Question: I am a recent graduate and have a question regarding the traumatic VSA protocol. We arrive on scene to find 5 patients. Two are VSA and three are CTAS 2. The next ambulance is 5 min away. We use triage but after the three CTAS 2 patients are gone what do we do with the 2 VSA patients? Are we to do a Trauma TOR? Or is it just left at that point?

 Thanks for the question. This exact scenario was actually the focus of a live rounds discussion on MCI patient management last year. The power point and Webinar can be found on our website here under MCI Jan 2011: www.lhsc.on.ca/About_Us/Base_Hospital_Program/Education/archived_rounds.htm

What we would suggest is to first consider your triage scheme. In mass casualty triage, your resources are overwhelmed (5 patients and one paramedic crew). In this circumstance and triage mode, your care must be directed to the most injured patients who have the highest chance of survival (not the VSA patients initially). Once however more crews arrive, your resources will no longer be overwhelmed and you should now revert back to multiple casualty triage where your care is now directed to the patients who are most unwell.

In the scenario you describe, this would now mean that (once you have adequate resources) you attend to the patients who are VSA assuming that they do not meet the criteria for obviously dead. These patients require assessment regardless as they have not been pronounced, and the trauma TOR would most likely be the result. The alternative would be to leave two patients VSA on scene who have had no medical assessment or pronouncement and this would not seem reasonable.

Cardiac/Circulation,MCI,Miscellaneous,Trauma Cardiac Arrest

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