Chapter 9

 

Triage and Medical Care

 

9.1 IMMEDIATE NEED FOR CARE OF INJURED IN AIRCRAFT ACCIDENTS

In the aftermath of an aircraft accident, many lives may be lost and many injuries aggravated if immediate medical attention is not provided by trained rescue personnel. Survivors should be triaged, given available emergency medical aid as required, and then promptly evacuated to appropriate medical facilities.

 

9.2 TRIAGE PRINCIPLES (ALL EMERGENCIES)

9.2.1 "Triage" is the sorting and classification of casualties to determine the order of priority for treatment and transportation.

 

9.2.2 Casualties should be classified into four categories:

Priority I:    Immediate care

Priority II:   Delayed care

Priority Ill:   Minor care

Priority IV:         Deceased

 

9.2.3 The first qualified, medically trained person to arrive at the site must immediately begin initial triage. This person(s) will continue performing triage until relieved by a more qualified person or the designated airport triage officer. Victims should be moved from the triage area to the appropriate care holding areas before definitive treatment is rendered. Casualties should be stabilized at the care holding areas and then transported to an appropriate facility.

 

9.2.4 Every effort should be made to ensure that Priority I casualties are treated first and receive ambulance transportation priority when stabilized. This is the responsibility of the triage officer.

 

9.2.5 Triage is most efficiently accomplished in place. However, the conditions at an accident scene may demand the immediate movement of casualties before triage can be safely accomplished. In that case, the casualties should be moved the shortest distance possible, well away from fire fighting operations, and upwind and uphill from the scene. (See Figure 9‑l.)

 

9.2.6 Triage of casualties should include the use of casualty identification tags to aid in the sorting of the injured and their transportation to a designated hospital. This technique is especially suited to multilingual situations.

 

9.3 STANDARDIZED CASUALTY IDENTIFICATION TAGS AND THEIR USE

9.3.1 Need for standardized tags. Casualty identifi­cation tags should be standardized through colour coding and symbols to make the tag as simple as possible. Tags help to

expedite the treatment of mass casualties in a triage situation and thus permit more rapid evacuation of the injured to medical facilities.

 

9.3.2 Tag design. Standardized tags should be designed to require only minimal information to be entered thereon, be usable under adverse weather conditions, and be water resistant. An example of such a tag is illustrate din Appendix 8. On this tag, numerals and symbols indicate the medical priority classification of casualties as follows:

 

Priority I or immediate care:                        RED tag; Roman numeral I; rabbit symbol

Priority II or delayed care                                          YELLOW tag; Roman numeral II; turtle symbol

Priority Ill or minor care:                             GREEN tag; Roman numeral Ill; ambulance with X symbol

 

 

Priority IN or deceased:                              

BLACK tag

 

9.3.3 Where tags are unavailable, casualties may be classified by using Roman numerals on adhesive tape or by placing marks directly on the forehead or on other exposed ,skin areas to indicate priority and/or treatment needs. Where marking pens are unavailable, lipstick can be used. Felt tipped pens are not advisable as they may smear in rain or snow and freeze in low temperatures.

 

9.4 CARE PRINCIPLES

 

9.4.1 Stabilization of the seriously injured should be accomplished at the accident site. The immediate transpor­tation of the seriously injured before stabilization should be avoided.

 

9.4.2 In accidents occurring on or adjacent to the airport, rescue and fire fighting personnel are generally the first emergency personnel on the scene. These personnel must be aware that it is imperative that seriously injured casualties be located and stabilized as quickly as possible. In cases where fire control or prevention does not require the efforts of all rescue and fire fighting personnel, available persons should immediately commence casualty stabilization under the direction of the most qualified trauma‑trained individual on the scene. First response rescue vehicles should carry initial supplies of casualty‑care equipment, including artificial airways, compresses, bandages, oxygen and other related equipment used for the stabilization of smoke inhalation casualties and severe trauma. Sufficient oxygen should be available for use on rescue and fire fighting personnel.

 

However, oxygen should not be used in areas where fuel spills or fuel soaked clothing is present due to the explosion hazard.

 

9.4.3 Actions taken during the first few minutes of medical treatment should stabilize the casualties until more qualified medical care is available. When specialized trauma teams arrive, more sophisticated medical care (i.e. cardiopulmonary resuscitation, etc.) will be provided.

 

9.4.4 The triage procedure and subsequent medical care should be placed under the command of one authority, the designated medical co‑ordinator, upon this officer's arrival. Prior to this, the command of triage should be assumed by the individual designated by the commanding rescue and fire fighting chief and should continue until relieved by the predominated medical co‑ordinator.

 

9.4.5 The medical co‑ordinator has responsibility for all medical aspects of the incident and should report directly to the on‑scene commander. The medical co­ordinator's primary function will be administrative, not as a participant of the medical team treating the injured.

 

9.4.6 As a means to easily identify and distinguish the medical co‑ordinator, a white hard hat and highly visible white coat or vest should be worn, with "MEDICAL CO­ORDINATOW' displayed front and back in reflective red lettering.

 

9.4.7 Care of Priority I (Immediate care) casualties. This type of casualty includes:

 

(a) major haemorrhages;

(b) severe smoke inhalation;

(c) asphyxiating thoracic and cervico‑maxillo‑facial injuries;

(d) cranial traumata with coma and rapidly progressive shock;

(e) compound fractures;

(f) extensive burns (more than 30 per cent);

(g) crush injuries;

(h) any type of shock; and

(i) spinal cord injuries.

 

9.4.8 The following actions are recommended:

 

       (a) first aid (clearing of the wind pipe, stopping of haemorrhages by means of haemostatic pads, and positioning the casualty in the recovery position;

       (b) resuscitation;

       (c) oxygen administration, except in areas of fuel or fuel soaked clothing; and

       (d) placing the injured under shelter pending transpor­tation.

 

 

9.4.9 Care of Priority 11 (Delayed care) casualties This type of casualty includes:

(a)   non‑asphyxiating thoracic trauma;

(b) closed fractures of the extremities;34

(c)   limited burns (less than 30 per cent);

(d) cranial trauma without coma or shock; and

(e)   injuries to soft parts.

 

9.4.10 Care of casualties sustaining injuries which do not need immediate emergency medical treatment to sustain life can be delayed until Priority 1 casualties have been stabilized. Transportation of Priority II casualties will be performed following minimum on‑site care.

 

9.4.11 Care of Priority III (Minor care) casualties. This type of casualty includes minor injuries only. Certain accidents/incidents will occur where passengers have either minor or no injuries, or appear not to be injured. Because these casualties can interfere with other priorities and operations, it is important that they be transported from the accident/incident site to the designated holding area where they should be re‑examined.

 

9.4.12 It is important that provisions be made for the care, comfort, and identification of Priority Ill casualties. This should be provided through airport operations, the aircraft operator (where involved), or international relief organization (Red Cross, etc.). Specific treatment areas should be predominated for this purpose, such as an empty hangar, a designated area in a passenger terminal, a fire station, or other available sites of adequate size (hotel, school, etc.). Any such area selected should be equipped with heating or cooling systems, electric light and power, water, telephones and toilet facilities. A number of such reselected sites should be available so that, when an accident occurs, the most advantageous site can be selected based on both travel distance and space needs (number of casualties involved). All aircraft operator personnel and airport tenants should know the location of such designated facilities.

 

9.5 CONTROL OF THE FLOW OF THE INJURED

9.5.1 The injured should pass through four areas which should be carefully located and easily identified (See Figure 9‑1).

(a)   Collection area ‑ location where initial collection of the seriously injured from the debris is accomplished. Need for the establishment of this area will be dependent upon the type of accident and the circum­stances surrounding the accident site. Custody of casualties is normally transferred from the rescue and fire fighting personnel to medical services at this point. In most cases, however, this transfer will occur at the triage area.

(b)Triage area ‑ The triage area should be located at least 90 m upwind of the accident site

(c)to avoid possible exposure to fire and smoke. If necessary, more than one triage area may be established.

(e)   Care area ‑ Initially, there will be a single care area. Subsequently, this area should be subdivided into three sub areas according to the three categories of injured, i.e. Immediate care (Priority % Delayed care (Priority II) and Minor care (Priority Ill). Care areas can be colour coded for identification purposes (Red ‑Immediate, Yellow ‑ Delayed, and Green ‑ Minor). The use of coloured traffic cones, flags, etc., may be used.

(d)   Transportation area ‑ A transportation area for the recording, dispatching and evacuation of survivors should be located between the care area and the egress road. Only one transportation area is normally required. However, if there is more than one transpor­tation area, it is essential to have communications between them.

 

9.5.2 Mobile facilities for the stabilization and treatment of Priorities I and II casualties are recommended. Ideally these facilities should be operational in less than thirty (30) minutes. Their design must therefore permit rapid conveyance to the site and rapid activation to receive casualties. These flaccidities should consist of:

(a)   conventional or resuscitation ambulances. A resusci­tation ambulance is an ideal shelter for a Priority I casualty. The casualty may be treated there and subsequently conveyed directly to a hospital;

(b) red tents to accommodate serious or extremely urgent cases. These facilities, with provisions for integrated heating and lighting, can be transported to the scene together with all the necessary medical equipment (See Appendix 3); and

(c)   yellow tents to accommodate Priority II casualties. Transportable mobile hospitals or ambulances can be used for stabilization treatment for all casualties