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Medical Education Division |
Operational Medicine 2001
Field Medical Service School
Student Handbook
CASUALTY TRIAGEFMST 0502 17
Dec 99
TERMINAL LEARNING OBJECTIVES:1. Given multiple casualties in a combat environment (day and night), conduct triage, per the references. (FMST.05.04) ENABLING
LEARNING OBJECTIVES: 1. Without the aid of reference materials and given a descriptive list of injuries, select the appropriate triage category for the injury, per the student handbook. (FMST.05.04a) 2. Without the aid of reference materials and given a descriptive list of injuries, select the appropriate treatment priority for each injury, per the student handbook. (FMST.05.04b) 3. Without the aid of reference materials and given a list of casualty conditions, select the appropriate MEDEVAC priority, per the student handbook. (FMST.05.04c) OUTLINE: A. TACTICAL TRIAGE 1. TRIAGE a. Definition: 1. The categorization of casualties for the priority of treatment and evacuation. 2. Triage is one of the most important tasks in casualty care. It requires the most informed judgement, knowledge, and courage. 3. Triage is a continuing process and the individual assigned should be the most capable and experienced health care provider available. 2. PRINCIPLES OF TRIAGE: a. Accomplish the greatest good for the greatest number of casualties b. Employ the most efficient use of available resources c. Return personnel to duty as soon as possible 3. TRIAGE FACTORS: a. Number of casualties requiring treatment b. Medical resources available to treat casualties (to include personnel and equipment) c. Attention towards easily treated conditions d. Rapid and accurate assessments e. Continuous reassessment and re-triage of all casualties B. THE FOUR CATAGORIES OF CASUALTY TRIAGE 1. The first formal triage establishes the patient’s category. These categories are color coded and are recognized as follows: a. Category I – IMMEDIATE (RED TAG) 1. Includes all compromises to a patient’s ABC’s. If immediate medical attention is not provided, the patient will die. These medical procedures should not be time consuming and concern only those casualties with high chance of survival. Examples include: a) Airway compromise – performing an emergency cricothyroidotomy for an obstructed airway b) Breathing compromise – performing a needle thoracentesis to decompress a tension pneumothorax c) Circulation compromise – applying a tourniquet to an arterial bleed b. Category II – DELAYED (YELLOW TAG) 1. Includes any injuries that may be serious and potentially life threatening. They may require extensive and intensive treatment. However, they are not expected to significantly deteriorate over several hours and therefore can safely wait until the immediate category of patients has been stabilized. Examples include: a) Compensated shock b) Fractures, dislocations, or injuries causing circulatory compromise c) Severe bleeding controlled with a tourniquet or other means d) Open fractures and dislocations e) Abdominal, thoracic, spinal, or head injuries f) Uncomplicated major burns c. Category III – MINIMAL (GREEN TAG) 1. Also called the “walking wounded.” These individuals have injuries that will still need treatment, however, are unlikely to deteriorate over the next few days. This includes those with relatively minor injuries who can effectively care for themselves or can be helped by untrained personnel. Examples include: a) Minor lacerations b) Abrasions c) Fractures of small bones d) Minor burns e) Sprains and strains d. Category IV – EXPECTANT (BLACK TAG) 1. This category is comprised of patients whose treatment would be time consuming and extremely complicated coupled with a low chance of survival. The extent of their treatment depends on available supplies and manpower. These patients should not be abandoned; however, every effort should devoted to their comfort. Once all immediate and delayed patients are treated, expectant patients will be re-triaged and treated based on remaining medical supplies and personnel. Examples include: a) Cardiac arrest from any cause b) Massive brain / head trauma c) Second or third degree burns over 70% body surface area (BSA) d) Massive exposure to radiation C. THREE PRIORITIES OF TREATMENT 1. After the first and formal triage, Category I - IMMEDIATE (RED TAG) patients will be further triaged into treatment priorities. This allows the most severely injured IMMEDIATE patients to be treated first. a. First Priority: These casualties suffer from any of the following: 1. Asphyxia 2. Respiratory obstruction from mechanical causes 3. Open/tension pneumothorax 4. Maxillofacial wounds 5. Shock due to major external hemorrhage 6. Major hemorrhage 7. Visceral (abdominal) injuries 8. Cardio/pericardial injuries 9. Massive muscle damage 10. Major fractures 11. Multiple wounds 12. Severe burns over 20% of body surface area b. Second Priority: These casualties suffer from any of the following: 1. Visceral (abdominal) injuries with perforations of the intestinal tract, wounds of the genitourinary tract, or thoracic wounds without asphyxia 2. Vascular injuries needing repair 3. Closed cerebral injuries with increasing LOC 4. Burns under 20% of the body surface area involving face, hands, feet, and genitalia c. Third Priority: These casualties suffer from any of the following: 1. Soft tissue wounds requiring debridement without major muscle damage 2. Lesser fractures and dislocations 3. Injuries of the eye 4. Maxillofacial injuries without asphyxia 5. Burns under 20% of body surface area D. MEDEVAC PRIORITIES: 1. Once a patient has been triaged and stabilized at the BAS, should that patient require further or additional medical treatment, he/she will be prioritized for evacuation from the BAS to the next higher echelon of medical care. 2. MEDEVAC priorities are different than the first and formal triage categories. 3. The priorities are as follows: a. URGENT EVACUATION 1. Evacuation to next higher echelon of medical care is needed to save life or limb 2. Evacuation must occur within 2 hours b. PRIORITY EVACUATION 1. Evacuation to next higher echelon of medical care is needed or the patient will deteriorate into the URGENT category 2. Evacuation must occur within 4 hours c. ROUTINE EVACUATION 1. Evacuation to the next higher echelon of medical care is needed to complete full treatment. 2. Evacuation may occur within 24 hours NOTE: The tactical situation of the BAS always dictates who is MEDEVAC’d out of the area first. Example – The BAS is coming under direct fire. The most number of individuals that can fill all the helicopters, ambulances, etc. will be evacuated first. Then, patients requiring more space will be evacuated (i.e. litter patients). REFERENCE
(S): 1. Tactical Emergency Care 2. Emergency War Surgery 3. Advanced Special Ops Medical Training 4. Operational Health Service Support (MCWP 4-02) 5. Health Services Support Operations (MCWP 4-11.1) Field Medical Service School
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