Control measure – Carry out triage

Control Measure Knowledge

The core principle of triage is to provide a systematic review of multiple casualties, where demand exceeds available resources. The initial triage method for a multiple casualty situation is the Ten Second Triage (TST) tool. The TST tool can be used by all first responders, including fire and rescue service personnel,  police officers.

At the point when it has been identified that multiple casualties will require treatment, the fire control room should be notified so that the required resources can be mobilised. It may be appropriate to declare a major incident using the JESIP M/ETHANE model.

Fire and rescue services should provide operational personnel with information and equipment to enable them to apply the TST tool if there are multiple casualties.

Ten Second Triage

The TST tool is designed to be quick, simple and effective at prioritising large numbers of casualties. There should be a focus on immediately providing life-saving interventions (LSI), to maximise the survival of casualties in the early stages of injury.

The interventions include:

  • Control of severe bleeding, using pressure, tourniquets or packing
  • Opening the casualty’s airway
  • Placing the casualty in the recovery position
  • Providing cardiopulmonary resuscitation (CPR) if resources allow

While principally designed for events where casualty numbers far outweigh the availability of responders, the TST tool is equally effective at any multiple casualty event.

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Casualty labelling following triage

Simple labelling to indicate the priority of the casualty should be used as part of the TST process. The label should clearly indicate their assigned priority to other first responders to avoid duplication of effort, and ensures casualties are dealt with in the order of priority.

The labels used for TST should incorporate a checked border to distinguish them from the NHS Major Incident Triage Tool (MITT) labels, which use a solid colour. Further information about the specification of labels, including size, design, colour and font, is provided on the NHS England website.

TST priority of casualty Colour of label Description
1 – Immediate Red Requires lifesaving treatment immediately and has time critical life-threatening injuries
2 – Urgent Yellow Requires significant intervention as soon as possible

Injured or unwell and are unable to walk

3 – Delayed Green Requires medical intervention but not with any urgency

Can walk to treatment

Not breathing Silver Breathing not detected

Gather and share information about casualties

Keeping a log or tally chart of the number and priorities of casualties who have been triaged can assist in the allocation of resources. This information can support the communication between emergency responders, at the scene of the incident and in control rooms.

Discretion should be used when sharing information about casualties, in case people such as relatives, friends, members of the public or the media could overhear sensitive details.

NHS Major Incident Triage Tool

Following initial triage using the TST, the ambulance service will determine if NHS clinicians will be required to use the Major Incident Triage Tool (MITT). The NHS Major Incident Triage Tool (MITT) is only to be used by NHS clinicians. They will also use black casualty labels for deceased casualties.

Further information about using the MITT is provided on the NHS England website

Strategic Actions

Tactical Actions