I use the term field expedient triage because it needs to be differentiated from clinical triage. Triage in the field, whether it be in a disaster situation, in the wilderness, or a major car accident, is much different than clinical triage. Let me take a step back and define triage for you. Triage is the art, and I use the word art because science seems too rigorous for something that is so fluid and subjective, even though it is based entirely on science. Where was I? Oh yes, triage is the art of sorting mass casualties based on the severity of injuries, the likelihood of survival, and available resources. Field expedient triage is different because of the severe lack of resources. There is no supply chain, little or no equipment and few human resources. You must do what you can with what you have as best as you can.
Statistics indicate that rapid assessment and medical care can save as many as 40% of disaster victims that require medical assistance. That being said, the primary focus of field expedient triage is to provide the greatest good, to the greatest number, in the shortest amount of time. This will often put you at odds with yourself, and given enough time and exposure you will run into a situation where there is a victim that needs help that you must decide not to help. This is a challenge for all of us. Let me elaborate so as not to sound callous.
Here is the scenario: you come upon a group of people that were just overcome by a rockslide, there are multiple injuries, there are only two in your group, and you are 30 minutes from any help. It is chaotic, as all disasters are, you do a quick count and find that there are 8
victims. The rockslide is stable, so you do a quick triage. This means you can spend 30 seconds to a minute assessing each person, any more than that and someone might die. I will talk about how to triage later. So, you quickly determine that there are three broken legs, a crushed skull who’s not breathing, a dislocated shoulder, a large deep cut to the upper arm with arterial bleeding, and one trapped under a large boulder with rapid breathing and no radial pulse.
How do you prioritize these victims? In the field where resources are limited the three primary killers are airway obstruction, bleeding, and shock. Without immediate assistance, these will lead to death. Always remember that only one thing is guaranteed in life, change. No matter how you find your victims they will do one of two things, they will get better or they will get worse. Unfortunately, there is no guarantee that you can save everyone, in fact, the odds are often against it. You must be able to rapidly assess your victims based on these three killers.
If a victim presents any of the three killers they are RED or Immediate. If the injuries do not jeopardize the life of the victim they are YELLOW or Delayed. If you have victims that have only minor injuries but are still functional they are GREEN or Minor. If the victim has no respiration after two attempts to clear the airway they are BLACK or Expectant. And you would treat them in that order, RED, YELLOW, GREEN, and BLACK. How would you triage the victims based on the information given? Will you be able to deal with a situation that requires this kind of training?
Field Expedient Triage
Here is a general guideline for conducting triage:
- Step 1: Stop, Look, Listen, and Think  Before you start, stop, assess the situation, look around, and listen. Ask yourself, is it safe to help? Do I have the capability? What are my limitations? If you decide to help, make a plan and make sure your group knows what it is.
- Step 2: First things first, clean the green Do a voice triage, announce yourself and ask anyone that can hear you, to come to your voice. Hopefully, this will be most of them. This will immediately give you most of your greens and get them out of the way. Remember, this is about time. You can also use these survivors to assist you by having them do simple tasks.
- Step 3: Start where you are and follow a systematic pattern Start with the closet victim and work your way outward in a systematic pattern.
- Step 4: Evaluate each victim and tag them as quickly as you can Tag or label each victim according to the guidelines.
- Step 5: Treat RED or Immediate, immediately Clear their airway, stop the arterial bleeding, or treat for shock as needed. Remember, in field expedient triage we do NOT administer CPR, it is too resource intensive. We are trying to do the most good for the most people in the shortest time.
Note, this is NOT training, it is only a small little piece of insight into what you might need to know if you want to be prepared to assist those in need during a disaster. Everyone should seek professional instruction.
As Always,
Stay Vigilant and Be Prepared
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