9. Always carry a litter patient feet first so that the
rear bearer can constantly observe the victim for
respiratory or circulatory distress.
the protocols for tactical and nontactical
Triage, a French word meaning to sort, is the
process of quickly assessing patients in a
multiple-casualty incident and assigning patient a
priority (or classification) for receiving treatment
according to the severity of his illness or injuries. In the
military, there are two types of triage, tactical and
nontactical, and each type uses a different set of
prioritizing criteria. The person in charge is responsible
for balancing the human lives at stake against the realities
of the tactical situation, the level of medical stock on
hand, and the realistic capabilities of medical personnel
on the scene. Triage is a dynamic process, and a patients
priority is subject to change as the situation progresses.
SORTING FOR TREATMENT (TACTICAL)
The following discussion refers primarily to
battalion aid stations (BAS) (where neither helicopter
nor rapid land evacuation is readily available) and to
shipboard battle-dressing stations.
Immediately upon arrival, sort the casualties into
groups in the order listed below.
Patients whose injuries require minor
professional treatment that can be done on
an outpatient or ambulatory basis. These
personnel can be returned to duty in a short
period of time.
Patients whose injuries require immediate
life-sustaining measures or are of a moderate
nature. Initially, they require a minimum
amount of time, personnel, and supplies.
Patients for whom definitive treatment can
be delayed without jeopardy to life or loss
Patients whose wounds or injuries would
require extensive treatment beyond the
immediate medical capabilities. Treatment
of these casualties would be to the
detriment of others.
SORTING FOR TREATMENT
In civilian or nontactical situations, sorting of
casualties is not significantly different from combat
situations. There are four basic classes (priorities) of
injuries, and the order of treatment of each is different.
Patients with correctable life-threatening
illnesses or injuries such as respiratory
arrest or obstruction, open chest or
abdomen wounds, femur fractures, or
critical or complicated burns.
Patients with serious but non-life-
threatening illnesses or injuries such as
moderate blood loss, open or multiple
fractures (open increases priority), or eye
Patients with minor injuries such as soft
tissue injuries, simple fractures, or minor
to moderate burns.
Patients who are dead or fatally injured.
Fatal injuries include exposed brain
matter, decapitation, and incineration.
As mentioned before, triage is an ongoing process.
Depending on the treatment rendered, the amount of
time elapsed, and the constitution of the casualty, you
may have to reassign priorities. What may appear to be
a minor wound on initial evaluation could develop into
a case of profound shock. Or a casualty who required
initial immediate treatment may be stabilized and
downgraded to a delayed status.
SORTING FOR EVACUATION
During the Vietnam war, the techniques for
helicopter medical evacuation (MEDEVAC) were so
effective that most casualties could be evacuated to a
major medical facility within minutes of their injury.
This considerably lightened the load of the Hospital
Corpsman in the field, since provision for long-term
care before the evacuation was not normally required.
However, rapid aeromedical response did not relieve
the Corpsman of the responsibility for giving the best
emergency care within the field limitations to stabilize
the victim before the helicopter arrived. Triage was
seldom needed since most of the injured could be
New developments in warfare, along with changes
in the theaters of deployment, indicate that the
helicopter evacuation system may no longer be viable