Perform Casualty Triage
A familiarity with the principles of casualty triage will assist the Soldier medic in rendering vitally important emergency medical care to soldiers in a timely manner and will help reduce the number of soldiers who die of wounds.
(1) Survey and classify casualties for the most efficient use of available medical personnel and supplies
(2) Assures treatment is directed first towards the patients who have the best chance to survive
(3) Locate troops with minor wounds, and return them to duty
CAUTION: Triage establishes the order of treatment, NOT whether treatment is given, regardless of the injury. Triage is usually the responsibility of the senior medical person.
(1) Necessity to transport casualties to a more secure collection point for treatment
(2) Number and location of the injured
(3) Severity of injuries
(4) Assistance available - buddy-aid, self-aid, medical personnel
(5) Evacuation support capabilities and requirements (i.e., air ambulance, ground transportation)
(1) Not to be used as criteria for sorting
(2) Field experience with these injuries does not exist
(1) Immediate - patient whose condition demands immediate treatment to save life, limb, or eyesight. This category has the highest priority
(a) Airway obstruction
(b) Respiratory and cardiorespiratory distress from otherwise treatable injuries (for example, electrical shock, drowning, or chemical exposure)
(i) Cardiorespiratory distress may not be considered an immediate condition on the battlefield
(ii) It would be classified as expectant - this evaluation is contingent upon the mission, the battlefield situation, number of casualties, support, etc
(c) Massive external bleeding e.g., amputation
(d) Shock
(e) Burns of the face, neck, hands, feet, or perineum and genitalia
(f) After a casualty with a life/limb-threatening condition has been stabilized, no further treatment (nonlife/limb-threatening) will be given until other "immediate" casualties have been treated
(g) Salvage of life takes priority over salvage of limb
(2) Delayed - patients who have less risk of losing life or limb by treatment being delayed
(a) Open chest wound (without respiratory distress)
(b) Abdominal wounds (without shock)
(c) Eye injury (severe, without hope of saving eyesight)
(d) Other open wounds
(e) Fractures
(f) Second and third degree burns (not involving the face, hands, feet, genitalia, and perineum) covering 20 percent or more of total body surface area
(3) Minimal - "Walking wounded", can be self-aid or buddy-aid
(a) Minor lacerations
(b) Contusions
(c) Sprains and strains
(d) Minor combat stress problems
(e) Burns 1st or 2d degree under 20 percent of total body surface area and not involving critical areas such as hands, feet, face, genitalia, or perineum
(f) Patients in this category usually are NOT evacuated to a medical treatment facility
(4) Expectant - patient so critically injured that only complicated and prolonged treatment offers any hope of improving life expectancy. Category to be used only if resources are limited, if in doubt as to severity of injury, treat in categories above
(a) Massive head injury with signs of impending death
(b) Burns, mostly third degree, covering more than 85 percent of body surface area
(1) Immediate
(a) Presence of life-threatening conventional injuries
(b) No signs and symptoms of chemical agent poisoning
(2) Chemical immediate
(a) Presence of signs and symptoms of severe chemical agent poisoning
(b) No conventional injuries
(3) Delayed
(a) Presence of mild signs and symptoms of chemical agent poisoning
(b) Presence of conventional injuries that are not life-threatening
(4) Minimal
(a) Presence of minor conventional injuries
(b) No signs and symptoms of chemical agent poisoning
(5) Expectant
(a) Presence of both severe signs and symptoms of chemical agent poisoning and life-threatening conventional injuries
(b) No conventional injuries and not breathing due to chemical agent poisoning
(1) Generally, casualties whose condition(s) cannot be controlled and have the greatest opportunity for survival are placed in the urgent category
(2) Cardiorespiratory distress
(3) Shock not responding to IV therapy
(4) Prolonged unconsciousness
(5) Head injuries with signs of increasing ICP
(6) Burns covering 20% to 85% of total body surface area
(1) Decreased circulation in the extremities
(2) Open chest and/or abdominal wounds with decreased blood pressure
(3) Penetrating wounds
(4) Uncontrollable bleeding or open fractures with severe bleeding
(5) Severe facial injuries
(1) Closed-chest injuries, such as rib fractures without a flail segment or other injuries that interfere with respirations
(2) Brief periods of unconsciousness
(3) Soft tissue injuries and open or closed fractures
(4) Abdominal injuries with no decreased blood pressure
(5) Eye injuries that do not threaten eyesight
(6) Spinal injuries
(7) Burns on the hands, face, feet, genitalia or perineum even if under 20% of the total body surface area
(1) Burns covering 20% to 80% of the total body surface area if the casualty is receiving and responding o IV therapy
(2) Simple fractures
(3) Open wounds including chest injuries without respiratory distress
(4) Psychiatric cases
(5) Terminal cases
(1) Minor open wounds
(2) Sprains and strains
(3) Minor burns under 20% of total body surface area
NOTE: Instructor give example of b. to students
(1) Determine brevity codes
(a) A - urgent
(b) B - urgent surgical
(c) C - priority
(d) D - routine
(e) E - convenience
(2) If using two or more categories, insert the word "break" between codes
(1) Security of pickup site (wartime)
(a) N - no enemy troops in area
(b) P - possible enemy troops in area
(c) E - enemy troops in area, approach with caution
(d) X - enemy troops in area, armed escort required
(2) Number and type of wounded, injured, or illness (peace time). Give specific information regarding patient wounds by type (i.e., gunshot, auto accident, heart attack). Report serious bleeding along with patient blood type, if known
(1) NBC contamination, if any (wartime) - (N) nuclear, (B) biological, (C) chemical
(2) Terrain description (peacetime) include details of terrain features in and around proposed landing site. If possible, describe relationship of site to prominent terrain feature (i.e., lake, mountain, tower)
SUMMARY
A firm understanding of triage will help the medic maximize resources and reduce complications. In this lesson, we have identified steps in performing triage. Given this knowledge, the medic should be able to perform a triage in a given situation.