START triage

[certguy]

I heard recently that START was changing the circulatory protocal from checking cap refill to checking whether the radial pulse was present . I haven't heard anything officially , has anybody else ? Present protocol as I was trained ; resp. over 30 , red tag , cap refill greater than 2 sec. , red tag , inability to follow basic commands ( squeeze my hands ) red tag . Resp. under 10 also used to be included as red tag criteria , but isn't covered in our training DVD . Is this still included ?

[stcommodore]

What happend to simple

Respirations (yes.no)

Pulse (yes/no)

Mentation

....move to next patient

[AnthonyM83]

I never understood the cap refill criteria seeing as it's hard to get a good cap refill on so many adult patients even with good circulation. I guess the idea is not wasting time on finding or not finding a pulse....but that really leaves out a lot of the older population. It should be CapRefillorPulse...it only takes a half second to decide which to use when you see the patient's nails.

[Chief1C]

(Initial)

Walking > P3

Breathing > Yes > Resp. Rate 10-30 > Yes > CapRefill <2 > Yes > P2

Breathing > No > Open Airway > Yes > P1

Breathing > No > Open Airway > No > Dead

CapRefill > <2 > Yes > P2

CapRefill > <2 > No > Pulse 70-140 > Yes > P2

CapRefill > >2 > Yes > Pulse <70-140> > P1

Just in case... (<) Less Than, (>) Greater Than.

[certguy]

Anthony brought up a good point about cap refill . this is only thought to be reliable in infants and kids now . I like checking the pulse better , but I'm trying to find something in writing to show our training officer to get it changed . I want to give my students up to date info . Our training officer and coordinator are both ex - paramedics very set in thier ways in old protocals .

[Dustdevil]

Google is your friend. The first several links that come up when you search "start triage" all include a pulse check as an alternative to the cap refill. They are all reputable sites that you can refer your dimwitted training officer and coordinator to.

It's been that way as long as I can remember, and I seriously doubt they have been around any longer than me.

Good for you for standing up to the status quo. It's inexcusable that a training officer would be so out of touch. I'm betting there are a lot of other things your fearless leaders are seriously misinformed about, so take their guidance with a grain of salt.

[AnthonyM83]

I like checking the pulse better , but I'm trying to find something in writing to show our training officer to get it changed . I want to give my students up to date info . Our training officer and coordinator are both ex - paramedics very set in thier ways in old protocals .

Check to see if they have the kinds of nails that would show cap refill, if not, go up to them, press on a fingernail, and say "over two seconds" and hand them a black tag, walk alway.

[medicmole]

Or just check the radial pule and forget about cap refill.

Start - Triage

[AnthonyM83]

PS My post was in regards to his paramedic administrators to prove a point to them, not actual patients.

[certguy]

Thanks for the info guys . By the way , Anthony , where do you work ? I worked a total of 7 years for Schaefer in San Diego . Found myself at the main in LA on long distance transfers a few times .