Evacuation, Triage & Handover

Overview

In multi‑patient or remote incidents, sort first, lifesave fast, prevent hypothermia, and move safely. Use simple triage models (START/SALT), package patients to protect airway/spine and warmth, and give structured handoffs (MIST/SAMPLE) with times.

START

Simple triage to prioritize care in multi‑patient incidents.

• RPM: Respirations, Perfusion, Mental status.
• Respirations: Not breathing → open airway; if still not breathing, tag Black (deceased/expectant). Breathing >30/min → Red (immediate).
• Perfusion: Cap refill >2 s or no radial pulse → Red.
• Mental status: Cannot follow commands → Red; can follow → Yellow (delayed) if not Red; walking wounded → Green (minor).

SALT

Structured approach from initial sort to transport.

• Sort: Identify those who can/will walk (Green), wave (Yellow), and still (possible Red/Black).
• Assess: Quick look for life‑threats.
• Lifesaving interventions: Control major bleed, open airway, chest seals, recovery position.
• Treatment/Transport: Assign priority based on condition and resources.

Packaging Patients

Protect the patient during movement.

• Spinal considerations: Inline stabilization if mechanism suggests; minimize movement.
• Litter: Use commercial or improvised (poles + tarp/blankets). Practice before you need it.
• Hypothermia: Wrap in insulating layers and a wind/water barrier (hypo wrap/bivy); insulate from ground.
• Monitor: Reassess vitals en route; secure dressings and splints.

Handoff Information

Give a concise, structured report to higher care.

• MIST: Mechanism of injury/illness, Injuries found, Signs (vitals), Treatments given.
• SAMPLE: Symptoms, Allergies, Medications, Past history, Last intake, Events.
• Times: Onset, treatment times (tourniquet application, medications), last vitals.

☑️ Checklist — Evac/Triage/Handover

• Triage tags or clear prioritization (Red/Yellow/Green/Black)
• Immediate lifesaving interventions done (bleeding, airway, chest)
• Hypothermia prevention in place
• Safe packaging for transport; monitor en route
• Handoff uses MIST + SAMPLE; times documented

Examples

• Multi‑bike crash: Direct pressure/TQ on severe bleed; START triage assigns Red/Yellow/Green; call EMS; MIST handoff with TQ time, vitals trends.
• Remote ankle fracture: Splint and hypo wrap; slow carry with frequent checks; handoff with mechanism, neuro checks before/after splint, pain course.

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Common Mistakes

• Jumping into detailed treatment before triage; misallocating scarce time and resources.
• Omitting hypothermia prevention during packaging and transport.
• Excessive patient movement without indications for spinal protection or stabilization.
• Poor documentation and handoffs (missing times, treatments, vitals trends).
• Failing to reassess and update triage as conditions and resources change.

Key Takeaways

• Triage fast and fairly; lifesaving interventions come before detailed treatment.
• Prevent hypothermia and secure packaging; reassess continuously during movement.
• Deliver structured handoffs (MIST/SAMPLE) with times to speed higher care.

Scenario

🧭 Scenario (Multi‑car collision): Three patients, varied injuries.
🔍 Decisions: START vs jumping to treatment; who is Red/Yellow/Green; what to tell EMS.
✅ Outcome: You START triage quickly, control a Red bleed, hypo‑wrap, and deliver a MIST report with times.
🧠 Lessons: Sort fast, lifesave first, then transport
🏋️ Drill: Practice START with friends in 3 minutes.