Thursday, April 10, 2014


There are some emergency medical articles in the works, so I thought I'd preface them with some posts that clarify terms and methods. Today’s word is “Triage”.

Triage is a method of deciding which victims of an incident get care (prioritizing care) when the number or type of injuries overwhelms a responder's abilities to help all of the victims. This may sound cruel or heartless, but when you're the only medically-trained responder at a ten car pile-up, you have to have some way of deciding who to help because you won't be able to help them all and trying to would only mean that none of them would get proper care.

The factors that determine when to start to triage an incident are:
  1. The number of victims - if the victims outnumber the people able to help, you should start prioritizing the victims.
  2. The severity of injuries to the victims - if the injuries are severe, you should begin triage
  3. The number of responders - see number 1 above. As more help arrives (you hope), things will get easier to handle.
  4. The training levels of the responders - a car load of physicians can handle more injuries than a car load of Boy Scouts.

The START system

Simple Triage And Rapid Treatment is the method that I was trained to use. It is one of a few slightly different triage systems in use, and the one I know best so I'll explain how it works. START was developed to give responders a quick way to prioritize treatment in a mass-casualty incident, and it breaks victims down into four color-coded categories.

  1. Green. The walking wounded, tag them “green” and move them out of the way to a safe area.
  2. Yellow. Delayed treatment. Injuries that are not life-threatening or don't require immediate aid.
  3. Red. Immediate treatment. Life-threatening injuries that you need to work on or transport to treatment right now.
  4. Black. Dead or Expected to die. Treatment has little to no chance of preventing death or victim is already dead and treatment would be pointless.

The color-coded categories are assigned by doing some very simple checks. Since I haven't figured out how to draw a flow chart, I'll just go through the steps.

  1. Are they ambulatory (walking under their own power)? Tag them Green and send them to a holding area. Make sure someone is at the holding area to keep them informed of the situation and monitor them.
  2. Are they breathing? If not, reposition the airway (like you would for CPR) and check again. If they start breathing, tag them Red. If they don't start breathing, tag them Black and move on to the next victim. If they were breathing on their own, check the rate of respiration - if they're breathing less than 10 or more than 30 times per minute tag them Red. If respiration is normal (10-30 times per minute) go to step 3.
  3. Check for pulse at the wrist or check capillary refill (squeeze a fingernail and see how fast the color comes back). If there is no pulse or the capillary refill (CR) takes more than 2 seconds, tag them Red. If they have a pulse or CR is less than 2 seconds, go to step 4.
  4. Mental status. Ask them to squeeze your hand or some other simple act. If they understand and obey, tag them Yellow. If they can't, tag them Red.

Triage is an on-going process. Once you have assigned a color to a victim, someone has to monitor the Green and Yellow tagged victims to watch for signs that their condition is getting worse. The Red tags should be treated or transported to treatment immediately, The Yellow tags next, and the Green tags last. The Black tags are sadly not going anywhere until everyone else has been taken care of.

As a side note, triage can also be applied to other situations in life. If you're evaluating anything that is in trouble you can create a triage system for it. Keep it quick and simple and learn to make decisions quickly and decisively. Being wishy-washy and not wanting to commit to any action is not a good way to prepare for anything.

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