LEARNING OBJECTIVE: Recognize the protocols for a triage environment.
Triage, a French word meaning “to sort,” is the process of quickly assessing patients in a multiple-casualty incident and assigning patient a priority (or classification) for receiving treatment according to the severity of his illness or injuries. The person in charge is responsible for balancing the human lives at stake against the realities of the current situation, the level of medical stock on hand, and the realistic capabilities of medical personnel on the scene. Triage is a dynamic process, and a patient’s priority is subject to change as the situation progresses.
SORTING CASUALTIES FOR TREATMENT
The following discussion refers primarily to major accident and disaster locations where neither helicopter nor rapid land evacuation is readily available.
Immediately upon arrival, sort the casualties into groups in the order listed below.
Class I Patients whose injuries require minor professional treatment that can be done on an outpatient or ambulatory basis. These personnel can be returned to duty in a short period of time.
Class II Patients whose injuries require immediate life-sustaining measures or are of a moderate nature. Initially, they require a minimum amount of time, personnel, and supplies.
Class III Patients for whom definitive treatment can be delayed without jeopardy to life or loss of limb.
Class IV Patients whose wounds or injuries would require extensive treatment beyond the immediate medical capabilities. Treatment of these casualties would be to the detriment of others.
There are four basic classes (priorities) of injuries, and the order of treatment of each is different.
Priority I Patients with correctable life-threatening illnesses or injuries such as respiratory arrest or obstruction, open chest or abdomen wounds, femur fractures, or critical or complicated burns.
Priority II Patients with serious but non-life threatening illnesses or injuries such as moderate blood loss, open or multiple fractures (open increases priority), or eye injuries.
Priority III Patients with minor injuries such as soft tissue injuries, simple fractures, or minor to moderate burns.
Priority IV Patients who are dead or fatally injured. Fatal injuries include exposed brain matter, decapitation, and incineration.
As mentioned before, triage is an ongoing process. Depending on the treatment rendered, the amount of time elapsed, and the constitution of the casualty, you may have to reassign priorities. What may appear to be a minor wound on initial evaluation could develop into a case of profound shock. Or a casualty who required initial immediate treatment may be stabilized and downgraded to a delayed status.
SORTING FOR EVACUATION
During the Vietnam war, the techniques for helicopter medical evacuation (MEDEVAC) were so effective that most casualties could be evacuated to a major medical facility within minutes of their injury. This considerably lightened the load of the medical professionals in the field, since provision for long-term care before the evacuation was not normally required. However, rapid aeromedical response did not relieve the medical technician of the responsibility for giving the best emergency care within the field limitations to stabilize the victim before the helicopter arrived. Triage was seldom needed since most of the injured could be evacuated quickly.
New developments in warfare, along with changes in the theaters of deployment, indicate that the helicopter evacuation system may no longer be viable
in future front-line environments. If this becomes the case, longer ground chains of evacuation to the battalion aid station or division clearing station may be required. This will increase the need for life-stabilizing activities before each step in the chain and in transit. Evacuation triage will normally be used for personnel in the Class II and Class III treatment categories, based on the tactical situation and the nature of the injuries. Class IV casualties may have to receive treatment at the BAS level, and Class I personnel will be treated on the line.
Remember, triage is based on the concept of saving the maximum number of personnel possible. In some cases, a casualty may have the potential to survive, but to ensure that casualty's survival, the treatment necessary may require a great deal of time and supplies. As difficult as it may be, you may have to forsake this patient to preserve the time and supplies necessary to save others who have a greater potential for survival.