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Use TRAIN matrix to triage patients in mass evacuation

Hospital Safety Insider, December 6, 2018

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Modify the Triage by Resource Allocation for IN-patient (TRAIN) matrix to suit your facility’s needs in case of a mass evacuation.

Developed by the Lucile Packard Children’s Hospital at Stanford in Palo Alto, California, the matrix is combined with the hospital’s electronic medical records system to allow quick assessment of patients and the types of transportation needed to evacuate them to safety. The matrix is also available in PDF form online (see Resources).

“Caregivers have prompt access to a fully automated report that categorizes patients in terms of their specific needs, such as what types of intravenous medication they receive, whether they’re on ventilators or whether they need an intensive care unit bed,” according to the Stanford Medicine News Center in announcing the program in 2015.

Hospitals across California and other areas, including the Sharp Healthcare system in San Diego, have modified the matrix for use as part of their all-hazards preparation for emergencies, including wildfires.

According to a toolkit by Lucile Packard, the matrix allows a hospital to:

Be able to quickly assess and accurately request the right resources from the emergency operations center.

Streamline communication with a common code.
Implement a standardized and automated inpatient hospital evacuation triage system with minimal impact to workflow.
Increase awareness and disaster preparedness across the institution.
System is color-coded

“TRAIN helps determine what vehicles and equipment are necessary for continuous patient care during a crisis event and simplifies communicating patients’ needs to other hospitals or command centers coordinating transfers. For instance, TRAIN helps the hospital decide whether cars or vans are needed, how many ambulances or specialty transports are required and even how many IVs and ICU beds should be in place at the receiving facility,” according to the news center article.

“Under TRAIN, patients are assigned a color, with red designated for patients in critical condition. These patients need specialized transport, such as an ambulance or military vehicle, in addition to life-support equipment, such as ventilators and multiple intravenous drips for medication. TRAIN allows care teams to communicate the medical needs of this patient, as well as the severity of his or her condition, with a single word: red,” according to the news center. “In comparison, patients marked with blue tags are considered stable and can be transported in a car or bus, without any specialized equipment.”

The toolkit is available through HHS Assistant Secretary for Preparedness and Response’ Technical Resources, Assistance Center, and Information Exchange (ASPR-TRACIE) collection of evidence- and experience-based resources for emergency management. It is part of the Healthcare Facility Evacuation/Sheltering collection of resources.

Resources

• Preplanning Disaster Triage for Pediatric Hospitals: TRAIN TOOLKIT: https://asprtracie.hhs.gov/technical-resources/resource/1875/preplanning-disaster-triage-for-pediatric-hospitals-train-toolkit
• HHS’ ASPR-TRACIE evacuation resources: https://asprtracie.hhs.gov/technical-resources/57/healthcare-facility-evacuation-sheltering/56
• Stanford Medicine News Center, “New system aims to simplify patient transfers in emergency:” https://med.stanford.edu/news/all-news/2015/03/new-system-aims-to-simplify-patient-transfers-in-emergency.html

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