Sighting Category
The division of patients into viewing categories is the result of the viewing (also called triage ) in the event of a mass attack of injured or sick people .
This categorization enables the planning and targeted use of the emergency medical resources that are necessary to cope with the operation. In this way, for example, rescue equipment is requested, subsequent emergency services are briefed quickly and care is structured (e.g. within a treatment center ).
The division into viewing categories takes into account the injury / illness as well as the resources available for treatment. This is a major difference to other scoring systems for medical classifications / prognoses of injuries or illnesses, which are more tailored to the individual needs of a patient.
Current system
The system used today is almost uniform worldwide, for some European countries ( Belgium , Germany , Greece , Great Britain , Austria , Switzerland , Hungary ) the detailed resolution of a consensus conference in 2002 (convened by the German Protection Commission at the Federal Ministry of the Interior ) applies :
| category | Patient condition | consequence | colour |
|---|---|---|---|
| T1, I. | acute, vital threat | Immediate treatment | red |
| T2, II | seriously injured / ill | Deferred urgency, surveillance | yellow |
| T3, III | slightly injured / ill | later (possibly outpatient) treatment | green |
| T4, IV | no chance of survival, dying | Caring (waiting) treatment, terminal care | blue |
Deaths are not recorded by this system, but marking with black color is common. Uninjured people are also not recorded by this system, they are registered by name by the care service .
This system adopts the essential elements of the military NATO standard (see below) and is compatible in terms of naming and coloring. However, there is a difference in the direct specification of the principal degrees of severity and in the more flexible assignment of the transport priority.
Classification
The classification into the inspection categories ( triage ) depends on the number of patients, the severity of the injuries and the available medical staff and can vary depending on the course of the mission.
If initially few resources are available, then life-threatening injuries that are not immediately classified into category III (delayed treatment) may initially be classified, even if they would normally require more intensive care from an individual medical point of view (e.g. an open bone fracture ). Patients who require a lot of time and help (e.g. resuscitation ) are classified in Category IV under these circumstances.
If more options are then available in the further course, these classifications are changed again. The division into viewing categories is therefore a dynamic process that is repeated several times and adapted to the current circumstances. The aim is to provide the best possible help for all patients with the resources available at the emergency site at the time.
Documentation / labeling
The viewing category is usually documented on an injured person's attachment card. However, an electronic system now exists. Documentation is usually in the form of a "T" (for triage ) and a number 1–4, in Roman numerals I-IV and / or as a color code.
With the color coding, the viewing category should also be printed in clear text (I-IV) for helpers with color ametropia and because of the difficulty in recognizing colors in unfavorable lighting conditions.
With regard to (radioactively) contaminated patients, the consensus conference proposes that they be additionally marked with a yellow triangle.
Transport priority
In the past, the viewing category was accompanied by a classification in the order of transport. According to this, patients in category T1 were transported preferentially, T2 delayed, T3 finally. This is no longer appropriate for a modern rescue service with a large number of different options, which is why today each category is assigned its own transport priorities a and b :
| Identifier | meaning |
|---|---|
| a | high transport priority |
| b | lower transport priority |
| no | Transport at the end |
The actual order of transport is then selected depending on the suitable rescue equipment available for the individual viewing category.
history
Pirogov's sighting principle (ca.1860)
The Russian military surgeon Nikolai Iwanowitsch Pirogow (1810–1881) developed graduated treatment methods and the principle of "dispersing the sick" (distributed treatment of the injured / sick) to order the overcrowded dressing stations with dividing the wounded into five from his experience in the Caucasian War and the Crimean War Stages:
| classification | meaning | consequence |
|---|---|---|
| 1 | Hopeless | left on site / with the troops |
| 2 | critically injured people who require immediate treatment | treat immediately |
| 3 | Wounded who also need urgent, only conservative-operative help | treat according to group 2 |
| 4th | Wounded who require immediate surgical help only because of harmful or uncomfortable transport | treat according to group 3 |
| 5 | all wounded in whom a simple covering bandage or an extraction of the superficial ball is carried out | left on site / with the troops |
This scheme is considered to be one of the first classifications that also take into account external circumstances (medical possibilities, transport), but was clearly aimed at war surgery. This scheme is of particular importance because it was also established internationally. In 1866 it was adopted by the Prussian army , and later also by the other medical services of allied armies. It was still in use in the First and partly also in the Second World War .
NATO standard (around 1950)
The classification of the North Atlantic Treaty Organization ( NATO ) is internationally known today, which specifies the following classification for the military medical system and the requirements of war medicine in the alliance countries:
| classification | meaning |
|---|---|
| T1 | Immediate treatment |
| T2 | Delayed treatment |
| T3 | Minimal treatment |
| T4 | expectant treatment |
It is noticeable here that the patient's condition is not included, only the urgency of the treatment. This makes it clear that the scheme is only used for quick on-site classification. The sifting helper / doctor must decide the urgency himself, taking into account the patient's condition and the possibilities of assistance, the scheme does not help him.
The colors were assigned for the first time as part of this NATO scheme and are still used today.
Classification according to Lent (1972)
| classification | meaning |
|---|---|
| seriously injured | decompensated disorder of vital functions |
| moderately injured | compensated disruption of vital functions |
| slightly injured | no disturbance of the vital functions |
The classification is strictly based on the impairment of vital functions. This scheme is intended for daily rescue service use and has been shown to be unsuitable for mass casualties of injured or sick people, as it does not take the circumstances into account and implies a treatment sequence only indirectly. However , it is still used today in individual medical emergencies .
BAND recommendation (1996)
In September 1996, the Federal Association of the Emergency Doctors Working Group in Germany (BAND) proposed the following classification specifically for the major emergency rescue incident in Germany :
| category | Patient condition | Urgency of treatment |
|---|---|---|
| 1 | vital threat | urgent immediate treatment |
| 2 | Seriously injured - initially not vitally threatened | monitoring |
| 3 | Slightly injured | Collective monitoring |
| 4th | dead | Registration, handover to the police |
This established a treatment sequence. In contrast, there was no “dying without a chance” in this scheme, which takes into account the fact that, according to BAND, this is an ethically extremely questionable classification, which should not be carried out in modern rescue services even with a higher number of injured persons . However, this setting is not compatible with the NATO standard and was used with the above. Consensus conference abandoned in 2002. A transport sequence is not included in this scheme.
literature
- UB Crespin, G. Neff (Ed.): Handbook of sighting . Stumpf & Kossendey, Edewecht 2000, ISBN 3-932750-20-9 .
- R. Kirchhoff (Ed.): Triage in the event of a disaster . primed-Fachbuch-Verlag, Erlangen 1984, ISBN 3-88429-115-7 .
- Peter Sefrin , Johann Wilhelm Weidringer, Wolfgang Weiss: Viewing categories and their documentation . In: Deutsches Ärzteblatt , 100, issue 31/32 (August 4, 2003), pp. A2058–2058, bundesaerztekammer.de .
Individual evidence
- ↑ Allgemeine Zeitung Rhein Main: The district of Germersheim is testing the RescueWave system from the Bad Kreuznach company Vomatec as a pilot project . Ed .: VRM GmbH & Co. KG. ( Allgemeine-zeitung.de [accessed June 1, 2017]).