Triage 81

Extract

In recent years a number of disasters have been handled less than perfectly. Large numbers of patients are sent to the medical facility with little or no warning. Hysterical relatives and friends also arrive, plus the media and curiosity seekers. Well-meaning volunteers and off-duty medical people begin to fill in where each individual thinks he or she fits in best. Soon the rooms and the corridors of the hospital are filled with people lying, standing and sitting. All sorts of treatments are attempted, orders for assistance go unanswered and general confusion reigns.

For many years the military have claimed leading roles in disaster care, giving and taking orders more readily than do most groups of medical civilians. It is the nature of their business to plan for disaster. They take the time to practice and may even be able to test their concepts during wartime.

Primary to all these plans is triage or sorting with “the object being to provide preferential treatment for those who could be attended readily and returned to battle, leaving aside those with more complex injuries until either they could be transported or time became available” (1).

Watt writes that in 1863 a Doctor Moyle tried to convince military sugeons to adopt a triage system to save lives: “Death, wounds, … limbs lacerated and torn off, wounds from muskets or splinters, bayonet wounds, all these appalling and horrible injuries have to be coped with in a few minutes…” He suggested a system of dividing casualties into three groups: slight, serious and fatal and argued that immediate live-saving surgery be done on the severely injured only if the slightly injured were deferred and the fatally injured put aside (2).