Understanding Emergency Triage During a Multiple Casualty Incident

People who work as health care providers, particularly emergency medical technicians (EMTs), paramedics, and police officers and firefighters who are also EMTs or paramedics, are among the first responders to multiple casualty incidents (MCIs) such as September 11th. It's a good idea for everyone to at least have an idea of how emergency medical care is rendered in such events because they or their friends or loved ones might be among the victims who must be handled according to emergency triage guidelines.

The Purpose of a Triage System

The word triage comes from a French word meaning to sort and an emergency triage system is designed to sort the victims of a multiple casualty incident in order to provide medical care in an orderly fashion as quickly as possible. While this might sound at first like a system that ensures everyone gets the best care they need to survive, it's not quite that simple because of the demands placed on the medics responsible for providing care. Such an incident can be extremely disturbing because a fundamental concept of an emergency medical triage says that spending a lot of time attempting to save just one life might interfere with numerous other patients getting the care they need. I have no criticism against the triage guidelines, however, there are some very unnerving instructions that must be followed. Victims of a multiple casualty incident are sorted into four categories according to priority for treatment: red (priority 1), yellow (priority 2), green (priority 3), and black (priority 4 or 0). Victims who are tagged red are in the category for the highest priority for treatment, yellow is next followed by green. Finally, the black or priority zero group of victims might not receive any medical treatment at all--at least not in time to survive. The most common method for prioritizing victims of an MCI in the United States is the START system which stands for Simple Triage and Rapid Treatment.

Medics who respond to the scene are required to spend preferably no more than 30 seconds to assess a patient's priority for receiving medical care. To go into detail regarding these triage guidelines is beyond this article; however, there is one that deserves to be mentioned as it's the most disturbing. A victim's respiration or breathing status is assessed first. Basically, if he isn't breathing at all, the only care he's given initially involves the medic attempting to open his airway usually by simple repositioning. If spontaneous respiration (breathing on his own) isn't restored, he's tagged as priority 0 or 4 meaning he won't receive any further treatment at the moment because the rescuer must move on to other victims until all have been assessed. There's a secondary triage that follows the initial one, but depending on the magnitude of the MCI, victims tagged as priority 0 or 4 have practically no chance of survival. The reason for this is that when they were first assessed and found to not be breathing, they didn't receive cardiopulmonary resuscitation (CPR) because of the time it requires to be performed. They might have had a chance to be resuscitated, but were not given that chance by the medic who must comply with triage guidelines designed to handle MCIs.

Source:

My EMT training.