Mass Evacuations: Using TRAIN Matrix to Triage Patients

This member-only article appears in the February issue of Patient Safety Monitor Journal.

By Brian Ward and A.J. Plunkett

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

Sharp HealthCare has been working with other community organizations as part of a healthcare coalition in the San Diego area to improve communication during emergencies like wildfires, which can necessitate quick evacuations.

Sharon Carlson, RN, director of emergency preparedness at Sharp HealthCare, has been working on a committee that is reviewing how evacuations are carried out in the community. She and others are using lessons learned during a massive fire in 2007 that forced several hospitals, nursing homes, and behavioral health hospitals in San Diego County to evacuate, as well as the Cedar Fire in 2003—and, of course, the devastating Camp Fire of last year.

While Sharp HealthCare facilities did not have to evacuate in 2007, they did have to take in patients from other facilities. And after the Cedar Fire, Sharp and other organizations realized that communications overall were a concern. “We needed to make some improvements,” Carlson says.

Today San Diego has a strong disaster coalition that meets once a month to share plans and best practices and look for ways to improve.

The coalition has two sub-committees that work on identifying best practices, including for evacuations. “Then we share those tools with all the other hospitals and healthcare entities to make sure that people are on the same page,” says Carlson.

The tools include using TRAIN as a way to identify “what kind of transportation your patient needs to be evacuated. For instance, if it’s someone in the ICU who has a ventilator to help them breathe and IVs and tubes coming everywhere, they aren’t going to be able to get out of bed and walk to a school bus to be evacuated,” she says.

Medical records integration
Developed by the Lucile Packard Children’s Hospital at Stanford in Palo Alto, California, the TRAIN 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.

“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.

According to Lucile Packard, the matrix allows a hospital 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,” according to the news center article. “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.

“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,” the article states. “In comparison, patients marked with blue tags are considered stable and can be transported in a car or bus, without any specialized equipment.”

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