5 Medical Needs: Triage and First Aid
5 Medical Needs: Triage and First Aid
5.1 There are two broad categories of medical need in these circumstances: the injuries and conditions that people have acquired as a result of the incident itself, and pre-existing requirements for care and/or medication. The latter are unlikely to be of immediate concern aboard a rescue unit: they will be addressed at the 'final' place of safety (see guidance paper 2.7). Some injuries or medical conditions, however, may need more urgent attention. In most cases this will take the form of whatever first aid treatment can be managed during the transfer. With many people to be assessed, treatment priorities need to be established. This is done by triage.
5.2 Triage is the process of determining the priority in which injured or sick people should be treated, based on the severity of their condition. It is used when there are too many people to treat at once: someone has to wait. In emergencies people are usually triaged several times, with the analysis becoming progressively more sophisticated at each stage. In the early stages, people who are judged unlikely to survive will not be the first priority; nor will people whose handling will be so difficult that it will take longer to retrieve them than it would to recover many more able people. A helicopter capable of taking 15 'walking wounded' may only be able to manage two stretcher cases, for example. If the 15 will not survive until another unit can rescue them, they will be the priority.
However, if there is a choice of rescue units available, helicopters may be better used for cases whose transfer into boats etc would be difficult and delay the rescue of others. See guidance paper 4.7.
Later, with more, and more sophisticated, medical and transport resources available, the priorities are likely to change.
5.3 Ideally, triage should have begun aboard the unit in distress, although this may have been little more than distinguishing between those who can and cannot help themselves, depending on the rapidity of the evacuation – see guidance paper 2.4. A more thorough review should take place aboard the rescuing unit while survivors are being transferred to the 'final' place of safety.
5.4 The form the triage process takes during transfer to the final place of safety will depend on the medical expertise immediately available. Designated SAR units should, ideally, have medically trained personnel aboard, either as part of their usual crews or by prior arrangement. Other rescue facilities (vessels of opportunity, for example) may have limited medical capability. They should be supported during the transfer.
5.5 The support provided will depend on the need identified during triage. If the rescue unit does not have sufficient medical expertise on board, the Rescue Coordination Centre (RCC) should be notified. In some circumstances, when survivors may have to remain aboard the rescue unit for some time, it may be practicable to transfer the most urgent cases to a faster means of transport – a helicopter, for example – or to place medical teams aboard the rescue unit to assist. Medical advice can be arranged by the RCC, preferably using an established Telemedical Assistance Service (TMAS). See IAMSAR Volume II chapters 1.4 and 6.6, and appendix R; and Volume III 'Medical assistance to vessels'.
5.6 In any event the RCC must be told as early as possible the number of people each rescue unit has aboard, the number who require treatment and a summary of their condition, and the number of any confirmed dead, so that the receiving authorities ashore can be notified and prepared. Triage is therefore a primary function aboard rescue units. The information sent to the RCC should be updated and amended as necessary as the transfer proceeds.
5.7 As noted above, the survivors themselves or people in a rescuing vessel's passenger complement may be able to assist by monitoring the injured or unwell or by providing first aid or more sophisticated medical care during rescue.
5.8 Triage systems in use around the world differ in detail. It is not the purpose of this guidance to recommend particular systems – but it is recommended that, where practicable, a common system should be adopted locally by the response organisations planning for MROs together. This means that the system will work for the survivor wherever s/he is in the rescue system – except, probably, at the start – and will help to ensure that information gathered early in the response is not lost. The latter point is particularly important for survivors given medical attention during rescue, when a full history is very helpful to subsequent carers. The triage system selected should enable record-keeping as well as rapid identification of priorities. There are various triage cards available, for example, which use colours to indicate a person's current condition at a glance but which also allow for additional information to be written in. The card travels through the rescue process with the survivor.
5.9 Except for designated SAR units, ferry companies and the offshore industry, it is unlikely that organisations involved at the beginning of the rescue operation will be able to participate in the common triage and recording process recommended above. MRO planners should encourage its adoption where possible, and arrange for it to be introduced at as early a stage as practicable in all mass rescue responses.
5.10 For further discussion of prioritisation in rescue, see guidance paper 2.4. For on-board support, see guidance paper 3.3. For further discussion of medical support at the place of safety, see guidance paper 2.7. IAMSAR Volume III, 'Care of survivors', provides guidance on what medical information should be recorded.