EMS Incident Management - RAMP Triage System

The RAMP (Rapid Assessment and Medical Prioritization) triage system is an approach used by EMS Providers to quickly assess and prioritize patients in a mass casualty incident. Here's what EMS providers need to know about the RAMP triage system:

1. Purpose: The RAMP triage system aims to efficiently allocate limited medical resources by categorizing patients into different priority levels based on their severity of injury or illness.

2. Triage Categories: RAMP uses four triage categories:

- Red: Immediate (highest priority) - Patients with life-threatening conditions requiring immediate intervention.

- Yellow: Delayed (second priority) - Patients with significant injuries or illnesses but who can wait a short time for treatment.

- Green: Minimal (third priority) - Patients with minor injuries or illnesses who can wait longer for treatment.

- Black: Expectant (lowest priority) - Patients with severe injuries or illnesses that are unlikely to survive even with medical intervention.

3. Triage Criteria: EMS providers assess patients based on specific criteria such as breathing, circulation, mental status, and injuries. These criteria help determine the appropriate triage category for each patient.

4. Simple and Rapid Assessment: The RAMP system emphasizes a quick evaluation process to ensure efficient triage in a mass casualty incident. It allows providers to rapidly assess a large number of patients and identify those in immediate need of critical care.

5. Flexibility: The RAMP triage system is designed to be flexible and adaptable to various situations. It can be modified based on available resources, such as the number of personnel, equipment, and medical supplies.

Remember that specific protocols and guidelines may vary between different EMS systems and regions. It's important for EMS providers to receive training and familiarize themselves with the triage system implemented in their area to effectively respond to mass casualty incidents.

EMS Incident Management - JumpSTART Triage System

The JumpSTART triage system is a method used by EMS Providers to assess and prioritize pediatric patients in a mass casualty incident. The system was developed at the Miami, Florida Children's Hospital in 1995 by Dr. Lou Romig.

Here's what EMS Providers need to know about the JumpSTART triage system:

1. Focus on Pediatric Patients: JumpSTART is specifically designed for triaging infants and children (typically aged 1 to 8 years) during mass casualty incidents. It takes into account the unique physiological and anatomical characteristics of pediatric patients.

2. Triage Categories: The JumpSTART triage system uses four triage categories:

- Green: Walking Wounded. Patients who can walk and have minor injuries. Lowest priority.

- Yellow: Delayed. Patients who require medical attention but are not in immediate danger. Middle priority

- Red: Immediate. Patients with life-threatening injuries who require immediate intervention. Highest priority.

- Black: Deceased or Expectant. Patients who are deceased or have injuries incompatible with survival. Lacking priority

3. START Assessment: JumpSTART utilizes a simplified version of the START (Simple Triage and Rapid Treatment) assessment for pediatric patients. EMS providers quickly evaluate each patient's respiratory status, perfusion, and mental status to assign a triage category.

4. Focused on Breathing: JumpSTART places significant emphasis on respiratory status. Children who can walk, follow commands, and have a respiratory rate of less than 45 breaths per minute are classified as green. Those with respiratory rates above 45, altered mental status, or poor perfusion are assigned higher triage categories.

5. Age-Appropriate Assessments: The JumpSTART system recognizes that different age groups may exhibit varying physiological responses. EMS providers use age-appropriate methods to evaluate respiratory status, such as observing chest rise, auscultating breath sounds, or assessing the patient's ability to speak.

6. Ongoing Reassessment: Like other triage systems, JumpSTART emphasizes the importance of ongoing reassessment. Patients initially classified as green or yellow may deteriorate, requiring a change in the triage category as their condition evolves.

Remember, that specific protocols and guidelines may vary between different EMS systems and regions.

It's crucial for EMS providers to receive training and familiarize themselves with the triage system implemented in their area to effectively respond to mass casualty incidents involving pediatric patients.

EMS Incident Management - START v SALT Triage Systems

EMS providers need to be knowledgeable about the skill of triaging, which involves prioritizing patients based on the severity of their condition in order to allocate resources effectively.

When comparing the START (Simple Triage and Rapid Treatment) and SALT (Sort, Assess, Lifesaving Interventions, Treatment/Transport) models, here are some pros and cons to consider:

START Model:

START was developed by the Newport Beach Fire and Marine Department and Hoag Hospital in Newport Beach, California in 1983.

Pros:

1. Simplicity: The START model is straightforward and easy to learn, allowing for rapid implementation in chaotic situations.

2. Speed: It enables quick initial assessment and sorting of patients, allowing prioritization of resources for those with the most critical injuries.

3. Field-based: The START model is primarily designed for use in prehospital or field settings, making it suitable for EMS providers.

Cons:

1. Limited Assessment: The START model focuses primarily on identifying patients who require immediate lifesaving interventions, potentially overlooking patients with less severe injuries or illnesses.

2. Lack of Treatment Guidance: It provides minimal guidance on treatments beyond immediate lifesaving interventions, which may be a limitation in certain situations.

3. Overtriage: There is a tendency for a higher rate of overtriage, which means some patients may be categorized as more severe than they actually are, potentially diverting resources from those who need them most.

SALT Model:

It was developed as a national all-hazards mass casualty initial triage standard for all patients.

Pros:

1. Comprehensive Assessment: The SALT model incorporates a more thorough assessment of patients, including physiological and anatomical criteria, to triage patients effectively.

2. Treatment Considerations: It provides guidance on appropriate treatments based on the patient's condition, facilitating decision-making for EMS providers.

3. Flexibility: The SALT model can be adaptable to different scenarios and can be used in both prehospital and hospital settings.

Cons:

1. Complexity: Compared to the START model, the SALT model may require additional training and practice to ensure accurate implementation.

2. Time-Consuming: The comprehensive assessment involved in the SALT model may take longer to complete, potentially delaying the allocation of resources in time-sensitive situations.

3. Potential Subjectivity: The SALT model relies on clinical judgment, which introduces the possibility of variability in decision-making between different providers.

Ultimately, the choice between the START and SALT models depends on the specific needs of the EMS provider and the context in which they are operating.

Both models have their advantages and disadvantages, and it is crucial for EMS providers to receive proper training in the chosen model to ensure effective triage in emergency situations.

EMS Incident Management - Ten Second Triage

The Ten Second Triage (TST) tool, developed by NHS England, is designed to address the need for rapid triage in major incidents when assessing casualties' physiology may not be practical initially. Here's what EMS providers need to know about TST and how it compares to established models like START and RAMP:

1. Speed of Assessment: TST focuses on rapid assessment, aiming to triage a casualty within ten seconds. This allows for immediate life-saving interventions to be performed simultaneously.

2. Mechanism of Triage: TST utilizes a mechanism called "Threat, Breathing, Circulation" to prioritize casualties. It emphasizes identifying threats to life, assessing breathing, and evaluating circulation to make triage decisions quickly.

3. Simplicity and Training: TST is designed to be simple, intuitive, and easy to learn. It requires minimal training for EMS providers, enabling quick implementation in the field.

4. Comparison to Established Models: Established triage models like START (Simple Triage and Rapid Treatment) and RAMP (Rapid Assessment, Management, and Prioritization) focus on assessing physiological parameters.

In comparison, TST prioritizes threats to life and emphasizes immediate interventions.

It's important to note that the effectiveness of TST, START, and RAMP may vary depending on the specific context and the resources available during a major incident. EMS providers should be familiar with multiple triage methods and adapt their approach based on the situation at hand.

Additional Reading:

https://journals.sagepub.com/doi/10.1177/14604086231156219