Thread by @SeanHarris999

A proud day at #TraumaCare22 where the ‘Ten Second Triage’ tool has been officially launched

Recommended as first line triage tool for all incidents

/1

TST is designed as a pan-emergency service early scene triage tool, actively confronting the challenges experienced by tools that have come before it (none of which were good enough)

Signed off for:
Amb & Military

Recommended for:
Police & Fire
(sign off likely imminent)

/2

TST rapidly filters walking patients

Especially relevant for initial responding police officers who are likely to control ‘walkers’ robustly

Training will include a caveat for those who are walking with critical injury - you there, sit down

/3

It does not rely on physiological measurements:

We know that such measurements are irrelevant in the emerging phase of an incident

Theory ≠ Real World

Try finding any alive casualty with a pulse below 100 or even 120 immediately post explosion or during a marauding attack

/4

Try reliably finding a pulse if you are an incredibly stressed police officer, firefighter or paramedic in ballistic/CBRN PPE

Try finding a first responder who legitimately & accurately quantifies resp rate in the immediate assessment of GSW victim

Me = Lots, some or none

/5

TST utilises a nuanced response check

Talking is proxy for adequate cerebral perfusion. In the world of AVPU it may feel non clinical but is useful across the spectrum of responders and is sensitive for critical injury

‘Talking’ also P1 safeguards children too young to talk

/6

It prioritises unconscious casualties and encourages immediate essential airway management.

TST is not prescriptive and is adaptable, allowing for local interpretation of ‘airway management’ for those who may carry additional airway adjuncts

/7

TST is designed to be pragmatic and is reflective of the gold standard, real world actions of any police officer or ambulance responder to the victim of a stabbing or gunshot

/8

I want a police officer to prioritise the victim who is on the floor

I want them to aggressively arrest external haemorrhage

I want them to assess a responsive casualty for central injury in order to report accurately, enabling appropriate enhanced care support

/9

I want a police officer to prioritise the victim who is on the floor

I want them to aggressively arrest external haemorrhage

I want them to recognise reduced levels of consciousness and intervene with airway management or resuscitation as required

/10

I use police officers in this example because if I’m bleeding to death, I don’t care who applies my tourniquet or packs my junctional injury

I also don’t care what brand of tourniquet or type of dressing

The measure of success is effective haemorrhage control

/11

This is what we want our initial responders to do for single patients… and under pressure it is what they’ll do for multiple

TST is a structure that can be overlaid on ‘real world’ high threat care and provide triage categories in order to aid what happens next

/12

TST is pragmatically based on real world actions rather than suggesting staff should measure physiology, actioning a complicated, unwieldy and rarely practiced system

On a bad day, we know people will revert to what they know (and what they know is right!)

/13

TST prioritises external haemorrhage

The primary cause of preventable death

/14

TST prioritises central penetrating injury

Neck, Chest, Back, Axilla, Abdomen, Groin, Buttocks

This is a new consideration

This is the injury pattern I lose sleep over as it’s the one we know we cannot effectively manage out of hospital

/15

If I’m bleeding to death from a non compressible injury I now do care about what uniform you are wearing!

The inclusion of ‘P1 - Central Injury’ is huge, it builds in a bias to action for these patients. The same group we aim for ‘minimum on-scene times’ for every other day

/16

TST allows for all responders to identify those not breathing, using an objective assessment of respiratory effort through an open airway

The following actions are scenario dependent

‘Dead’ is not the simple decision as perhaps we’ve trained it, almost enforcing futility

/17

The tactical scenario can change

The resourcing scenario can change

Traumatic Cardiac Arrest is not always futile

Impact Brain Apnoea should not be fatal

Resuscitation should occur where possible

Decisions regarding ‘death’ should be handled with appropriate gravity

/18

TST is an important cog in the mass casualty response machine

Policing has been historically focussed on threat confrontation

Healthcare has been historically delayed by threat mitigation

TST allows for concurrent, collaborative clinical activity

/19

TST allows any activity before formal healthcare to be truly meaningful

Priorities should always include enabling access, but there will be scenarios when this is impossible

TST provides structure for policing to start a casualty management plan compatible with formal NHS

/20

It prevents duplication of effort and allows healthcare resources to hit the ground running instead of starting from scratch, triaging patients that have been with the police for x amount of time already

What an opportunity for marginal gains!

/20.5

Casualty flow, or more importantly the lack thereof, has been a challenge in practically every mass casualty incident

Providing police officers a structure that can enable flow in scenarios where healthcare cannot access a scene is crucial

/21

If you can’t get health care in… get patients out

/22

The Ten Second Triage sieve looks to address many of the challenges presented by high threat mass casualty management

It’s pragmatic

It’s faster

It’s effective in the hands of police officers, ambulance staff and FRS

It’s sensitive where other systems have failed

/23

I’ve been very lucky to have been a part of the development of this tool, from initial concept, evolution through to final testing

Rolling out in Spring 23

Huge thanks and kudos to @ClairePark01, @NARU_org and @NHSEngland and all others involved

What started as a local idea for the streets of London gained traction far beyond what I thought possible

@ClairePark01 has led and driven the piece phenomenally

The team @NARU_org & @NHSEngland Phil Cowburn, Jamie Vassallo, Jason Smith and Dave Bull have given it wings

What started off as a scribble in a notebook in wintery wales a number of years ago has been developed by the team into something that I believe is capable of improving outcomes in mass cas incidents

Hearing Phil & Claire announce it in its current guise is a career highlight!

The enormity of the challenge to bring us to this point; the amalgamation of multiple other streams of work, including some alternative models across the country can’t be overlooked

I humbly applaud all of those involved who have made it happen

/end