Triage

History

Triage—medical triage in disaster situations—is the process of deciding how seriously ill/sick or injured a person is, so that the most serious cases can be treated first. The term comes from the French verb trier, imposed by Dominique Jean, Baron Larrey (1766–1842), a military surgeon under Napoleon (who also described in his work things such as the type of hip amputations needed in situations of war, the condition known as trench foot, and the term stretcher-bearer).

British surgeon John Wilson proposed in 1846 using different types of treatments to be consistent with the chance of survival, thus inspiring categories of treatments on levels of triage. Military medicine over the years had a significant impact on the development of medical triage. The difference in doctrine between the two types, civil and military triage, lies in the strategies of the two entities, the war, and the need to have fighters in a very short time with the aim of assisting as many victims as possible.

Definition and Methods

Triage is a formal system used to identify, classify. and treat victims according to their severity of suffering. Under the guidance and goal of disaster medicine, it offers a chance to be saved to as many people as possible.

Triage is a true race against time, operating under the utilitarian rule that governs emergency and disaster medicine: the greatest good for the greatest number of people. This rule is justified only in clear need of the public good in crisis situations. Triage consists of the following elements:

• Rapid assessment of victims
• Assessing the severity of injuries and their consequences on the victim's vital functions
• Categorization of victims
• Resuscitation, stabilization, and safe conditions of transport
• Targeting the correct evacuation of victims
• Creating a dynamic, continuous, and progressive process

Medical examinations should be simple maneuvers with the following criteria:

• As soon as possible, to not delay treatment and disposal
• Accurate, safe, and reliable
• Meticulous; even if the clothing is not removed, the examination will be a complete process

One of the most commonly used methods is to examine using the MASS algorithm, as follows:

• Move: search and rescue
• Assess: assess and analyze
• Sort: decide triage category
• Send: evacuate, decide where

Targeting the correct evacuation of victims, implementing a medical intervention that determines the order of treatment and evacuation priorities in such a way as to achieve a perfect use of existing facilities, will provide the greatest chances of survival for the greatest number of victims, thus accomplishing the goal of disaster medicine.

In developing processes for the emergency system, it became necessary to impose a way of ranking the different emergencies. Establishing such a ranking system had been considered by many different medical professionals. Considerations were primarily medical, seeking to achieve better and more effective health care. With the development of emergency medical facilities and the introduction of ambulance services that offer facilities comparable to a hospital, not to mention air medical transport (ambulance helicopters and planes), the economic aspect became a prevailing factor. Using more precise codes to provide a streamlined approach in the emergency action, on one hand, and supplying the most comprehensive information, on the other, would soon prove to be a necessity.

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