending time confirming they are uninjured is the liability.

So why does the system not account for the liability of the "walking?"

 

Because until now there was no WHITE category.

To be tagged WHITE in an MCI a person (they are not injured so are not a patient) must:

1) Be ambulatory

2) Have no sign or symptom of illness or injury

 

There, wasn't that easy?  I just saved you 8 backboards and 3 ambulances at your MCI.

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11 Comments

  1. Mmorsepfd April 10, 2011 3:30 pm

    This is amazing-at first I was chuckling along, having experienced the same bus jumpers a number of times, then I recalled the mass casualty drills where I just didn’t have the time or resources to deal with all of the patients (you are correct, those green tags do take time) and I realized this is no joke, but a much needed addition to the triage system.

    Bring on the white flags!

  2. Mmorsepfd April 10, 2011 3:30 pm

    This is amazing-at first I was chuckling along, having experienced the same bus jumpers a number of times, then I recalled the mass casualty drills where I just didn’t have the time or resources to deal with all of the patients (you are correct, those green tags do take time) and I realized this is no joke, but a much needed addition to the triage system.

    Bring on the white flags!

  3. NJ_EMT April 10, 2011 3:32 pm

    They actually have this in NJ…

    • Thehappymedic April 10, 2011 6:35 pm

      I’ll need a picture of those tags then.

  4. NJ_EMT April 10, 2011 3:32 pm

    They actually have this in NJ…

    • Thehappymedic April 10, 2011 6:35 pm

      I’ll need a picture of those tags then.

  5. Bill C. April 10, 2011 7:27 pm

    There’s an entire presentation with our statewide triage tags, it’s a few slides in: http://nj.gov/health/ems/documents/njdisastertag.pdf

    The white is to track the non-injured which is your call to make while triaging.

  6. Bill C. April 10, 2011 7:27 pm

    There’s an entire presentation with our statewide triage tags, it’s a few slides in: http://nj.gov/health/ems/documents/njdisastertag.pdf

    The white is to track the non-injured which is your call to make while triaging.

  7. Loch Ness RNLI Crew April 13, 2011 10:13 pm

    Okay – Can we try “Chequered” For the patient/casualty that is the first in your face and standing on top of something waving you in as you arrive?

  8. Loch Ness RNLI Crew April 13, 2011 10:13 pm

    Okay – Can we try “Chequered” For the patient/casualty that is the first in your face and standing on top of something waving you in as you arrive?

  9. reverse lookup November 18, 2011 4:28 pm

    This is really good stuff by the way.

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