Triage, mass casualty management

Triage is an intial assessment and sorting of casualties based on medical need and likely response to treatment.

In a multiple-casualty situation, triage is essential to effectively sort casualties and prioritise their order of treatment to ensure that the greatest good can be done for as many casualties as possible. Its not fun and can be traumatic but is needed to save as mant people as possible.

mass-casualty-mockupsThe principles of assessment can be used to determine the degree of urgency in the management of most casualties. Triage should be prioritised over treatment and only the following procedures should be carried out while assessing casualties:

  • ensure that the airway is open
  • control major bleeding

Triage is essential for managing multiple casualty events as it:

  • prioritises treatment to use available resources as efficiently as possible
  • ensures that care is focused on those casualties most likely to benefit from the limited resources available
  • provides a framework for difficult and stressful life-and-death decisions creates order in a chaotic environment

Triage is initially performed to assess and apply priority in 30 to 60 seconds per casualty.

Triage must be:

  1. dynamic – effective, changing based on initial and following assessments and response to treatment
  2. safe – and evidence based
  3. fast

Triage methods

There are a variety of triage systems in operation across the world, we will use a simple method.

  1. Is the casualty breathing? (clear airway whilst checking)
  2. Is there major bleeding?
  3. Are they responsive? (answer commands, blink, etc)

Casualties are then attributed to one of the following four categories:

Immediate (red tag): casualties with life threatening but treatable injuries requiring immediate medical attention are assigned a red tag. These casualties are the first to be transported to hospital when medical help arrives, apply first aid once all casualties have been triaged.

Urgent (orange or yellow tag): casualties with serious injuries, but able to wait a short time for treatment are assigned an orange tag. Encouage the casualty to apply personal first aid if possible until help can be given.

Delayed (green tag): casualties who can wait hours to days for treatment are assigned a green tag. These casualties can be separated from the more seriously injured by asking for casualties able to walk (i.e. ‘minor’ casualties) to congregate in a specified area. Encourage them to help each other or help the more injured if possible.

Dead (white or black tag): casualties who are dead or not expected to live because of the severity of their injuries and the limited resources available. These casualties are assigned either a white or black tag. If alive ask a green tag casualty to provide comfort/support to the casualty.


About the author: James Richards

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