Emergency War Surgery NATO Handbook: Part III: General Considerations of Wound Management: Chapter XII: Sorting of Casualties

General Considerations

United States Department of Defense

Sorting, or triage, implies the evaluation and classification of casualties for purposes of treatment and evacuation. It is based on the principle of accomplishing the greatest good for the greatest number of wounded and injured men in the special circumstances of warfare at a particular time. The decisions which must be made concern the need for resuscitation, the need for emergency surgery and the futility of surgery when the intrinsic lethality of certain wounds is clearly overwhelming. Sorting also involves the establishment of priorities for treatment and evacuation.

Military medical activities differ from those in the civil sector in that they must adapt to the special circumstances of a tactical combat situation. Combat hospitals must be not only mobile but also capable of receiving and treating large numbers of casualties that arrive simultaneously, the so-called mass casualty situation. The facility should be designed and staffed with these contingencies in mind. The medical officers, nurses, and support personnel must be well trained in the medical tactics necessary to cope with the ever-present possibility of receiving an overwhelming number of casualties presenting within a short period of time. During such situations, conventional standards of medical care cannot be delivered to all casualties. Some of the very seriously wounded will not receive the same degree of care they would have received had they presented as a single admission. Others may receive no immediate care except to insure that they are made as comfortable as possible under the circumstances.

In all mass casualty situations, there are logical categories into which all casualties can be classified. Some will have sustained critical injuries but will have a high potential for survival with prompt treatment. These should have a high priority for treatment, while others, with mortal wounds, are not salvageable no matter what degree of medical care resources are expended upon them. Certain others do not require immediate lifesaving procedures and will tolerate reasonable delays while the more critical are being cared for. The group with minor injuries will survive with directed self care or no care at all.

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Operational Medicine 2001

Health Care in Military Settings

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