OnSite Medical Care

In the field, rescue personnel often use a simple triage and rapid treatment (START) technique that depends on a quick assessment of respiration, perfusion, and mental status.51 Subsequently, determining how much and what type of care to administer at the disaster site depends on several factors. If the number of patients is small and sufficient prehospital personnel and transportation resources are available, on-site medical care can proceed in a fairly normal manner, with rapid stabilization and transportation to nearby hospitals. When extrication will be prolonged, potentially lifesaving interventions, such as crystalloid infusion for hypovolemic shock, should be instituted in the field.5 53 On the other hand, early, rapid transportation with a minimum of treatment should be practiced when there is danger to rescuers and casualties from fire, explosion, falling buildings, hazardous materials, or extreme weather conditions.

When there is an overwhelming number of casualties that exceed transportation capacities, advanced field medical and surgical treatment may be beneficial, since it may be hours before seriously injured patients can be evacuated.54 This may necessitate the establishment of field hospitals with operating-theater capabilities. Casualties are brought there from the disaster site for further assessment and initial treatment of their injuries. After a period of observation and stabilization, they are either sent home or transported to a hospital.

If evacuation of ambulatory victims and those with minor injuries rapidly overwhelm local hospitals prior to the arrival of the more severely injured, it may be better to treat them locally. To address these considerations, the secondary assessment of victim endpoint (SAVE) system of triage has been proposed. 55 The SAVE triage system is designed to identify patients who are most likely to benefit from the care available under austere field conditions. When combined with the START protocol, the SAVE triage is useful for any scenario where multiple patients experience a prolonged delay to definitive care ( Fig 5-1). The SAVE triage method divides patients into three categories: (1) those who will die regardless of how much care they receive, (2) those who will survive whether or not they receive care, and (3) those who will benefit significantly from austere field interventions.

FIG. 5-1. Medical disaster response modified simple triage and rapid treatment (START). There are three SAVE triage categories: unsalvageable, immediate care, and delayed care. (Used with permission, copyright Medical Disaster Response Inc., Dana Point, CA, 1990.)

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