Emergency Medicine Book

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SALT Triage

Aka: SALT Triage, SALT Mass Casualty Triage Algorithm
  1. See Also
    1. Trauma Team Activation (TTA)
    2. Trauma Primary Survey
    3. Trauma Secondary Survey
    4. Pediatric Trauma
    5. ABC Management (Cardiopulmonary Resuscitation)
    6. Emergency Procedure
    7. Trauma Center
    8. Mass Casualty Incident
    9. Trauma Triage in the Field
    10. JumpSTART Pediatric Multiple Casualty Incident Triage
    11. Simple Triage and Rapid Treatment (START Triage)
    12. Decontamination
    13. Contaminated Casualty Management
    14. Decontamination in Children
    15. Chemical Weapon
    16. Biological Weapon (Bioterrorism)
    17. Biological Neurotoxin
    18. Toxin Antidotes
    19. Violence in the Hospital
  2. Indications
    1. Mass Casualty Incident (MCI) triage method
  3. Background
    1. SALT is an acronym for Sort, Assess, Lifesaving interventions, and Treatment/Transport
    2. Alternative to START Triage protocol for general MCI victim triage
      1. Livesaving interventions are administered before assigning a severity category
    3. Pediatric patients are best triaged with the JumpSTART Triage protocol
  4. Categories: Triage
    1. Minor (Green)
      1. Delayed care (may be delayed up to 3 hours)
      2. Avoid letting these patients overwhelm resources before arrival of the more seriously injured patients
      3. Examples
        1. Lacerations or abrasions
        2. Minor Fractures or burns
    2. Delayed (Yellow)
      1. Urgent care (may be delayed up to 1 hour)
      2. Injuries requiring less immediate intervention
      3. May start Intravenous Fluids or antibiotics while awaiting definitive management
    3. Immediate (Red)
      1. Immediate care for life threatening injuries
      2. Examples
        1. Airway obstruction
        2. Tension Pneumothorax
        3. Uncontrolled Hemorrhage
        4. Major injury to the head, neck, or torso
    4. Expectant (Gray)
      1. Patient is mortally wounded and is not expected to survive without significant resources
      2. Critical Vital Signs not responding to initial measures
      3. As resources change, Resuscitation or palliative measures may be considered
      4. May attempt early maneuvers that may change status (e.g. airway repositioning)
    5. Deceased (Black)
      1. Patient has died and no further Resuscitation needed
  5. Procedures: Lifesaving interventions to consider at individual assessments
    1. See Field Trauma Assessment and Treatment (MARCH Field Trauma Protocol)
    2. Control major Hemorrhage
      1. See Massive Hemorrhage
    3. Open airway
    4. Consider 2 rescue breaths in children
    5. Chest decompression (Tension Pneumothorax)
    6. Auto-injector antidotes
  6. Evaluation
    1. Step 1: Global Sorting
      1. Still or obvious life threatening injury (assess first)
      2. Wave or make other purposeful movement (assess second)
      3. Walking (assess third)
    2. Step 2: Assess individuals
      1. See lifesaving interventions listed above
      2. Assess Breathing
        1. Open airway
        2. Consider two rescue breaths in children
        3. Triage to Deceased if not breathing
      3. Assess for life threatening injuries
        1. Criteria
          1. Obeys commands or makes purposeful movements
          2. Has peripheral pulse
          3. Not in respiratory distress
          4. Major Hemorrhage controlled
        2. Indications to triage to Minimal
          1. All criteria above are present and only minor injuries identified
        3. Indications to triage to Delayed
          1. All criteria above are present, but significant injuries are identified
        4. Indications to triage to Immediate
          1. At least one of criteria is NOT met AND
          2. Victim is likely to survive given available resources
        5. Indications to triage to Expectant
          1. At least one of criteria is NOT met AND
          2. Victim is not likely to survive given available resources
  7. Resources
    1. DHS REMM SALT Triage
      1. http://www.remm.nlm.gov/salttriage.htm
  8. References
    1. Seeyave and Bradin (2014) Crit Dec Emerg Med 28(12): 2-13
    2. Lerner (2011) Disaster Med Public Health Prep 5(2):129-37 [PubMed]

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