- Product Details
- List of User Organisations
- Usage Advice & Notes
The system can be used to sieve and/or sort victims and to mark the scene; it identifies records, personal possessions, associated child/close relatives and even separated body parts using a unique number/barcode number strip with numbered wrist band.
It can also be used by Victims Bureau staff or police liaison officers at hospitals and/or temporary facilities/body stores. It provides a verifiable link between victim and possessions, which may have been bagged for forensic examination in the event of contamination, explosive incident or other actual or potentially criminal acts. Fire service staff will find it useful for decontamination incidents where victims need to be unclothed and decontaminated and their bag of clothing and other possession identified.
Contents in Cruciform® Casualty Triage System (Box of 25 Cards):
- A Triage Sieve guidance and casualty numbers card
- 25 expandable, amendable Cruciform® cards
- Cards are secured via elastic loop and contained in a liquid-proof, sealable bag
- Per card, a set of uniquely numbered/GS1 bar-coded stickers with wristband
- Other supporting documentation and pen
- Cruciform® is available in a number of major languages and is endorsed by clinical practitioners and major disaster specialists in the UK as well as France and Spain.
- It is used by a large number of hospitals for major incident response, and is highly regarded in pre-hospital emergency care.
- Cruciform® is ideal for decontamination problems, as it enables casualty and clothing to be linked for forensic purposes as well as for tracing rescuers and hospital staff who may have been exposed to a contaminant.
- Cruciform® will assist with clinical audit due to its carefully formulated contents and the unique GS1 numbering/barcode system.
- Police investigators and coroner's officers find the system enables them to improve both the accuracy and speed of their investigations and it can prove particularly beneficial in linking all rescuers who have been involved with a specific victim.
The Triage Sieve
Triage usually begins with a process known as "sieving" or sorting casualties and victims in a particular incident. The Cruciform Triage Sieve card provides an at-a-glance reminder of the process for juniors, medics and volunteers that may be unfamiliar with the process.
This simple guide allows the rescuer to quickly sieve multiple victims into a logical order of priority so that the right resources can be brought to the scene to deal with the various victim categories.
Triage Sieve (back)
The Triage Sieve is designed for initial sieving / sorting of victims, typically at the scene. The reverse of the sieve card allows for quick collation of victim numbers and for initial priorities to be assigned.
Victims are given a barcoded wristband, which has the same GS1 barcode number as those affixed to the back of the Triage Sieve, Cruciform® card and to all amendable pages.
The initially determined triage category can of course be changed to a higher or lower priority as the victim's condition alters. Subsequent changes in priority will be determined by a more careful / qualified examination, possibly using the trauma scoring system (RTS) contained in the Cruciform® card.
Each Triage Sieve is designed for 25 victims.
UK Organisations Using Cruciform® Cards
(Not an exhaustive list)
- Addenbrookes Hospital - Cambridge
- Altnagelvin Hospital - Londonderry
- Antrim Hospital - Antrim
- Barnet General Hospital - Barnet
- Belfast City Hospital - Belfast
- Bournemouth General Hospital - Bournemouth
- Bromley Hospital - Bromley
- Bronglais General Hospital - Aberyswyth
- Colchester General Hospital - Colchester
- Coleraine Hospital - Coleraine
- Craigavon Hospital – Portadown
- Countess of Chester Hospital - Chester
- Cumberland Infirmary - Carlisle
- Daisyhill Hospital – Newry
- Derriford Hospital – Plymouth
- Diana Princess of Wales Hospital - Grimsby
- District General Hospital - Southport
- Downe Hospital - Downpatrick
- Dundee Royal Infirmary - Dundee
- Erne Hospital – Enniskillen
- Frenchay Hospital - Bristol
- Frimley Park Hospital – Frimley
- Haslar Hospital (Royal Navy) - Gosport
- Hinchinbrooke Hospital - Huntingdon
- Homerton Hospital - London
- Hope Hospital - Salford
- James Paget Hospital - Great Yarmouth
- Llandough Hospital - Penarth
- Manchester Royal Infirmary - Manchester
- Mater Infirmorum Hospital – Belfast
- Medway Maritime Hospital - Gillingham
- Mid Ulster Hospital - Magherafelt
- Morriston Hospital - Swansea
- Newham General Hospital - London
- Ninewells Hospital - Dundee
- North Manchester General Hospital - Manchester
- Ormskirk and District General Hospital - Ormskirk
- Perth Royal Infirmary - Perth
- Peterborough District Hospital - Peterborough
- Portsmouth Hospitals NHS Trust – Portsmouth
- Prince Charles Hospital – Merthyr Tydfil
- Prince Philip Hospital - Llanelli
- Princess Royal Hospital - Telford
- Queen Alexandra Hospital – Cosham
- Queen Elizabeth the Queen Mother Hospital - Margate
- Rochdale Infirmary - Rochdale
- Royal Albert Edward Infirmary - Wigan
- Royal Bolton Hospital - Bolton
- Royal County Hospital - Brighton
- Royal Free Hospital - London
- Royal Hospitals NHS Trust - London
- Royal Oldham Hospital - Oldham
- Royal Lancaster Infirmary - Lancaster
- Royal Preston Hospital - Preston
- Royal Surrey County Hospital - Guilford
- Royal Victoria Hospital- Belfast
- Scarborough General Hospital – Scarborough
- Scunthorpe General Hospital - Scunthorpe
- St Mary's Hospital (Praed St) - London
- Southampton General Hospital - Southampton
- South Tyrone Hospital – Dungannon
- Southport and Formby District General Hospital - Southport
- Stepping Hill Hospital - Stockport
- Stracathro Hospital - Brechin
- Tameside General Hospital - Ashton-under-Lyne
- Trafford General Hospital - Manchester
- Tyrone County Hospital - Co Tyrone
- Ulster Hospital - Dundonald
- United Leeds Teaching Hospitals NHS Trust – Leeds
- Wansbeck General Hospital - Ashington
- West Wales General Hospital - Carmarthen
- Weymouth & District Hospital - Weymouth
- Whipps Cross Hospital – London
- Wirral Hospital - Upton
- Whiteabbey Hospital - Newtownabbey
- Great Western Ambulance Service NHS Trust
- Isle of Wight Healthcare NHS Trust
- Northern Ireland Ambulance Service HSS Trust
- North West Ambulance Service NHS Trust
- Scottish Ambulance Service – Tayside
- South Central Ambulance Service NHS Trust
- South East Coast Ambulance Service NHS Trust
- South Western Ambulance Service NHS Trust
- States of Jersey Ambulance Service
- Welsh Ambulance Services NHS Trust
- Yorkshire Ambulance Service NHS Trust
Immediate Care Doctor Schemes
- BASICS Doctors - Northern Ireland
- Hampshire, Berkshire and Surrey Immediate Care Scheme
- Kent Accident Rescue & Emergency Service (KARES)
- Mid Anglia General Practitioners Accident Service (MAGPAS)
- Mid Essex Doctors Immediate Care Scheme - (MEDICS)
- Norfolk Accident Rescue Service (NARS)
- Patterdale Mountain Rescue Association
- Perth and Kinross Immediate Medical Scheme (PAKIMS)
- Plymouth Immediate Medical Support (PLIMS)
- Rutland Accident Care Scheme (RACS)
- Scarborough Medics Accident Care Scheme
- South Manchester Accident Rescue Team (SMART)
- Sussex Immediate Medical Care Scheme (SIMCAS)
Oil Companies and Standby Boats
- Boston Putford Offshore - Lowestoft
- British Gas Plc - London (North and Irish Seas)
- BP Explorations - Aberdeen
- BP International Ltd - Sunbury on Thames
- Chevron (UK) Ltd - Aberdeen
- CONOCO (UK) Ltd - Aberdeen
- ELF Enterprise - Aberdeen
- Global Marine Drilling Co – Aberdeen
- Gulf Offshore N.S. Ltd - Aberdeen
- Hamilton Oil Ltd - Aberdeen
- Havila - Aberdeen
- Liberty Occupational Health - Aberdeen
- Maersk Shipping/ Offshore Drilling - Aberdeen
- Sea Lion Shipping - Aberdeen
- Shell (UK) Ltd - Aberdeen
- Tidewater Marine North Sea Ltd – Aberdeen
- Texaco - Aberdeen
- Unocal Britain Ltd - Aberdeen
- Viking Standby Ltd - Montrose
- Vector Seacore – Montrose
Armed Forces, Airports and others
- Airbus UK Limited – Bristol
- Astra-Zeneca Pharmaceuticals - Macclesfield
- Belfast International Airport Ltd - Belfast
- Bristol International Airport - Bristol
- British Aerospace – Preston
- British Army - Mahon Barracks, Middle Wallop Airport (AATC), Shackleton Barracks
- British Energy – Hinkley Point B
- British Nuclear Fuels - Sellafield
- British Strip Products Plc - Newport
- Ciba-Geigy Plastics - Duxford
- Ciba Specialty Chemicals – Manchester
- City of Derry Airport – Co. Derry
- Civil Aviation Authority - Gatwick Airport
- Condor Marine Services – Poole
- Cunard Line - Southampton
- Department of Health - States of Guernsey
- Eden Centre - Cornwall
- Emergency Services Project/Heartbeat Romania - East Sussex (UK Medical Aid Romania)
- Eurotunnel – Folkestone and Calais (French and English variants)
- Farnborough International Air show - SBAC Ltd London
- International SOS Assistance UK Ltd - London
- International Specialty Chemicals Ltd – Southampton
- Maersk Marine Services - Dover
- Manchester Airport - Manchester
- National Air Traffic Services Ltd - Southampton
- Orkney Islands Council and Health Board - Kirkwall, Orkney Islands
- P&O Cruises – Southampton & P&O European Ferries – Portsmouth
- Pfizer Ltd - Sandwich
- RAF - Aldergrove, Coningsby, Cottesmore, Fairford, Leuchars, Lyneham, St Mawgan, Valley and Wittering
- RN - Coulport, Culdrose, Heron, Portland, Raleigh, Yeovilton, HMS Illustrious
- RNLI – Falmouth
- SAS – Hereford, SBS - Poole
- Shetland Islands Council
- Tayside Health Board
- The Event Medicine Company Ltd - Aldershot
- UK Med - Stoke on Trent (UK Govt Medical Aid to Bosnia)
Organisations Outside the UK Using Cruciform® Cards
(Not an exhaustive list)
- Beaumont Hospital - Dublin, Republic of Ireland
- Groupe Hospitalier du Havre – Le Havre, France
- Hospital Geral de Santo Antonio, S.A,- Porto, Portugal
- James Connolly Memorial Hospital - Dublin, Republic of Ireland
- King Edward Memorial Hospital - Stanley, Falkland Islands
- Letterkenny General Hospital - Letterkenny, Republic of Ireland
- Mater Misericordiae Hospital - Dublin, Republic of Ireland
- St James Hospital - Dublin, Republic of Ireland
- St Vincent’s Hospital - Dublin, Republic of Ireland
- Sligo General Hospital - Sligo, Republic of Ireland
- University College Hospital - Galway, Republic of Ireland
- Eastern Health Board Ambulance Service - Republic of Ireland
- Elite Private Ambulance Service - Cork, Republic of Ireland
- Limerick Ambulance Service - Republic of Ireland
- Midland Health Board Ambulance Service - Republic of Ireland
- Mid Western Health Board Ambulance Service - Republic of Ireland
- North Eastern Health Board Ambulance Service - Republic of Ireland
- North Western Health Board Ambulance Service - Republic of Ireland
- South Eastern Health Board Ambulance Service - Republic of Ireland
- Southern Health Board Ambulance Service - Republic of Ireland
- Western Health Board Ambulance Service - Republic of Ireland
- British Gas Plc (Exploration and Production) - Caspian Sea, Kazakhstan, Tunisia
- Horizon Explorations - Falkland Islands
- Kuwait Oil Company – Ahmadi, Kuwait
- LNG PLUS - Eiffage International - Nigeria
- Nigeria LNG – Shell International Limited
- Qatar Petroleum – Qatar
- Premier Oil Myanmar - Union of Myanmar
- Schlumberger Drilling Services - UAE
- Shell Iran Offshore Ltd – UAE
- TotalFinaElf - Indonesia
- Unocal International Ltd – Indonesia, Singapore and Thailand
Armed Forces, Airports and others
- Aer Rianta – Shannon Airport – Republic of Ireland
- Belfast International Airport - Belfast
- British Antarctic Survey (research stations and ships) - Antarctica
- Brittany Ferries - Roscoff, France
- DFID Aid Management - Montserrat, West Indies
- Dublin Airport – Dublin, Republic of Ireland
- Geneva International Airport – Geneva, Switzerland
- Kerry Airport Plc - Farranfore, Republic of Ireland
- Malta International Airport - Malta
- Mount Pleasant Airport – Stanley, Falkland Islands
- National Fire Corps - Brazil
- Princess Cruises, Santa Clarita, California, USA.
The purpose of the "Cruciform"® Emergency Documentation System is to provide, in one box, a method of relaying information about the dead and injured, from the scene of an incident to the final destination. It can be used by any individual, rescuer organisation, or service involved in handling the victims, at the scene, during transportation or in hospital. The card can be used to sieve and/or to sort victims and to mark the scene, identify records, personal possessions, an associated child/close relative and even separated body parts. It is also usable by Victims Bureau staff or police liaison officers at hospitals and/or temporary facilities/body stores. It will provide a verifiable link between victim and possessions, which may have been bagged up for forensic examination in the event of contamination, explosive incident or other actual or potentially criminal acts. Fire service staff will find it useful for decontamination incidents where victims need to be unclothed and decontaminated and their bag of clothing and other possession identified.
The CBRN-E "Flags" will enable rescuers to "flag" up anyone who may have been contaminated by any of these agents so anyone dealing with that victim subsequently is made aware of a potential problem in treatment and/or handling.
The card is divided into several modules, and any one or any combination may be used for each victim, depending on the skill and training levels of the rescuers and the other circumstances prevailing at the time. The card is packed with the red panel showing so that the victims with the greatest perceived urgency for evacuation/transport or treatment can be identified and highlighted first. The Triage Sieve and Casualty Estimate document, also included in the box, can be used at a multiple victim incident to rapidly prioritise injured victims using medically valid assessment criteria. The colour/number module can also be used by the police or fire service personnel, to identify persons for evacuation to/from specified locations, even if uninjured or uncontaminated.
The box of cards should be kept available in a bulkhead locker, emergency box/case, patrol car boot or other convenient place. Boxes of cards kept in a locked store back at the base or other fixed location are of little use to the rescuer on scene. The cards should be used routinely. Routine use will ensure familiarity with the contents of each module and that, in the event of a larger scale incident, users are comfortable with the system.
The Cruciform® system should be introduced to colleagues in immediate care medical schemes, local authority emergency planning offices and other emergency services, including the military and air/sea/mountain rescue organisations. In that way, they too will understand how it works and how they could use or add to the information it contains. This joint use will enhance partnership working.
ACTION BY FIRST ATTENDER AT THE SCENE OF AN INCIDENT
ACTION BY FIRST ATTENDER AT THE SCENE OF A LARGER INCIDENT
Any incident where numbers of victims are high and which may be declared a Major Incident
Remember :- If there are no other rescuers or services present, the most important action is to provide the relevant control centre with information. First attenders/responders should not engage in rescue or life-saving activities until there are more rescuers on scene to assist.
Ignore the least injured and the dead at this stage (though they can be labelled if time permits.)
Do not waste time writing down anything on the card but apply the wrist band to link victims and card and take a numbered tag for your own records.
Utilise the Colour Module only. Writing information and/or making adjustments to priority colour can be undertaken later, when more rescuers are available.
It is important that the dead are labelled as early as possible, to prevent waste of medical time. As the scene is, forensically, a crime scene, the police may also wish to leave the dead in situ to take measurements or photographs, and a "dead" label will ensure that bodies are not unnecessarily disturbed. When the necessary information relating to the body has been filled in, the card can be sealed in its plastic sleeve. The police may also wish to use their own labelling system for the dead in addition to the Cruciform®.
Entering information on the card can be done without removing the card from the victims' neck. Push the plastic sleeve up and make whatever notes or alterations are necessary. Ensure that the sleeve is always replaced over the card to hold it together and protect it from inclement weather, blood, oil etc.
All persons involved with the victims may at a subsequent stage be called forward to give evidence, and it is vital that everyone is identified. This module gives a convenient place for that information to be written down. All persons have a legal obligation to HM Coroner (in the UK) to provide evidential continuity of the handling of a victim who dies, from its location at the incident through its recovery to the post mortem examination The unique number/bar code will also assist rescuers in identifying specific victims after the incident or to clarify which victim had gone to which destination.
Medical staff, offshore medics, nurses and paramedic ambulance or military staff will have no difficulty with this module, which will provide the receiving medical staff with a definitive and time based set of parameters specific to that victims' reaction to injury.
Seriously injured victims should have their trauma score checked on several occasions. TheTrauma Score Module allows this to be done on up to ten occasions. Ensure that the time each score was taken is recorded in the space provided.
After scoring the victims, the information gained may enable attention to be focused on those aspects of the victims' condition, which could be deteriorating. The information gained may lead to unsuspected injuries or suggest a change in the destination to which the victim should be transported. The control centre should be consulted regarding any changes recommended.
The Trauma Score Module can be used to record oxygen saturation, if the necessary equipment is available to measure it, as well as changes to pulse rates and pupil reaction.
If the Trauma Score Module is used up, seal the card and put another onto the victim to continue trauma scoring.
Victims scoring consistently at 3 or below are least likely to survive, regardless of the degree of medical intervention they receive. If choices have to be made on which victims are to be conveyed or treated first, preference may be given to injured victims scoring 4 - 12.
Victims scoring consistently at 3 or less may be classed as "expectant" and identified visually by folding the corners of the green/delayed page in to show red "flashes" underneath. This will differentiate them from victims who are classed as green/delayed because their injuries are comparatively minor.
The green/delayed panel can also be used as follows:
Fold the green page in to show white "flashes" - for victims considered dead by rescuers but who need confirmation of death by legally qualified personnel.
Fold the green page in to show yellow "flashes" - for those uninjured victims, who may be infested, infected or contaminated and could benefit from specialised transport. These victims’ plastic sleeve should also be “flagged” using the appropriate CBRN-E stickers.
Use the Additional Observations/Treatment given/Comments Module provided to document any additional information not catered for elsewhere, for example, known or suspected medical conditions, personal effects, suspected contaminant (plus action taken to alleviate) or next of kin etc.
The information contained can be utilised for subsequent treatment purposes, and the card itself could be the first entry into the victims' file. Naturally, the Trauma Score Module can also be utilised by hospital based medical and nursing staff, if desired and a number from the strip entered on hospital records to permanently link the Cruciform® card to the victim’s record.
The card should, in any event, be retained with the victims' file for subsequent analysis and continuity purposes and as a permanent legal record of injuries found, action taken and the names of persons involved in dealing with that victim before admission.
The card is identified with a unique sequential number strip with bar code, which should enable the movement of the victims to be logged through the various agencies and personnel involved and should provide the necessary verification and evidential continuity. The wrist-band will ensure that card, victim and possessions remain linked and will link rescuers to the victim, if required, so they could be traced for health screening if the victim was later discovered to be infected or contaminated.
The card modules can be scanned and the details transferred electronically to any relevant agency.
ACTION BY HOSPITAL BASED STAFF
The "Cruciform"® card is also ideal for the hospital environment, particularly if staff are faced with a major incident or, even worse, mass casualties.
The card should be immediately available at the ambulance entrance for the medical and nursing staff who may be engaged in triage at the door. By utilising the card, victims coming into the hospital can be rapidly sorted into categories for treatment in various areas, if they are not already identified by a Cruciform® card put on at the incident site by the police, ambulance service or hospital medical teams.
Hospital Triage teams can use the sieve card (inside every box of cards) to assign victims to various priority categories for treatment, then “tag” the victims with the Cruciform® card set to the appropriate colour. Triaged victims can then be sent to locations within the accident and emergency department or other locations set up for the incident, where treatment teams can start their more definitive treatments.
The numbered Casualty Details Module from the card can be sent to the police documentation team for their records. A tear off or adhesive number can be given to the paramedics or others who brought the victim in, if they have not already got a number. This way they can be traced if, subsequently, they might need health screening due to inadvertent exposure to some toxic or disease agent, or police or other officials can find them for any subsequent investigations.
Mass Casualty incident
In a mass casualty incident, a hospital might find itself inundated with large numbers of victims. (Over 5500 people sought medical help in the Tokyo Sarin attack – at least 4000 of which made their own way to medical help. Over 900 were seriously injured needing hospital admission.)
The ability to send people to other facilities, while tracking who went where, should prove invaluable and will help to keep the inevitable congestion manageable. Normal administration systems may become overwhelmed, but the less complex Cruciform® system will allow victims to be numbered and simple records made, in the short term, until more definitive records can be made a few hours further on, when staff and systems have geared up.
The permanent record made on the Cruciform® card will allow the health professionals to provide definitive information to a subsequent enquiry or hearing and will ensure that a legal challenge can be properly managed.