Managing the Scene (2 of 2) --

Remember this simple formula to guide your START assessment. RPM stands for 

RESPIRATION
PERFUSION
MENTAL STATUS

Sequentially use this assessment system for every patient.

Entering the scene
As always, make sure the scene is safe for you to enter. If it is not, wait until it has be made safe.

Next, ask those who are not injured or who have only minor injuries to identify themselves. Tag those with minor injuries as MINOR. 

Ask several uninjured victims to stay close to assist you, direct the others to a designated spot away from the immediate scene to wait for additional personnel.

Respiration
First, determine if the patient is breathing. If yes, immediately check the respiration rate.

_____ VIDEO _____
(Microsoft Windows Media Player needed.)
Click here to download.
[START triage rescuer quickly checks respirations to determine if they are too fast.]

If not, reposition the patient. If the patient does not start breathing spontaneously, DO NOT start CPR. 

Move on to the next victim.

(Not starting CPR may be the hardest thing you must do at a multiple casualty scene. But if you perform CPR on one patient, many others may die.)

C-spine injury
You will have to position the airway without manually stabilizing the cervical spine. This is counter to what you have been taught and may result in worsening a cervical spine injury. But if you don’t reposition the victim immediately, the person will die in the field. You won’t have the personnel to carefully stabilize the C-spine and you can’t afford to let other victims die while you take time to do it yourself. 

If the patient begins breathing spontaneously after repositioning, tag the person IMMEDIATE and move on. If necessary, ask an uninjured victim to help maintain the open-airway position.

If the victim is breathing when you approach, but has a respiratory rate of more than 30, tag IMMEDIATE and move on. Don’t take time to formally count the respirations. If the rate seems too fast, tag the victim IMMEDIATE and move on.

Perfusion
If you can feel a radial pulse, move on to the Mental Status assessment.

_____ VIDEO _____
(Microsoft Windows Media Player needed.)
Click here to download.
[START triage rescuer quickly checks perfusion status.]

If you can’t feel it, tag the patient IMMEDIATE, have an uninjured victim put direct pressure on any visible, serious bleeding and move on to the next patient.

Next check for capillary refill. If capillary refill is more than 2 seconds, tag the patient IMMEDIATE, have an uninjured victim put direct pressure on any visible, serious bleeding and move on to the next patient.   

If capillary refill is less than 2 seconds, move to MENTAL STATUS.

Mental Status
If the victim is unconscious or can’t follow simple commands, tag them IMMEDIATE and move on to the next victim.

_____ VIDEO _____
(Microsoft Windows Media Player needed.)
Click here to download.
[START triage rescuer quickly checks mental status.]

If the victim can follow simple commands, tag them DELAYED and move on to the next victim.