The Mass Casualty Incident: Triage

[Jonas]

[Grumpy Grandpa]

Thanks Jonas. That's the most well worthwhile med doc I've read in a quite a while... Doing the exercise was really interesting - I got two wrong! (Gave them a better chance than they warranted. Better than the other way round, I suppose...)

[Grumpy Grandpa]

This really should be compulsory reading...

[Grumpy Grandpa]

I'd really like to pull this thread back into view, it's such a good one and didn't get too many views last time around. It's a wee bittie long I know but well worth the extra few minutes spent on it.

[Highlander]

The trouble is with long posts like these many people will never read them.

I think it has flaws in it,... take the guy who comes across the incident, according to this piece, he has to start triaging not treating,... how in reality does he do that, he is not medically trained, he will almost certainly not have pretty labels on his person

So he starts going amongst the casualties he will not be able to see most of the wounds,.. he cant leave `red` cases to continue with his triaging and leave a very badly injured casualty to die,..... basically the rescuer is in a mess

We did a certain amount of training for this kind of thing in the Army, albeit coming across an ambush situation,.. but in every case there were quiet a few men around to do the job,...and in the piece above that would have to be the case as well,... because just one or two people couldn't manage in the form that it is written down there

All an individual could hope to do, is to first access the risk of further damage being done,... if he thinks it safe enough he would move in,.. he would NEVER ask the casualties for help, he risks people moving about who shouldn't be moved, a person with a broken neck or back doesn't always know it until they move, and that often too late, many will be in shock and are likely to do very different things to what you have asked,..and even the ones who are able could kill casualties by doing the wrong thing

you would have to use your eyes, access each in this way,.. deal with heavy bleeding first, because that's the ONLY symptom that will appear clearly desperate

The piece above was either written for medical personal who come across a situation, or military personnel

[Grumpy Grandpa]

Accepted HL, maybe it is far from perfect, you're never going to be walking around with labels in your pocket just in case but if you have made at least some prior mental preparation (and that's where I think this piece is so valuable,) you will be better able to classify casualties in your mind, at the very least. If there's some way of marking them as well, so much the better.

I think the point of triage is that you have to assess all the casualties (even it means moving on from someone who needs immediate treatment,) so you can properly assess priorities. Maybe one or two people would have difficulty managing the situation but if that's all you have, you have to make the attempt. I think also that to triage effectively, you would have to try to close off emotion and for it to be most effective, it would have to be cold and maybe brutal. I don't think I'd hesitate to use walking wounded if I needed extra hands and in this case, you certainly would!

Tell you what though, it focused your thoughts on what you would do, didn't it?

[Highlander]

If you were on your own then you have assess everyone in a very quick way,.. the worst are likely to be easily noticed, as will many of the less injured ones,... I agree that getting help from able wounded is a great idea, but it for the rescuer to get certain walking wounded to help, rather that shouting `I need help` and having miss guided, [ more seriously injured] people trying to help and making matters worse

Try and place yourself, arriving into such turmoil as this scenario, the noise, the panic, the shock, the fire, dust, smoke, the screams, the badly injured lying everywhere, and the less injured running around trying to find friends, family or safety

The Belfast bus station bombing was what focused my mind to such things as this, two land rovers of us were the first into that place, so I have experience in this kind of situation, and I can tell you, it will never be as easy as that written piece seems to imply

[Grumpy Grandpa]

I certainly agree with you HL - the general call of " I need help", is likely to do more harm then good. I would think that directing walking wounded to specific tasks, would be much more effective.

I also bow to your experience at the bus station (my mobile patrol was ambushed at the back of it one night in '79, I think it was...). The nearest I have come to anything like your experience or to the scenario was an overturned mini-bus on an A road, which was messy enough but nowhere near the same scale.

Easy, it will never be and I tried to read the article with imagination, trying to put myself in the situation. I think that's the real value here - look at what we're doing now, discussing it - with mental preparation (and as much training as we can get!) we're much more likely to be of use than without it.

[Jonas]

The trouble is with long posts like these many people will never read them.

So basically you're saying that I shouldn't have posted this (actually 3 articles) because it's too long?

I think it has flaws in it,... take the guy who comes across the incident, according to this piece, he has to start triaging not treating,... how in reality does he do that, he is not medically trained, he will almost certainly not have pretty labels on his person.

The article was written by a physician and a registered nurse practioner, primarily for emergency medical personnel. I'm sure that there are at least a few of us on the board. And no, I don't carry triage tags in my med bag either!

So he starts going amongst the casualties he will not be able to see most of the wounds,.. he cant leave `red` cases to continue with his triaging and leave a very badly injured casualty to die,..... basically the rescuer is in a mess

No, he/she first calls 911 or 999 and concisely reports the situation. Then he/she, by verbal command, gets the "walking wounded" to stand up and move to a safer location - thus limiting the number of patients that have to be triaged. Unfortunately, in this situation, emergency medical personnel may very well have to "play God" and leave a very badly injured patient to die while using his/her skills and supplies to save more viable patients. If you're ever put in a situation where you have to make that call, I can promise you many sleepless nights, feelings of guilt, and a lot of second-guessing yourself. No, it's not pleasant.

We did a certain amount of training for this kind of thing in the Army, albeit coming across an ambush situation,.. but in every case there were quiet a few men around to do the job,...and in the piece above that would have to be the case as well,... because just one or two people couldn't manage in the form that it is written down there

But in a SHTF situation, one or two people may be all available, and if you re-read the article, you'll find that the goal is for one person (the first on the scene) to:
1. Call it in and report it
2. Get the "walking wounded" away from the immediate area, and
3. Triage all the remaining victims, spending approximately 30 seconds on each.

All an individual could hope to do, is to first access the risk of further damage being done,... if he thinks it safe enough he would move in,.. he would NEVER ask the casualties for help, he risks people moving about who shouldn't be moved, a person with a broken neck or back doesn't always know it until they move, and that often too late, many will be in shock and are likely to do very different things to what you have asked,..and even the ones who are able could kill casualties by doing the wrong thing

Reread the article... what is asked of casualties (and this is a mass-casualty event that is being described) is not beyond their capabilitiy, and possible cervical injuries are addressed.

you would have to use your eyes, access each in this way,.. deal with heavy bleeding first, because that's the ONLY symptom that will appear clearly desperate

Really? Heavy bleeding? Have you ever seen an accidental amputation where there is very little bleeding? To a trained EMT or Paramedic, MANY non-obvious symptoms will appear "clearly desperate", like a "blown" pupil. Others which may appear desperate to an untrained eye will be seen as non-life-threatening. Training pays!.

The piece above was either written for medical personal who come across a situation, or military personnel

Yes, and for preppers who are interested in learning and upgrading their medical skills too. I'm sorry tht you didn't find it useful.

[Highlander]

All very organized Jonas,........and yes I have seen people walking after losing limbs, but if the bleeding is not sever, then someone pumping blood is a more urgent casualty

I am not sure from your replies if you are agreeing with me or not,... I suppose not, but I know how I reacted in a situation like this, and I saw how everyone else did including the victims so I will stick to my replys

....and the Belfast bus station bombing was just this kind of situation, it was bad enough that our last job was to shovel body parts into black bags

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.... and of course you should post long items, I am only saying that many people dont read them if they are so long

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...and I did find the piece useful,..as I do almost any post, just because I am not in full agreement with it, doesn't imply I didn't find it interesting