Secondary Triage - example

We are going to have a look at secondary triage or triage sort as it is known. In order to do this, we are going to have a simulated casualty and a medic, and we are going to take you through the process on the board of assessing the patient and applying the scores for first the GCS and then translating that score into a Triage Revised Trauma Score, to give us a total score which will give us a triage category. So now we are going to give you three examples of assessing a patient for a triage sort and using the card.

Hello. Can you hear me? Eye-opening to pain.

Eye-opening to pain scores us a two.

Hello, can you hear me? Talk to me? Can you hear me? Yeah, we have got incomprehensible speech.

So verbal response, incomprehensible sounds gives us a score of two.

Hello. Hello. Yeah, we have got flexation, mate. He is reacting to the pain.

Motor flexating to, is a score of three which gives us a total GCS score of seven. A GCS score of seven on a revised score is three. Respiratory rate for the patient?

Respiratory rate, 19.

19, which is between 10 and 29, which is a score of four. Systolic blood pressure?

Systolic blood pressure, when we did the blood pressure, it is 127.

So that is greater than 90 which scores us a three. Six, seven, eight, nine, 10, as a Revised Trauma Score, which makes them them a category one patient.

Hello. Hello. Can you hear me?

Yeah.

How are you feeling?

Just really dizzy, I don't know, but I think I am okay.

Okay, just relax for a second. So his eye-opening is spontaneous.

Eye-opening spontaneous gives a score of four.

His verbal response is orientated.

Which is a score of five.

Just squeeze my hand for me. Okay, and he obeys commands.

A score of six. Giving us a total GCS score of 15. Revised score for GCS of between 13 and 15 is a score of four. Patient's respiratory rate?

Respiratory rate is 14.

14, so that is between 10 and 29, which is a score of four.

And his blood pressure 120/80.

Okay. So systolic blood pressure is over 90, which gives us a score of four. Four, eight, 12, means that he would be a priority three patient.

Hello. Can you hear me?

Yeah, my face.

Okay, no problem. Just move your hand for me. Just a little look, just have a little bit of a look, okay, no problem at all. So his eyes opening are spontaneous?

Score of four.

He is orientated.

Score of five.

And he is obeying commands.

Score of six, GCS of Fifteen. GCS of fifteen scores us four.

His respiratory rate, 13.

13, so that is between 10 and 29 which scores us a four.

And his blood pressure is 110 over 85.

So systolic blood pressure is over, 90 which scores us four, which theoretically gives us a Revised Trauma Score of 12.

He has severe burns to his airway and his face, which I am concerned about.

Alright so whilst normally, that will make us a priority three patient, because he has got those severe burns, we are going to upgrade him to be a priority one case because of the airway burns.

We can see, secondary triage or triage sort is a reasonably simple process. It must however be done by a clinician. It is not something that could be done by somebody with low level of training like triage sieve. It also, having followed the algorithm, allows the clinical to make key decisions as to whether they wish to up or downgrade the patient based on the other injuries they might have. As we have seen in the last case there because there were airways burns, even though the patient scored 12 and would normally would be a priority three, the patient was upgraded to priority one.