Secondary Triage

With secondary triage, the assumption is that the triage card will already have been put on the patient in the primary triage process, in order to do a secondary triage at the casualty clearing point or the casualty clearing station, you will need to take the card out of the envelope and follow through the algorithm that is on the inside.

1. The first thing we are going to look at is, are the patient's eyes open? If they are open spontaneously, he scores four. If they open to voice, he scores three, opens to the pain he scores two, no reaction at all scores one.
2. The next thing to look at is the verbal response of the patient, if the patient is orientated and talking to you normally, then that is a score of five. If the patient is confused in any way, then the score is four, if the patient uses inappropriate words, the score is three. If he just makes grunts and noises, in other words, incomprehensible sounds that are a score of two, there is no response, that is a score of one.
3. The last thing to look at in this section of the Glasgow Coma Scale as part of secondary triage is the motor response. For motor response, we look as to whether the patient obeys commands, if he obeys commands, then that is a score of six. If he localises to pain, which means he can detect the fact that you are touching him and causing him pain and can move to push you away to stop the pain, then that scores as five. He can't do that, but he can withdraw you touch him and he pulls away from you, then that scores as a four. If he flexates the pain, which basically means that he curls up, then that scores as a three, if he extends the pain, which means he pushes out like this, then that is a score of two, and if there is no response, that is a score of one.

You add the three scores you get together, which will give you a total for the Glasgow Coma Score, you then take that score to the next box where it is translated into a simple score, so if the patient score between 13 and 15, the revised trauma score for that is four. If it was nine to 12, the revised trauma score is three. Six to eight, the score is two, four to five the score is one, and if the Glasgow Coma Score is three and you can't actually get any lower than three on a GCS, the score is zero.

You take a note of the patient's respiratory rate and again that is stored on the card, 10 to 29 equals four, more than 30 equals three, six to nine equals two. One to five equals one. No respiratory output equals zero. A measurement of the patient's systolic blood pressure. 90 or more scores as four. 76 to 89 scores you three, 50 to 75 scores you two, one to 49 scores you one. No systolic blood pressure, a really bad sign, gives you a score of zero. You add to those three scores together, if the score is 10 or less, then that becomes a priority one patient, a score of 11 makes the patient a priority two and a score of 12 makes the patient a priority three.

You can see that it is quite important that you follow the process because actually, the scoring difference between those is potentially only one in each area, 10, 11 or 12 will give you one, two or three, it is also important to record on the card the time that you took those observations at, and make sure that you have recorded the GCS and the revised trauma score and showing the totals on the card. Normally, if you are a paramedic looking after the patient, you will be with that patient all the way through the system, but as you may be handling this patient over to someone else, it is important that the next person who takes the card out and does the scoring, can see what the previous sets of scores were, so he can tell whether the patient is getting better or worse, and what the trend is in that patient.