In just about any large-scale disaster, there will likely be a large number of people who will experience minor, critical, or life-threatening injuries. First responders may not reach your neighborhood for hours, or even days. So if a disaster happened in your area, injuring dozens of people, what would you do?
You and your neighbors will have to select a triage leader and set up a triage area where the injured can receive treatment until medics arrive. In disasters like earthquakes, hurricanes, or tsunamis a triage could last for days or weeks.
Photo Courtesy of Otis Historical Archives Nat’l Museum of Health and Medicine
The goal of disaster triage is to separate people into groups ranging from minor injuries to those who are deceased. You must ‘sort’ these people into specific areas as quickly and efficiently as possible so they can receive the help they need.
The purpose of this article is to help you perform the role of ‘triage leader’ to the best of your abilities before medical experts arrive.
Your role as the triage leader
First, let’s look at your role as triage leader. You must understand that Triage is not treatment. It’s only a means of sorting people into appropriate areas, which takes limited medical skill. However, a triage situation is just one reason why everyone should get some sort of medical training (CPR, basic first aid, or Community Emergency Response Team [C.E.R.T] training). These classes are available just about anywhere.
If you do not have an extensive amount of medical training, no one expects you to be perfect. Your instincts, calmness, and direction can get you (and those who have volunteered to help you) through a disaster situation, whether you have medical training or not. The main purpose of disaster triage is to do the greatest amount of good for the greatest number of people in the shortest amount of time.
Once you’ve sorted everyone, others can be assigned to take care of victims in the different groups . When medics arrive, they will assume the role of triage, and you can assist them in any way they deem necessary.
Three main objectives you must be aware of as a triage leader:
1. Safety– If the area you plan to use as your triage area is not safe, move it to a place that is. In inclement weather, make sure you can find a building or shelter that is not damaged, and won’t cause further injury to anyone.
2. Surroundings– Be continually aware of your surroundings. Stop, look, and listen. Look for any overhead or adjacent dangers around you. Ideally, you want to find a spot that’s large enough to handle the number of victims you have and that will be safe for the duration of the disaster. Don’t let your guard down. Continually monitor the area for safety concern. Just because an area has been deemed safe at first, it doesn’t mean it can’t become a danger at a later time.
3. Victims– Call out to any victims in your area and ask them if they are able to come to the sound of your voice. Based on their responses, you can start to triage these victims and sort them appropriately. Have the un-injured spread out and tell others of your triage location. Have them help the injured get to your triage area. Assigning the un-injured this task will give them a way to help, if they are looking for one.
If you become the triage leader, you’re going to have to make some very difficult decisions. You’ll have to put your personal feelings and emotions away and stay focused on the task at hand. The people you will have to triage may be strangers, neighbors, or even family and friends.
You can’t get personally involved and forget your role; if you do, you may delay treatment to other victims whose conditions may worsen. By providing quick triage and rapid treatment, many lives could be saved.
During medical triage, victims’ conditions need to be evaluated quickly (20 to 30 seconds per person.) Victims can be marked with anything you have available—tape, markers, strips of cloth or other materials you can find that will distinguish their level of triage. After marking them, you can prioritize them into one of the following four categories:
• Immediate (I): The victim has life-threatening injuries (airway, bleeding, or shock) that demand immediate attention to save his or her life; rapid, lifesaving treatment is urgent, and they should be the first ones sent to the hospital when first responders arrive. These victims are marked with a red tag or labeled “I”
• Delayed (D): Injuries do not jeopardize the victim’s life. The victim may require professional care, but treatment can be delayed. They have severe bleeding that can be stopped and maintained, and severe limb injuries that will require hospitalization or possibly surgery. These victims are marked with a yellow tag or labeled “D”.
• Minor (M): Walking wounded and generally ambulatory. They may have cuts, scrapes, injured extremities or other minor injuries. These patients can even assist with those who may have more severe injuries. These victims are marked with a green tag or labeled “M”.
• Dead (DEAD): No respirations after 2 attempts to open the airway. Because CPR is a one-on-one care and is labor intensive, CPR is not performed when there are many more victims than rescuers. There are going to be those who are obviously deceased because of their injuries. There are going to be those who are critically injured, and it may take lots of resources to possibly save them. You will have to make a decision as to whether or not you have the resources available to provide care that may or may not save their life. These victims are marked with a black tag or labeled “DEAD”.
One of the most important things you can do is set up the area for the dead in a location close to your triage zone, but away from the view of victims in the other three categories. It’s very emotional and difficult for those who are injured and being treated to see those who have not made it through the disaster.
How to Assign Victims to Categories
Remember that this needs to be done in 20 to 30 seconds per victim, and then move on to the next casualty. If patients need immediate treatment, such as stopping severe bleeding or opening their airway, have your volunteers take care of these tasks so that you can continue to sort victims into the appropriate areas.